Can You Have Sleep Apnea Without Snoring?

One of the hallmarks of sleep apnea is snoring, followed by a long pause in breathing and a gasping inhale. This pattern may be what alerts your partner to your sleep disordered breathing and sends you to a sleep clinic for a full evaluation. But can you have sleep apnea without snoring? Surprisingly, yes. Here’s what you need to know.

Why is sleep apnea and snoring so often connected?

Sleep apnea is a type of sleep disordered breathing that affects an estimated 25 million people in the U.S. (although that number may actually be much higher). There are three main types of sleep apnea:

1. Obstructive sleep apnea
2. Central sleep apnea
3. Complex sleep apnea

Of the three types, one is most closely related to snoring: obstructive sleep apnea.

In this type – also the most common type of sleep apnea – the sleeper’s airway becomes blocked by relaxed throat muscles and possibly even the tongue. Before the airway is completely blocked, air passing through the slight blockage causes vibration in the tissues, what we identify as snoring, especially if the sleeper is on their back.

The American Sleep Association estimates that approximately 90 million people in the U.S. snore. They separate these sleepers into two equal categories: simple snorers and those who potentially have obstructive sleep apnea. Simple math indicates the possibility of 45 million people with obstructive sleep apnea, 20 million more than current statistics have officially identified.

Snoring is just one of the many sleep apnea symptoms. Others include:

• Daytime fatigue and excessive sleepiness
• Mental fogginess and difficulty concentrating
• Noticeable cessation of breath followed by a choking intake of air
• Dry mouth or sore throat upon waking
• Morning headaches or migraines
• Loss of sexual drive
• Nighttime sweating unrelated to another condition (e.g., menopause)
• High blood pressure

But can you have sleep apnea without snoring? Keep reading.

Can you have sleep apnea without snoring?

Sleep apnea snoring is a stereotypical and distinctive symptom, but it is not always present. Snoring is a result of changes in the anatomy surrounding the airway, and this does not always occur in all types of sleep apnea or in all sleeping positions.

In central sleep apnea, apneas (pauses in breath) occur when the central nervous system “forgets” to tell the lungs to breathe. Although many other daytime sleep apnea symptoms are similar, one of the ways central sleep apnea is diagnosed is by eliminating a common symptom of obstructive sleep apnea: snoring. Central sleep apnea does not usually present with snoring.

Additionally, much of snoring is caused by the sleeper’s position. Many people (with or without sleep apnea) snore when they are sleeping on their backs. Once they move to their side, sleep apnea may still be present but sleep apnea snoring may not be.

There may also be a difference between genders. Women are less likely to be diagnosed with sleep disordered breathing like sleep apnea because they are less likely to snore. In general, men are born with narrower airways than women, resulting in a higher chance of snoring.

Additionally, alcohol consumption contributes to increased chances of snoring, as does obesity. For both categories – drinking and weight gain – men have the statistical upper hand. All this points to the fact that women can very likely have sleep apnea without snoring.

How can I get a sleep apnea diagnosis?

Getting a sleep apnea diagnosis without snoring is possible. Snoring is not the primary symptom in obstructive sleep apnea – pauses in breath are. If you do not live with a partner who can pay attention to either pauses in breath or snoring while you sleep, it is possible to record yourself sleeping (get a sound-activated device) to see if you might have either symptom.

Even if you do, this is not a definitive diagnosis without a sleep study in one of two ways: in a sleep clinic or using an at-home kit. Unfortunately, if you have sleep apnea without snoring that might be linked to central sleep apnea, it’s important to have a sleep study done in a sleep lab accredited by the American Academy of Sleep Medicine. Central sleep apnea can be very dangerous just on its own, so it’s important to identify the cause and start treatment as soon as possible.

Polysomnography (the official name for your sleep study) uses leads and lines attached to the outside of your body to measure the following things:

• Brain waves with an electroencephalogram (EEG)
• Chin and eye movement that signals sleep stages with an electrooculogram (EOG)
• Heart rate and rhythm with an electrocardiogram (EKG)
• Respiration
• Oxygen and carbon dioxide levels in the blood
• Leg movement

Your sleep technician will also measure your apneas, including the number of them and the length of time they last, to arrive at your apnea-hypopnea index (AHI). The AHI index is the total number of both and it measures the severity of your sleep apnea.

• 5 to 15 is mild obstructive sleep apnea
• 15 to 30 is moderate obstructive sleep apnea
• 30+ is severe obstructive sleep apnea

Treating sleep apnea

Once you have a diagnosis, treatment is important. Many patients get good results with a CPAP machine, while others find that the portability and comfort of a sleep apnea dental device works better for them. Changing sleeping position, eliminating or reducing alcohol consumption, and losing weight are also positive lifestyle changes you can make to manage your sleep apnea.

If you are diagnosed with central sleep apnea, your sleep technician will most likely refer you to a specialist to diagnose the root cause. Treating any neurological disturbances or trauma that is disrupting your brain waves is a key intervention for treating central sleep apnea without snoring.

Sleep apnea is a serious disorder associated with other health risks such as stroke, dementia, and heart disease. Even without sleep apnea snoring, a proper diagnosis is possible.

AZ Sleep is your sleep apnea dentist in Phoenix and all over the Valley. Get in touch today to see how we can help you get a good night’s sleep.