Can you have sleep apnea without snoring? Yes, and here's what to watch for

You can have sleep apnea without snoring. Snoring is the best-known sign, but some people with obstructive sleep apnea snore only lightly or not at all, and central sleep apnea usually causes no snoring. Women in particular often notice tiredness, insomnia or waking up a lot rather than noisy nights. If those sound familiar, a sleep test is the only way to find out.

Can you have sleep apnea without snoring?

You can have obstructive sleep apnea without snoring. A Cleveland Clinic sleep medicine specialist says it absolutely happens, and that you may have no snoring or just very light, intermittent snoring. The specialist also points out that if you sleep alone, you may not know whether you snore at all.

The reason is that snoring and sleep apnea are related but not the same thing. AASM Sleep Education explains that in obstructive sleep apnea, the tissue at the back of the throat collapses during sleep and blocks the airway. Snoring is the sound of that tissue vibrating as air squeezes through a narrowed space. Cleveland Clinic notes that not everyone with obstructive sleep apnea snores, or snores loudly enough for anyone to notice.

Cleveland Clinic says this quieter form, sometimes called silent sleep apnea, has the same underlying cause as other obstructive sleep apnea. It just doesn't produce as much snoring. Our guide to snoring vs sleep apnea explains how the two overlap.

Is snoring always a sign of sleep apnea?

Snoring isn't always a sign of sleep apnea. AASM Sleep Education says snoring is the most common symptom, but not everyone who snores has sleep apnea. It says snoring is likely to be a sign when it's followed by silent breathing pauses and choking or gasping sounds.

So the question to ask isn't only whether you snore. It's whether anything else is going on at night or during the day. Plenty of people snore without any breathing pauses, and plenty of people with sleep apnea barely snore. Our list of reasons you snore covers the common harmless causes, and sleep apnea warning signs covers the ones that need a doctor.

What are the signs of sleep apnea if you don't snore?

The signs of sleep apnea without snoring are mostly about how you feel during the day and how broken your sleep is. A Cleveland Clinic sleep specialist lists these common signs of silent sleep apnea:

• Excessive daytime sleepiness
• Feeling unrested when you wake up
• Morning headaches
• Waking up many times during the night
• Fatigue

The NHLBI adds dry mouth, insomnia, sexual problems or lower libido, and waking up often during the night to urinate. AASM Sleep Education lists unrefreshing or restless sleep, trouble concentrating, memory loss and irritability.

Someone who shares your bed may also notice pauses in your breathing, even without obvious snoring. The NHS suggests that if it's hard to tell, it may help to ask someone to stay with you while you sleep so they can watch for symptoms. Waking up tired is one of the most common clues, and our guides to waking up tired and morning headaches look at other causes too.

Why do women with sleep apnea often not snore?

Women with sleep apnea often have symptoms that look different from the loud, gasping snorer people picture. The NHLBI says frequent loud snoring is more common in men, while fatigue, morning headaches and insomnia are more common in women. It also lists anxiety, depression and waking up often among the symptoms women more often have.

The NHLBI says that because women may not have symptoms such as snoring, they may not think they have sleep apnea. A Cleveland Clinic specialist puts it plainly, saying that in women, obstructive sleep apnea commonly presents with multiple nighttime awakenings, with no history of loud snoring.

Research backs this up. A 2007 study in the journal Sleep gave a detailed questionnaire to 2,739 men and 782 women before they had overnight sleep studies. Women complained significantly more often of insomnia, restless legs, depression, nightmares, palpitations at night and hallucinations. Among people with a low AHI, men were more likely than women to report witnessed breathing pauses and snoring that got worse on their back. The authors said these differences should be considered when evaluating women with possible sleep apnea.

Menopause adds another layer. The NHLBI says women's risk rises during and after menopause, and that menopause itself can cause insomnia, headaches and fatigue, which can make sleep apnea harder to recognize. Our guide to sleep apnea in women goes into more detail.

Does central sleep apnea cause snoring?

Central sleep apnea usually doesn't cause snoring. A Cleveland Clinic sleep specialist says central sleep apnea presents without snoring. AASM Sleep Education explains that it happens when the body decreases or stops the effort to breathe during sleep, because the brain doesn't send the right signals. It's different from obstructive sleep apnea because the airway isn't blocked.

Central sleep apnea is less common than obstructive sleep apnea. Sleep Education says it's usually caused by a problem in the brain or heart, and that certain medications, especially opioids, can cause it too. The Cheyne-Stokes form is seen in 25% to 40% of men with chronic congestive heart failure, according to the same page.

The symptoms are easy to mistake for ordinary poor sleep. Sleep Education lists disrupted sleep with frequent awakenings, difficulty falling asleep and daytime sleepiness, along with pauses in breathing and waking up short of breath. It says most of the causes of central sleep apnea are serious conditions that should be evaluated and treated.

How do the signs compare?

This table pulls together what the sources above say about each pattern. It's a guide for talking to your doctor, not a way to diagnose yourself.

Can you have sleep apnea if you're slim and quiet?

You can have sleep apnea if you're slim and don't snore, though it's less likely. AASM Sleep Education calls excess body weight the major risk factor, but says sleep apnea can occur in slim people too. People who don't fit the usual picture on either count are among the easiest to miss.

Sleep Education lists other risk factors that have nothing to do with weight or noise. These include a neck size of 17 inches or more for men or 16 inches or more for women, airway problems such as a deviated septum or nasal polyps, alcohol or sedating medication, and a family history of sleep apnea. It notes that inherited traits such as a recessed jaw can raise the risk. The NHS adds large tonsils or adenoids, smoking and sleeping on your back. If you have several of these and feel unrefreshed, it's worth raising with a doctor.

Can mouth tape hide sleep apnea?

Cleveland Clinic mentions a small study in which 30 people snored less after mouth taping, but quieter nights don't rule out sleep apnea. A Cleveland Clinic sleep specialist says snoring can be a sign of other conditions like sleep apnea, and calls mouth taping a short-term fix for what might be a larger problem with your airways. The specialist recommends talking to your doctor about what's going on before trying it.

That's the right order of things. Mouth tape is not a treatment for sleep apnea. If you have any of the signs above, get checked first, and see our guide to whether mouth taping is safe before you start. We don't recommend mouth tape for children.

How is sleep apnea diagnosed if you don't snore?

Sleep apnea is diagnosed the same way whether or not you snore, with a sleep test. The AASM's 2017 guideline recommends against using questionnaires or prediction tools alone to diagnose sleep apnea in adults. It recommends an in-lab sleep study, or a home sleep apnea test for uncomplicated adults with signs of moderate to severe sleep apnea.

The guideline recommends an in-lab study rather than a home test for people with significant heart or lung disease, chronic opioid use, a history of stroke or severe insomnia. Several of those overlap with the risk factors for central sleep apnea, so mention them to your doctor. Our guide to the home sleep apnea test explains what's involved, and what AHI means helps you read the results.

When should you see a doctor?

See a doctor if you regularly wake up exhausted, struggle with daytime sleepiness or wake up often at night, even if you don't snore. That's the advice from the Cleveland Clinic specialist, who notes that people who don't snore often assume they can't have sleep apnea and put off getting checked.

The NHS says to see a GP if your breathing stops and starts during sleep, you make gasping, snorting or choking noises, or you always feel very tired during the day. It adds that if someone else has seen the symptoms, it can help to bring them along. Our list of questions to ask your doctor about snoring works for these appointments too.

This article is general information, not medical advice.

Read next

• Sleep apnea in women: symptoms that get missed
• Sleep apnea warning signs
• What is AHI?

* This content is for informational and educational purposes only and is not medical advice. It is not intended to diagnose, treat, cure or prevent any disease or health condition. Talk to a qualified healthcare provider about your health.