Can You Have Sleep Apnea Without Snoring? - Types and Symptoms

Can You Have Sleep Apnea Without Snoring?

Snoring is a very common symptom of sleep apnea, but it is possible to have sleep apnea without snoring. Sleep apnea is a sleep disorder characterized by pauses in breathing or shallow breathing during sleep. There are three main types of sleep apnea - obstructive sleep apnea (OSA), central sleep apnea, and complex sleep apnea. Each type has different causes and symptoms.

Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) is the most common type, making up about 84% of sleep apnea cases. It occurs when the muscles in the back of the throat relax, causing the airway to narrow or collapse during sleep. These blockages can reduce or completely stop airflow, resulting in loud snoring, choking noises, and repeated awakenings. OSA often does involve snoring, but not always.

OSA Without Snoring

It is possible in some cases to have OSA without snoring, especially for those who sleep primarily on their stomachs or sides. Factors that allow for OSA without snoring include:

• Narrowed airway anatomy that doesn't produce vibration
• Mouth remaining closed during apneas
• Breathing through nose instead of mouth while sleeping
• Short apneas not allowing time to build up snoring

Someone with OSA may experience repeated sleep disruptions and daytime fatigue even without loud snoring. Other common symptoms include:

• Gasping or choking during sleep
• Restless sleep
• Morning headaches
• Trouble concentrating
• Irritability

Risk Factors

Certain risk factors make OSA more likely even without snoring:

• Being overweight or obese
• Large neck circumference
• Nasal congestion or obstruction
• Large tonsils or tongue
• Small jawbone
• Gastroesophageal reflux disease (GERD)
• Family history of OSA

Central Sleep Apnea

Central sleep apnea is much less common, accounting for about 0.4% of sleep apnea cases. It occurs when the brain fails to properly signal the muscles that control breathing. This results in repeated lapses in breathing effort during sleep, even when the airway is not obstructed.

Symptoms of Central Sleep Apnea

The major symptoms of central sleep apnea include:

• No snoring
• Very quiet breathing with pauses of 10+ seconds
• Sudden gasping or choking breaths when breathing resumes
• Sleep disruption and insomnia
• Morning headache
• Excessive daytime sleepiness
• Poor concentration and memory

Central sleep apnea often goes undiagnosed because it typically does not involve loud snoring or gasping noises. Patients simply report not feeling restored after a full night's sleep.

Causes

Central sleep apnea can result from:

• Stroke
• Brain tumor
• Brain infection
• Spinal cord injury
• Opioid pain medications
• Congestive heart failure
• Neurological disorders like Parkinson's

It arises from instability in the respiratory control center of the brain during sleep.

Complex Sleep Apnea

Complex sleep apnea is diagnosed when someone has a combination of both obstructive and central sleep apnea events. This mixture of apnea types occurs in about 15% of sleep apnea patients.

Complex Sleep Apnea Symptoms

Complex sleep apnea may involve some of the symptoms of both OSA and central apnea. Typical symptoms include:

• Snoring intermittently
• Periods of very quiet breathing
• Choking or gasping during apneas
• Insomnia
• Morning headaches
• Difficulty concentrating
• Irritability

Patients may report a combination of loud snoring with breathing pauses, along with other sleep complaints.

Causes

Complex sleep apnea appears to arise from having a sensitive respiratory control system combined with anatomical factors predisposing to airway collapse.

Potential causes include:

• Being overweight
• Large neck size
• Narrow airway
• Respiratory control instability

There is ongoing research into exactly what triggers the combination of central and obstructive events in these patients.

Diagnosing Sleep Apnea Without Snoring

Because sleep apnea can occur without the classic symptom of loud snoring, diagnosis requires an overnight sleep study. This test, known as a polysomnogram, monitors your breathing patterns, heart rate, and oxygen levels while you sleep.

The sleep study data can confirm episodes of disrupted breathing and determine whether they are caused by obstructive or central apnea events. A proper diagnosis is key for tailoring the most effective treatment approach.

Home Sleep Apnea Tests

If signs and symptoms indicate a high probability of moderate to severe OSA, a home sleep apnea test (HSAT) may be done instead of a full overnight sleep study. These portable monitors record breathing patterns, oxygen saturation, and snoring.

While HSATs do not monitor brain waves or body movements, they can effectively identify OSA in many straightforward cases. However, they may miss central apnea or complex apnea events.

Follow-up Testing

Following initial evaluation, repeat or specialized testing may be needed to differentiate obstructive versus central causes and guide therapy. This can include:

• Repeat polysomnography to identify central apneas
• imaging
• Drug-induced sleep endoscopy
• Multiple sleep latency test
• Genetic testing

Ongoing care with a sleep specialist ensures proper diagnosis and management if your symptoms are not well controlled with initial therapy.

Treatment Options

Treatment choice depends on the type of sleep apnea and reasons for breathing lapses during sleep. Several options may be used alone or in combination.

CPAP

Continuous positive airway pressure (CPAP) is a primary treatment for obstructive sleep apnea. The CPAP machine blows pressurized air through a face mask to keep the airway open. This eliminates apneas, snoring, and improves oxygen levels.

CPAP is extremely effective for OSA regardless of snoring. Compliant use provides restorative sleep and relief of symptoms.

Oral Appliances

Custom-fitted oral appliances are designed to hold the jaw slightly forward or keep the airway open with pressure. These can be effective alternatives to CPAP for mild OSA or primary snoring.

Surgery

Various surgeries may be performed depending on the obstruction site, including:

• Uvulopalatopharyngoplasty (UPPP)
• Somnoplasty
• Maxillomandibular advancement
• Tonsillectomy
• Adenoidectomy
• Septoplasty
• Thyroid surgery

Surgery can improve mild-moderate OSA by widening the airway. Success rates vary depending on individual anatomy.

Hypoglossal Nerve Stimulation

This implanted system activates the tongue muscles to prevent airway collapse during sleep. It may benefit some OSA patients who cannot tolerate CPAP.

Medications

Certain medications may be trialed to reduce the severity of obstructive sleep apnea, including:

• Nasal steroid sprays
• Oral appliances
• Nasal dilator strips
• Sedatives to prevent arousal from apneas

Medications play a limited role but can help mild OSA in some cases when other options are ineffective.

Oxygen Therapy

Supplemental oxygen administered through a CPAP mask may be used for central sleep apnea. The extra oxygen helps stabilize erratic breathing patterns.

Adaptive Servo Ventilation (ASV)

This non-invasive ventilation technology monitors breathing and delivers gentle air pressure when needed to prevent central apneas. ASV is often the first-line treatment for complex and central sleep apnea.

Outlook for Non-Snoring Sleep Apnea

Though snoring is a very common symptom, sleep apnea can occur without loud snoring. The key is to recognize other signs like unrefreshing sleep, morning headaches, and daytime fatigue that may point to sleep disordered breathing.

Diagnostic sleep testing can confirm the presence of apneas and determine the type - obstructive, central or mixed. Based on test results, an effective treatment plan can be implemented to manage apnea events and relieve symptoms even without snoring.

Consistent therapy greatly reduces health risks related to untreated sleep apnea. With proper diagnosis and care, individuals with non-snoring sleep apnea can achieve restful sleep and an improved quality of life.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.