While snoring is a common sign that you or someone you know may have sleep apnea, not every sufferer exhibits this auditory symptom. 

Silent sleep apnea is a condition where breathing pauses during sleep occur without the snoring sound. Despite the absence of loud snoring, this type of sleep apnea can still pose significant health risks. Relying solely on the presence of snoring could lead to a missed diagnosis, potentially resulting in serious health issues. 

This article explains what sleep apnea is, how it can exist without snoring and highlights other symptoms that may warrant a professional sleep evaluation. 

Sleep apnea may be present even when you do not snore 

Sleep apnea occurs when your breathing involuntarily stops and starts while you sleep. If left untreated, this irregular breathing can potentially happen hundreds of times a night. The snoring that often accompanies this condition occurs when there is either a complete blockage of airflow (apnea) or a significant reduction in airflow (hypopnea).^1,2 

There are three main types of sleep apnea: obstructive, central, and mixed. People may experience these conditions without snoring.^1,2 

Obstructive sleep apnea (OSA) is the most common form of sleep apnea. It occurs when the soft tissue in the upper airway blocks the flow of air in and out of the nose and mouth as the throat muscles relax during sleep.^1,2 

While loud snoring is common in OSA, some people may have silent pauses in breathing due to obstructions that prevent air from causing vibrations.^1,2 

Central sleep apnea (CSA) is a neurological condition. Unlike OSA, CSA does not involve a blocked airway. Instead, it occurs when the brain fails to send the correct signals to the respiratory muscles that control breathing. Snoring can occur in CSA but is less common than in OSA.^1,2 

Mixed sleep apnea (MSA) combines features of OSA and CSA. Just like these two conditions, MSA can occur without snoring.^1,2 

Why is silent sleep apnea missed? 

Silent sleep apnea is missed because many people mistakenly believe snoring is a necessary symptom. This misconception can prevent recognition of other signs. Additionally, those who sleep alone may be unaware of their snoring, further delaying diagnosis and treatment. 

Key warning signs other than snoring 

There are numerous symptoms of sleep apnea beyond snoring, such as:^3,4,5,6,7 

Breathing pauses: Apneas and hypopneas can cause breathing to stop potentially hundreds of times a night. You might not be aware of these interruptions since you only partially wake up when they occur. Often, bed partners are the ones who notice these pauses in breath. 

Gasping or choking episodes: Individuals with sleep apnea may struggle for air, leading to gasping or choking episodes. 

Morning Headaches: Depending on the severity of the condition, headaches can last from 30 minutes to four hours and occur most mornings. 

Excessive daytime sleepiness: Poor sleep quality due to sleep apnea often leads to excessive fatigue during the day. It is also linked to difficulty concentrating, memory problems, and mood changes, including depression, irritability, and anxiety due the lack of restful sleep. 

Night sweats: These can be symptoms of sleep apnea. Frequent breathing interruptions cause drops in blood oxygen levels, triggering cortisol release and resulting in sweating. This can also occur because natural body temperature regulation is disrupted. 

Dry mouth: People with sleep apnea often wake up with a dry mouth and sore throat due to their mouths staying open overnight, which dries out the mucous membrane in the throat. 

Risk factors to consider 

There are several factors that can make people more susceptible to sleep apnea. Understanding these risk contributors can help in identifying and managing sleep apnea effectively.  

Body weight: Obesity is a major risk factor for OSA. Excess weight can lead to fatty deposits around the upper airway, making it more prone to obstruction during sleep. While losing weight isn't a cure, it can reduce the risk and help manage OSA.^7,8,9 

Facial structure: Features like a small lower jaw, narrow airway space, and enlarged tongue or soft palate can increase the risk of OSA by causing airway collapse or obstruction during sleep.^7,8 

Family history: Biological factors can contribute to sleep apnea. You can inherit the disorder or traits that increase your risk. A family history of OSA may raise your risk but does not guarantee you will develop the condition.^7,8 

Age and gender: Men are more at risk of developing sleep apnea than women. Age also increases risk as airway muscle mass and tone decrease over time, making airway collapse more likely.^7,8,9 

Medications: Certain medications, such as muscle relaxants, benzodiazepines, and opiates, can affect muscle tone, breathing, and sleep patterns, increasing sleep apnea risk.⁷

How to know if you have silent sleep apnea 

Even without snoring, sleep apnea can lead to serious health problems. It can be advisable to track any concerning symptoms and seek medical advice if you or your bed partner notice any of the symptoms mentioned above. 

Sleep recording apps: Various apps and wearable devices can monitor sleep patterns and record potential sleep apnea-related breathing issues. While these tools can document possible breathing pauses, they cannot provide a medical diagnosis. 

Symptom tracking: Consider keeping a sleep diary to monitor your symptoms. This information can be valuable when shared with your healthcare professional. 

Medical evaluation and sleep studies: If you have concerns about sleep apnea, discuss them with your healthcare professional. They may suggest you undertake a sleep study, known as polysomnography, which is a common diagnostic test for OSA. 

For more information on this diagnostic test and at-home sleep studies, go to our article What is a Sleep Study?  
 

Treatment options 

Treatment options for sleep apnea, regardless of snoring, include CPAP machines or oral appliances to keep the airway open. Surgery may be recommended to remove or reduce airway obstructions. 

CPAP therapy: This therapy can help people with OSA breathe more easily during sleep. It is among the most widely prescribed and efficacious treatment options for OSA. CPAP therapy involves a mask connected to a machine via a tube, which together help keep the airway open. For more details, go to What is CPAP therapy and how does it work?^10,11 

Non-surgical options: These include oral appliances that adjust jaw and tongue position to keep the throat open, supplemental oxygen delivered through various devices to the lungs, and adaptive servo-ventilation (ASV), which continuously adjusts pressure to normalize breathing patterns.^4,10 

Surgery: Surgery can be an option for sleep apnea sufferers who haven’t had success with non-surgical therapies. Options include tissue shrinkage via radiofrequency ablation, tissue removal through uvulopalatopharyngoplasty (UPPP), nerve stimulation to control tongue movement, jaw repositioning with maxillomandibular advancement, and tracheostomy for severe cases.¹¹ 

Lifestyle changes: Regular physical activity can reduce sleep apnea symptoms, even without weight loss. Losing excess weight, a major factor in sleep apnea, can also lessen symptoms. Additionally, mouth and throat exercises to tone muscles behind the tongue may help, though they may not be effective for everyone. Lifestyle changes alone are rarely used to manage sleep apnea.¹¹ 
 
For more details on these treatment options, go to Can you treat sleep apnea without CPAP? 

Potential complications of untreated sleep apnea 

Silent sleep apnea can have the same serious complications as traditional sleep apnea, including increased risks of cardiovascular issues, stroke, and diabetes.  

Cardiovascular risks: Untreated OSA can significantly increase the risk of heart disease. It can lead to an enlarged heart, reducing its ability to pump effectively and potentially causing abnormal heart rhythms.^12,13,14 For more information, go to How does sleep apnea impact blood pressure?  

Stroke: Sleep apnea increases stroke risk by reducing blood oxygen levels, which can lead to changes in blood flow and pressure, raising the likelihood of both ischemic and hemorrhagic strokes.¹² 

Type 2 diabetes: OSA can disrupt the endocrine system, which regulates metabolism, growth, and energy levels. This may increase the diabetes risk.¹² 

Frequently asked questions 

How common is silent sleep apnea? 
Sleep apnea affects almost one billion people worldwide and around 30 million people in the United States. Up to 20% of those with sleep apnea may not snore, making it harder to identify. ⁶ 

Can thin people have silent sleep apnea? 
Yes, thin people can have silent sleep apnea. While obesity is a significant risk factor, other issues such as neck circumference and jaw structure can also contribute.⁴ 

Is silent sleep apnea harder to treat? 
No, the treatment options for all types of sleep apnea such as CPAP therapy, surgery, and lifestyle changes may work for silent sleep apnea. However, silent sleep apnea can be harder to diagnose which may delay treatment.⁵ 

Helpful resources 

For further insight into this condition, you may be interested in reading our articles, Is sleep apnea dangerous? and What is sleep deprivation? 

This content is for educational purposes only. It should not be used as a substitute for the medical advice of one’s healthcare provider.