As a snoring and sleep apnea surgeon, I see patients all the time who snore and report being sleepy. We will order a sleep study, assuming that they have obstructive sleep apnea. However, the sleep study may show no evidence of obstructive sleep apnea. This can be both good and bad news. The good news is that the patient does not have obstructive sleep apnea and its association with some significant health concerns. The bad news is that most medical insurance plans in the United States do not cover treatment for snoring without obstructive sleep apnea. The patient is therefore tired and not covered for medical treatment.
Am I the only person who is snoring and sleepy without having sleep apnea?
In short…No! A study in the July 2016 issue of the medical journal The Laryngoscope sheds more light on this all-too-common situation. Of 307 patients without sleep apnea, almost one-third (101) were sleepy, based on a high Epworth Sleepiness Scale score. The Epworth Sleepiness Scale measures how likely it is for someone to fall asleep during the day in a range of situations. In addition, the study found that men and those with loud snoring during the sleep study were more likely to be sleepy, even if the sleep study showed no evidence of obstructive sleep apnea.
What should I do if I am snoring and sleepy?
The first thing to do is to make sure the sleep study was a reasonably normal night of sleep. The monitors involved with a sleep study can often lead to sleep disruption, leading some patients to feel that they never slept normally. My own general rule is that I do not want the sleep study night to be someone’s best or worst night of sleep. I want it to reflect more of an average night. If the sleep study was not a typical night, we may actually repeat the sleep study.
If we think the sleep study results are accurate, we think about treatment options. I personally have the same categories of treatments for snoring and sleep apnea. In some cases, conservative treatment such as weight loss, sleeping on one’s side, or avoiding alcohol within 2-3 hours of bedtime work well. Positive airway pressure therapy (such as CPAP) can be very helpful in sleep apnea but is not typically used for snoring without sleep apnea.
What about surgery?
Surgery and oral appliances are the other two treatment options that are often better in this group of patients. Surgery requires a careful evaluation to determine the right kind of procedure for each patient. Minimally-invasive office procedures like the Pillar Procedure can be very effective in snoring without sleep apnea because I do not need as much opening of the space for breathing as in those with substantial obstructive sleep apnea. This can be combined with treatments to open the space for breathing in the nose if needed.
If you have snoring and are sleepy but have a sleep study showing no sleep apnea, do not just accept your sleepiness as part of life. There are many options out there, and we can help. Please do not hesitate to reach out to me with any questions.
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Katherine Dilworth says:
Fantastic post! I really enjoyed reading your article..My husband has been suffering from snoring for a long time..And honestly, Its very irritating…Thanks to your blog post..It was very helpful.
Sherrie Anderson says:
I have had the sleep study done three time. The doctors are convinced that I have sleep apnea, but the results are always the same. I do not have it. So I think what is happening is my tongue relaxes and Slides back into my throat thus block my air. I am always tired and fatigued! I have tried two different types of snore guards but my mouth just wants to be open thus releasing my bottom teeth and allowing my tongue to slide backward again. I have tried two types of chin straps and I also tried to make my own chin strap. I am having no luck. I feel that this is a huge reason for other heath reasons that I am experiencing. Do you have any suggestions?
Dr. Kezirian says:
This is not so unusual in young, healthy patients, particularly women. You should make sure that the sleep study is being evaluated with the newer criteria for hypopneas that count arousals from sleep associated with decreases in breathing.
Janie Ellington says:
Where to turn. I am 68. Frequently exhausted. Sciatica and rib injuries prevent comfortable side sleeping. On my back, I wake myself up with a snort then sometimes fall back to sleep only to snort/wake again. Chinup strips no help. Chin straps no help. Didjeridu practice no help. Two negative sleep studies. I live in Texas. Medicare and plan F supplement.
Dr. Kezirian says:
If your sleep studies have been relatively normal nights of sleep for you, then this may not be sleep apnea at all. Pain, by itself, can disrupt your sleep, even if you are not aware of waking up fully. I assume you are being followed by a sleep medicine specialist, but if not, then you should see one.
Cyndi V. says:
I am a 54 year old post menopausal woman. I had the home sleep study done, but they found no apnea. I fall asleep quickly but wake up several times a night. My 4 point saliva test that checks cortisol came back normal and my insulin is normal. The next day I’m tired. I’ve tried everything it seems. Could it be the loss of estrogen? Any suggestions?
Dr. Kezirian says:
Changes with menopause can really affect sleep dramatically. Waking up repeatedly during the night is a type of insomnia, and you should talk to your sleep medicine physician (or other provider) about treating that. Medications are usually not the best choice, and they can discuss options with you.
Rachel says:
Hello,
I have a similar situation to Sherri Anderson. I have done a sleep study and it was determined I do not have sleep apnea. I do think my sleep is being disturbed though as I do feel tired. I have noticed more over the last few years. If a device such as Sleep Nora works to stop your snoring would it also help with improving your sleep?
Thank you,
Rachel
Dr. Kezirian says:
These devices like Sleep Nora have not been proven to stop snoring, to my knowledge, so it is not possible to answer this question.
Deb henke says:
Husband snores so loud he it a sleeping in guest room now. He snores, stops then graps for air but just had sleep study and was told he doesn’t have sleep apnea. I dont get it. He has all the symptoms.
Dr. Kezirian says:
Is it just that they will not approve an in-laboratory sleep study but would approve a home sleep study?
Lindsey says:
Hi there!! I am a very loud snorer but did a home sleep study that didn’t indicate apnea. I’m interested in the Pillar procedure but I live in Ohio (I see you’re in California)… do you know anyone out here that you would recommend for this procedure? Thanks!!! 🙂
Dr. Kezirian says:
I would check with the company’s website. I do see many patients who travel to see me for this procedure and others.
Nicole G. says:
I have the same situation as Sherrie. I had a sleep study done a few yrs ago because I started getting symptoms since around 23-24 yrs old of overwhelming fatigue and tiredness. I am 37 now. It revealed it do not have sleep apnea. I do snore if I sleep on my back or side, but I’m a stomach sleeper. My sleep dr diagnosed me with day time narcolepsy and night time insomnia. He said I wake up every 20-30 mins and I don’t get into my REM sleep stage. Initially I thought I had chronic fatigue syndrome. He leaned more towards the narcolepsy. As I said, I am overwhelmingly tired all the time. Even when I say up late every day, can’t fall asleep earlier. It’s horrible.
Tamara Turner says:
I had a sleep study done about 5 years ago and was diagnosed with sleep apnea. I had somethings happen a divorce and didn’t get the machine and hadn’t had it to use so fast forward went again for another study and this time it was a split night with only two hours of sleep to determine if I had it. Honestly I thought about that the whole time- so that made me anxious and couldn’t be comfortable to sleep. I took my meds to help me and the time came. I didn’t pass. My last 5 years nothing’s changed if anything’s it’s gotten worse as far as snoring and being so tired and sleeping during the day and not feeling rested. So what’s going on?
Dr. Kezirian says:
There are many reasons why obstructive sleep apnea can change over time: change in weight, the natural aging process, and, for women, going through menopause. I would recommend reconnecting with a sleep medicine team for evaluation and treatment.
Lillian Strass says:
My husband is 43, non-smoker, thin and fit, and snores so loudly that I have to send him out of the room to preserve my own sanity. He went for a sleep study and it turns out he does not have sleep apnea. His PCP is willing to give him a prescription for CPAP pressure settings which he says may or may not help with the snoring. We would have to pay out-of-pocket for it because he does not officially have sleep apnea and I am willing to out of desperation. Do you I think the CPAP would be effective in eliminating the snoring? He has tried many other things like the dental appliance, the chin strap and clippel, but they have not worked. Please advise! Thank you!
Dr. Kezirian says:
The Clipple looks like it would not help many people at all. I would not recommend this to anyone, and I am not surprised it has not helped.
CPAP should help quite a bit with snoring. It may not eliminate it, but it should make a major difference. Surgery is another option, of course.
It is also possible that he might have sleep apnea. Home sleep studies will understate sleep apnea, especially in young, healthy patients. If your husband had a home sleep study, another option would be to get an in-laboratory sleep study (polysomnogram). This would be especially important if you are noticing that he stops breathing or if he does not have refreshing sleep (for example, if he is sleepy or has fatigue in spite of getting enough hours of sleep).
Funderburk says:
I just had a sleep study done today. She said I had mild sleep apnea but not enough to set me up on a CPAP that night. I feel quite depressed about this. I’ve been tired since college. I’m 36, 5′ 10″ a d 155 pounds.i also workout. I also quit smoking over 2 years ago. The ENT said I have a diviated septum but nothing blocking airways. My dentist did say my tongue is too large for my mouth. I’m not sure what to do next? I’m just tired of being tired with no answers. I feel my short term memory is quickly declining as well.
Dr. Kezirian says:
If you did have sleep apnea and are sleepy, you should be covered. You may have had some events like sleep apnea but been within the normal range. If you had a home sleep study, you may be a candidate for an in-laboratory sleep study that would be more likely to show sleep apnea that was no longer within the normal range (home sleep studies generally understate sleep apnea, espeially in younger, thinner, and healthier patients).
Shauna Kenley says:
I have had both a home sleep study and 2 hospital sleep studies and all say no sleep apnea. I am a stomach sleeper and still snore horribly!! What can I do to stop snoring? Is surgery my only option?
Dr. Kezirian says:
Surgery is one option, but you can also try any of the conservative approaches I have listed on one of my first blog entries: https://sleep-doctor.com/blog/12-keys-to-stop-your-snoring.
Paige Waddoups says:
My husband snores like clockwork…. very very loud clockwork…. yet if I even reposition in bed he wakes up startled as if something dramatic has happened. Anyone who sleeps in a-joining rooms knows to wear ear plugs. He has no obvious apnea, and he snores no matter what position he’s in and nothing seems to improve it. He will take a deep breath (which causes a very loud snore) and wake himself up, but most of the time he sleeps right through it, yet a pin drop caused by someone else will wake him. If possible, he will sleep 10 hours, but absolutely requires at least 8 hours or he is intolerable. I don’t think his quality of sleep is good, but the sleep centers in our area send everyone straight to CPAP so we’ve been hesitant. Seems like everyone that walks in the places here walks out with a membership for life, which is fine if that’s what he really needs but we’d like to at least hear the options. Thoughts?
Dr. Kezirian says:
Starting with CPAP is definitely the right choice for someone with obstructive sleep apnea. If he is not comfortable with that (it sounds like it may be difficult for him), then he should consider options. Surgery can be a great option for many patients, but getting a sleep study and starting with CPAP is the way to go.
Misty A Miller says:
My son is 7yo. Excessive daytime sleepiness. Adhd symptoms and Irritability. Was diagnosed with anxiety. He sleeps 12-15 hours at night and will still complain of daytime fatigue, often falling asleep for naps of 1-2 hours. First sleep study resulted in mild OSA. Tonsils and adenoids removed and still the same sleep issues after. Was told to take him off medication for anxiety to assess for side effects. No change off of medication. Second sleep study and daytime study impression: snoring but no apnea. Decreased REM and atypical sleep architecture but anxiety and difficulty falling asleep during study impacted study result. This is not typical for my son’s sleep but he does have medical anxiety and was not permitted to be on anxiety medication during this test. Daytime study impression: 17 minute average for sleep onset, 3/4 opportunities for nap resulted in sleep. My son was anxious to leave facility resulting in last opportunity for nap not taken, however as soon as we got to our car he fell asleep. Any thoughts? Super concerned and frustrated.
Dr. Kezirian says:
I do not treat children and would not be the best person to comment on this. Your son’s case is certainly complex, and it sounds like a discussion needs to occur between the sleep medicine team and his mental health team.
Kuru says:
I have been having excessive tiredness and fatigue since I was around 17, and I am now 26. I also snore extremely loud, although there are nights when I barely snore as well. I’ve tried sleeping varying amounts, breathing strips, and I have a mouth guard for grinding at night. I did two sleep studies (the ones where you take the machine home), and the doctor said that I have a bit of mild sleep apnea, but nothing serious to the point where I require treatment. He said that I should just do nothing about it. I’ve also been tested for diabetes, etc. and he says I am healthy. I’m tired of being tired and my friends and partners don’t want to sleep in the same room as me due to my horrendous snoring. The doctors did say that I have very large tonsils (which also always get infected) I’m not sure how effective it will be to take them out in terms of improving my sleep/snoring.
Dr. Kezirian says:
A young person will be much more likely to show mild obstructive sleep apnea on a home sleep apnea test with this sleep apnea causing the sleepiness and fatigue that you mention. You should likely be treated for your mild sleep apnea. If you have already spoken with a sleep medicine provider, you should consider finding a different one or talking to a sleep surgeon.
Michael McElhany says:
Hi, Im a 34 yr old male, I am tired all the time, even when I get enough sleep. I have been told that I snore loudly. would you recommend me to get a sleep study?
Dont know if this is hereditary or not but my dad and sister both have sleep apnea and use cpap machines.
Dr. Kezirian says:
Yes, you should likely obtain a sleep study.
Edward McCormac says:
I have CSA but it’s fully under control usin resumed ASV machine, however at least 1-2 time a month I will sleep all day waking now and again, sometimes this can last 3 days.
Any Ideas?
It’s ruining my life and has been happening for years
Dr. Kezirian says:
I do not have an obvious answer. I expect you have discussed this with your sleep medicine team, but if not, I would recommend that.
Zach Antinelli says:
Hi Dr Kezirian, I am a 29 yr old male and often wake up tired after 8+ hours of sleep. I have been told I snore. I’ve had two sleep studies done, one at home and one in lab. Both studies said I do not have sleep apnea but both times I did the study I had horrible sleep as I was either woken up by the device making loud noise at home or the technician waking me up at the lab. I am also usually tired during the day and have horrible short term memory. Is there anything else I can do here or am I doomed to be tired? Thank you
Dr. Kezirian says:
Obviously, you can pay for a treatment for sleep apnea yourself, such as buying a CPAP machine and the supplies. Otherwise, you can try to get another in-lab sleep study, thinking about how you might be more comfortable during the study. Sometimes, people can have what is called a first-night effect, in that they do not sleep comfortably on the first night of an in-lab sleep study but then sleep more naturally in future studies because they know what to expect.
Christine says:
Although I do not feel tired during the day, when I lay down to sleep, I get so much drainage that it is causing me so snore at night. I did a sleep study and they said no apnea but it is interfering with my sleep. Not sure what to do. I wake up 5-10 times a night.
Dr. Kezirian says:
You should probably see an ear, nose, and throat doctor (otolaryngologist) to see what can be done. They will want to examine you to evaluate what might be the cause and potential treatment.
Deb says:
Hi my sleep apnea test came back negative too but the snoring n sleepiness hasn’t stopped. I tend to wake up with a funky feel in back of throat and sometimes a gargly sound. This isn’t coming from my nasal passage and concerns me… could it be from my lungs?
Dr. Kezirian says:
There are many potential explanations. I cannot really provide a clear diagnosis without evaluating you and, potentially, ordering additional tests. One thing I might recommend is making sure you had an in-laboratory sleep study if your first sleep study was at home).
Jenni V says:
I had a sleep study (both an over night one and an mslt) years ago and was diagnosed with atypical narcolepsy. It showed no signs of sleep apnea. I have always snored on occasion, but over the past year or so my snoring has become more loud and more frequent. To the point that my husband leaves the room because I wake him up and he can’t fall back asleep. Any suggestions on what could be causing my snoring and what I can do to make it better?
Dr. Kezirian says:
Because snoring and obstructive sleep apnea are so common, they can occur in combination with other sleep disorders like narcolepsy. It sounds like you might benefit from a reevaluation by a sleep specialist and consideration of another sleep study.
Whitney Stipes says:
I had an in home sleep study done a few years ago and they said I do not have sleep apnea. My husband says I’m never snoring until he wakes up to use the bathroom. It’s like the movement jump starts my snoring but I don’t wake up? Sometimes it takes forever of him pushing me until I wake up to be able to move to another bedroom. I need help so badly but I feel like no doctor can explain my snoring and to say I’m frustrated is a VERY extreme understatement. I’ve tried chin straps, Anti snore pillows for elevation, side sleeping, nasal sprays, nasal strips, a white noise machine…..hot towels on my nose….and NOTHING works. Ive even resorted to taping my mouth shut at night because I think the mouth breathing causes it? I am in absolute desperate need of help!
Dr. Kezirian says:
It sounds like you might want to get another sleep study (maybe in a sleep laboratory) to look for sleep apnea more carefully. There is something called Rule 1A that can be used for interpreting in-laboratory sleep studies. Basically, it looks for blockage of breathing that can be waking you up before your oxygen levels drop. These are not detected on most home sleep studies but can be counted on the in-lab sleep studies if they are interpreted in this way.
I am not sure what to make of the start of snoring only when your husband gets up to go to the bathroom. Later in the night, people get more REM sleep, which is a time that one would be more likely to snore and have sleep apnea. An in-laboratory sleep study could evaluate whether any sleep apnea was occurring mainly in REM sleep.
Nic Edg says:
I snore almost as soon as my head hits the pillow, i usually go to bed about 12:30am and wake about 7-7:30, i fell very tired but have sleep procrastination! i will never fall asleep during any of the epworth scenarios unless I am ill. I wake every morning with really sore throat and headache, i also clench my teeth. I have also always suffered from rhinitis/allergies so my nasal airways are not great but i still always breath through my nose.
Dave says:
I’ve tried twice now for a sleep study and both times were negative but both times I didn’t sleep particular well.
I never feel rested, fatigued all the time. My smart watch shows around 20 or more wakes compared to my wife’s watch of maybe two or three.
This said I don’t snore too much but on occasions I do and don’t think I wake up gasping.
My Dr and dentist both put me forward for the rest because of symptoms and I have a very small mouth. I also have a deviated septum and can’t breath properly out of the right nostril which spays don’t make any be difference to.
I noticed there was a post regarding a newer test about sleep arousal. I do notice this disturbs or wakes me up a lot. What kind of test do I need to ask for for this and is it likely I need this test
Dr. Kezirian says:
The WatchPAT home sleep study and in-laboratory sleep studies are validated tests that do include evaluation of arousals. They do differ, however. You can speak with your team about whether these might make sense for you.
Amanda Fitzgerald says:
I just had an in home sleep study that showed no slerp apnea but snoring and waking up. Im confused. I had a in lab sleep study 16years ago and they said i did have OSA. But i never got a cpap. I fall asleep alot during the day and always tired. I have trouble falling asleep too. Ive been told my insurance wont pay for the in lab sleep study. My father and both of my sons wear cpaps. What should i do next??
Dr. Kezirian says:
The issue may have to do with the fact that most home sleep studies only count sleep apnea events when you drop your oxygen levels, whereas in-lab studies can count sleep apnea events with blockage of breathing and awakening before you might drop your oxygen level. A negative home sleep study in a patient in whom a provider highly suspects sleep apnea should be followed with an in-lab study. This should be pursued by your sleep medicine provider and appealed, if necessary.