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.