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.

 

22 Responses to “Snoring and Sleepy but No Sleep Apnea–What to Do?”

  1. Katherine Dilworth

    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.

    Reply
  2. Sherrie Anderson

    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?

    Reply
    • Dr. Kezirian

      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.

      Reply
  3. Janie Ellington

    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.

    Reply
    • Dr. Kezirian

      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.

      Reply
  4. Cyndi V.

    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?

    Reply
    • Dr. Kezirian

      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.

      Reply
  5. Rachel

    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

    Reply
    • Dr. Kezirian

      These devices like Sleep Nora have not been proven to stop snoring, to my knowledge, so it is not possible to answer this question.

      Reply
  6. Deb henke

    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.

    Reply
    • Dr. Kezirian

      Is it just that they will not approve an in-laboratory sleep study but would approve a home sleep study?

      Reply
  7. Lindsey

    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!!! 🙂

    Reply
    • Dr. Kezirian

      I would check with the company’s website. I do see many patients who travel to see me for this procedure and others.

      Reply
  8. Nicole G.

    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.

    Reply
  9. Tamara Turner

    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?

    Reply
    • Dr. Kezirian

      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.

      Reply
  10. Lillian Strass

    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!

    Reply
    • Dr. Kezirian

      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).

      Reply
  11. Funderburk

    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.

    Reply
    • Dr. Kezirian

      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).

      Reply
  12. Shauna Kenley

    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?

    Reply

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