Is It Possible to Have Sleep Apnea Without Snoring?

It is possible to have sleep apnea without snoring. Many people assume loud snoring is the main sign of a sleep disorder, but that belief can delay diagnosis and treatment. Silent sleep apnea is real, and it can be just as dangerous. You could stop breathing dozens of times each night without making a sound.

The lack of snoring often leads people to overlook symptoms like daytime fatigue, morning headaches, or trouble focusing. If you feel exhausted despite getting enough hours of sleep, your body might be sending quiet warnings that something is wrong.

Can You Really Have Sleep Apnea Without Snoring?

Sleep apnea can exist even without snoring. Snoring is a common symptom of obstructive sleep apnea (OSA), but it is not required for diagnosis. Some people with sleep apnea breathe silently during apnea episodes. Their airway collapses or the brain fails to send breathing signals, yet no sound occurs. This is particularly true in central sleep apnea (CSA), where the issue lies in the brain's regulation of breathing, not physical blockage.

Silent sleep apnea often gets overlooked because snoring is widely perceived as the hallmark symptom. People who sleep alone or who are light sleepers may never realize they stop breathing at night.

Snoring results from vibration of tissues in the upper airway. But apnea can occur with partial or complete obstruction without vibration. Some individuals stop breathing without any audible warning. Others may stop breathing hundreds of times per night but never produce a loud sound.

Fatigue, morning headaches, waking up gasping, frequent nighttime urination, difficulty concentrating, and mood changes are more reliable indicators. These symptoms often point to disturbed sleep and reduced oxygen levels, which are classic effects of untreated sleep apnea.

Who Is Most Likely to Have Silent Sleep Apnea?

Silent sleep apnea tends to affect specific groups who either do not snore or present with less obvious symptoms. Understanding who is at risk helps identify undiagnosed cases.

Women. Women with sleep apnea are less likely to snore compared to men. Their symptoms often mimic insomnia or depression, leading to misdiagnosis. A 2014 study in Chest found that women with sleep apnea scored significantly higher on the Stanford Fatigue Scale than men, despite similar disease severity on overnight sleep studies. While both genders reported similar levels of daytime sleepiness, fatigue was more prominent in women (p=0.03). This suggests that traditional screening methods focusing on snoring or sleepiness may miss cases in women (1).

People with Central Sleep Apnea. Central sleep apnea (CSA) differs from obstructive sleep apnea in that the airway remains open, but the brain intermittently fails to signal the body to breathe. As a result, many patients with CSA do not snore. This condition is more common in people with heart failure, chronic opioid use, high-altitude exposure, and certain neurological conditions. CSA accounts for less than 20% of sleep apnea cases but is frequently underdiagnosed due to its silent nature (2). Without classic symptoms like snoring or choking, many individuals with CSA only seek help after experiencing fatigue, brain fog, or cardiovascular symptoms.

Older Adults. In older adults, sleep apnea often goes unrecognized since snoring can decrease with age, even as sleep-disordered breathing becomes more common. One study shows snoring frequencies rise until ages 50–60, then decline, while OSA prevalence continues increasing (3). Many older adults instead experience cognitive changes, daytime drowsiness, or poor sleep quality, which can mask underlying OSA unless specifically tested.

Children. Children with obstructive sleep apnea may not snore at all. Instead, they often exhibit behavioral issues, attention deficits, and enuresis. Up to 25% of children diagnosed with ADHD may actually have untreated OSA, and children with OSA frequently show hyperactivity, focus problems, or bedwetting (4). Enlarged tonsils and adenoids frequently contribute. Because these signs overlap with ADHD or behavioral disorders, OSA in children is often underdiagnosed.

People who sleep alone. Many individuals with sleep apnea remain undiagnosed because living alone means there's no one to observe hallmark symptoms like snoring or breathing pauses. Without this feedback, people often only seek help after experiencing persistent fatigue, morning headaches, or concentration difficulties.

Low-body-mass patients. Normal or low‑BMI individuals can also be affected, often due to anatomical features or respiratory arousal thresholds. Up to 23.5% of OSA patients may have a normal or underweight BMI, and many non‑obese patients exhibit low arousal thresholds during sleep. These individuals may not snore and may not be considered at risk, which leads to underrecognition (5).

The risk is not always obvious. This makes clinical evaluation and screening essential for people with unexplained fatigue or sleep disruption.

Are There Screening Tools That Can Detect Silent Sleep Apnea?

Several tools can help detect sleep apnea without relying on snoring as a symptom. These include validated screening questionnaires, online assessments, and at-home sleep tests.

STOP-Bang Questionnaire. This tool assesses risk based on body mass index, age, neck circumference, blood pressure, and symptoms like fatigue and observed apnea. It does not depend on snoring alone.
Epworth Sleepiness Scale. The Epworth Sleepiness Scale (ESS) measures how likely someone is to fall asleep during everyday activities. It doesn’t ask about snoring, making it useful for spotting silent sleep apnea. High scores suggest poor sleep quality and may prompt further testing. However, ESS is a supporting tool, not a diagnostic or standalone apnea screener. Sleep specialists often use it to decide if a full sleep study is needed.
Online Sleep Assessments. Tools like Nightly’s free sleep assessment ask about symptoms, sleep quality, and health history. They screen for both insomnia and apnea in a structured way that accommodates silent symptoms.
Home Sleep Apnea Testing (HSAT). These devices monitor airflow, oxygen levels, heart rate, and breathing effort during sleep. They can detect apnea events even when no snoring occurs.
Polysomnography. Polysomnography is an in-lab sleep study that provides the most detailed and accurate diagnosis of sleep disorders, including silent sleep apnea. It monitors brain activity, breathing effort, oxygen levels, heart rate, and more. Capturing events even when there’s no snoring. This test can detect both obstructive and central sleep apnea. It’s the gold standard when symptoms are unclear or at-home tests are inconclusive.

What Happens After a Silent Sleep Apnea Diagnosis?

Once silent sleep apnea is diagnosed, treatment is personalized to the type and severity. Most cases involve obstructive sleep apnea, but some patients have central or complex forms. Each requires different management.

First, your sleep study results will show how often breathing stops or becomes shallow. This is called the apnea-hypopnea index (AHI). Severity is classified as:

Mild: 5 to 14 events per hour
Moderate: 15 to 29 events per hour
Severe: 30 or more events per hour

Depending on your AHI and symptoms, treatment may include:

CPAP therapy (Continuous Positive Airway Pressure): A device that keeps your airway open using steady airflow. It reduces apnea events and restores sleep quality.
Inspire therapy: An implantable device that stimulates the airway muscles via the hypoglossal nerve to prevent collapse during sleep. It’s often used when CPAP isn’t effective or tolerated.
Oral appliances: A custom-fitted mouthpiece that moves the jaw forward to prevent airway collapse. Often used in mild to moderate cases.
Positional therapy: Encourages side sleeping if apnea is worse on your back.
Weight loss support: For patients with elevated body mass index, losing 10 percent of body weight can cut apnea severity by nearly 30 percent.
Advanced therapies for central apnea: Adaptive servo-ventilation (ASV) or bilevel PAP may be prescribed if the issue involves brain signaling.

Treatment reduces the risk of cardiovascular problems, cognitive decline, depression, and daytime accidents. Many people feel a difference within weeks. Energy improves. Sleep becomes restful. Morning fog lifts.

Most importantly, silent sleep apnea becomes a managed condition. With the right therapy, people regain control of their health and well-being.

What Are the Signs of Sleep Apnea Without Snoring?

Snoring is often missing in silent sleep apnea. But the body still shows other signs that breathing is being interrupted. Recognizing those signs can speed up diagnosis.

Watch for:

Waking up gasping or choking
Morning headaches
Dry mouth or sore throat upon waking
Daytime sleepiness or fatigue
Difficulty focusing at work or school
Mood swings or depression
Frequent nighttime urination
Trouble falling or staying asleep
Waking up multiple times for no clear reason
Racing heart in the early morning

Many patients describe feeling "off" or "wired but tired." Their sleep quantity may seem normal, but the quality is poor. If this continues for weeks or months, apnea should be considered, even if there is no snoring.

Concerned About Your Sleep? We Can Help You Find Out

You do not need to snore to have sleep apnea. Many people live for years with silent sleep apnea, unaware their sleep is broken. They wake up tired. They push through their day in a fog. They blame stress, age, or bad habits. But the real cause may be hidden and treatable.

Nightly helps people identify the underlying cause of poor sleep. Our free online sleep assessment screens for both insomnia and sleep apnea in minutes using clinically based guidelines.

We built this tool to ask the right questions. About how you feel, how often you wake up, how refreshed you are, and what else might be contributing to poor sleep.

When your results suggest a sleep disorder, we guide you through the process. We believe no one should live exhausted. You deserve answers. You deserve clarity. You deserve to sleep well.

Take our free sleep assessment today. You may finally understand why your sleep never feels restful.

References

Eliasson, A., Kashani, M., Doody, M., Jones, M., & Vernalis, M. (2014). Fatigue in Women Is a Key Symptom in Evaluation of Sleep Apnea. CHEST Journal, 146(4), 938A938A. https://doi.org/10.1378/chest.1988062
Zhang, G., Zhao, X., Zhao, F., Tan, J., & Zhang, Q. (2023). Contribution of central sleep apnea to severe sleep apnea hypopnea syndrome. Sleep and Breathing, 27(5), 1839–1845. https://doi.org/10.1007/s11325-023-02776-6
Osorio, R. S., Martínez-García, M. Á., & Rapoport, D. M. (2021). Sleep apnoea in the elderly: a great challenge for the future. European Respiratory Journal, 59(4), 2101649–2101649. https://doi.org/10.1183/13993003.01649-2021
DeFreeze, L. (2019, August 27). Sleep apnea in children can cause ADHD-like symptoms. What are they? Norton Children’s. https://nortonchildrens.com/news/sleep-apnea-in-children-can-cause-adhd-like-symptoms-what-are-they/
Esmaeili, N., Gell, L., Imler, T., Mohammadreza Hajipour, Taranto-Montemurro, L., Messineo, L., Stone, K. L., Sands, S. A., Najib Ayas, Yee, J., Cronin, J., Heinzer, R., Wellman, A., Redline, S., & Azarbarzin, A. (2025). The relationship between obesity and obstructive sleep apnea in four community-based cohorts: an individual participant data meta-analysis of 12,860 adults. EClinicalMedicine, 83, 103221–103221. https://doi.org/10.1016/j.eclinm.2025.103221

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