Abstract—OSAHS is syndrome of sleep apnea characterized by intermittent closure/collapse of pharyngeal air way which causes apneic episode during sleep manifesting as brief arousals our case who was diagnosed as OSAHS presented to Emergency Department with CO₂ narcosis owing to non-compliance with the treatment (CPAP ). He had occult Hypothyroidism and improved significantly after treatment with Thyroxine. Our case highlights has two important issues of OSAHS (1) compliance with CPAP which patient needed to be counselled'/ regularly and revived appropriately. (2) Occult hypothyroidism which compounded the problem. Treating culture illness can have marked effect on the condition.