Sleep apnea isn’t just a problem for men. Right now, for almost every eight men who are diagnosed with obstructive sleep apnea (OSA), only one woman is diagnosed. But surveys of the general public suggest the actual ratio is much closer than 8:1. In fact, for every three men with sleep apnea, there is likely one woman who has it. While sleep apnea is more common among men, it’s hardly uncommon among women. The problem is that sleep apnea is harder to diagnose in women

Many of the women who suffer from sleep apnea go undiagnosed, and this could be due to the fact sleep apnea symptoms often manifest differently in women than they do in men. Stereotypical symptoms like obesity and snoring may not be present in women with obstructive sleep apnea. Instead, women are more likely to suffer from other symptoms like depression and insomnia. 

In this article, we’ll discuss how sleep apnea affects women and what they can do to deal with this very common sleep disorder.  

Do You Have Sleep Apnea?

Sleep apnea is a sleep disorder where a person’s breathing repeatedly stops and starts throughout the night, or where they struggle to breathe through a partial blockage of the airway. Left untreated, sleep apnea can lead to serious health problems like diabetes, hypertension, stroke, and heart disease.

We’ve written extensively about sleep apnea in the past. If you’re concerned you or a loved one may be suffering from this common but highly treatable sleep disorder, learn the warning signs of sleep apnea. You can also read our recent article Sleep Apnea Symptoms: 7 Serious Signs You Might Have Sleep Apnea.

Here are 11 key things women should keep in mind when it comes to sleep apnea: 

1. Women’s Sleep Apnea Symptoms Aren’t as Obvious

Two of the more common sleep apnea symptoms — loud snoring and choking and gasping during sleep — typically aren’t as common for women. While some women may suffer from these regular symptoms, sleep apnea often presents itself differently in women. 

For example, women who snore are usually quieter than men. As a result, a woman’s snoring is less likely to wake their partners. Women are also less likely to choke or gasp because their apneas (moments without breath) are more often shorter in length and less severe

Snoring is the most common, and typically most obvious, symptom of sleep apnea. Many men report they only went to the doctor for their snoring or gasping because their partner has asked them to. Since women tend to make less noise while snoring, their partners are less likely to be disturbed. There is, therefore, less pressure for women to see a doctor about their snoring — and makes it less likely their sleep apnea will be detected. 

2. Women with Sleep Apnea Are Often Misdiagnosed

Women with sleep apnea are also often misdiagnosed. A woman with undiagnosed obstructive sleep apnea may see her family doctor and describe experiencing fatigue and depression (both symptoms of OSA). Both fatigue and depression are common with numerous potential causes. 

Her family doctor is more likely to treat her for depression, without asking additional questions to determine if the root cause is a sleep related disorder. This happens because she doesn’t fit the stereotype of a  “classic sleep apnea patient.” As a result, her symptoms are treated, but not necessarily the underlying cause. 

Here are the top sleep apnea symptoms women are likely to report

  • Nightmares
  • Morning Headaches
  • Palpitations
  • Insomnia
  • Restless Leg Syndrome
  • Depression
  • Hallucinations

Women may also experience common symptoms such as:

  • Snoring (often softer snoring than men)
  • Gasping or Choking During Sleep 
  • Sore Throats in the Morning
  • Decreased Sex Drive 
  • Dry Mouth
  • Fatigue
  • High Blood Pressure 
  • Brain Fog
  • Mood Disturbances

There are several likely reasons that women express sleep apnea symptoms differently than men. Many of them are biological. 

One reason is that women’s anatomy of their upper airway is different than men’s upper airway. Another is that high levels of estrogen help women keep their throat muscles supple and firm, making obstruction of the airway less likely. Estrogen also increases serotonin, a neurotransmitter that helps control the tongue. Both of these are factors in why it’s often more difficult to properly diagnose women with sleep apnea.

3. Women with Sleep Apnea Are More Likely to Report Insomnia and Disrupted Sleep

When the airway is obstructed and the body can’t get enough oxygen, the brain produces adrenaline to rouse the body and “trick” it into believing it’s actually awake to open the airway. Although many people will never consciously register these subtle nighttime disturbances, others will wake up and struggle to fall back asleep. Many feel anxious, too, because they’ve felt themselves choking. Studies show that about half the people who have sleep apnea also suffer from insomnia. This is especially true for older adults.

4. Sleep Apnea Is Often Mistaken for Depression

It’s widely recognized that people with obstructive sleep apnea have higher rates of depression than other populations. In fact, 50 percent of patients with treatment-resistant depression also have sleep apnea, according to Dr. W. Vaughn McCall, chair of the Department of Psychiatry and Health Behavior at the Medical College of Georgia at Augusta University.

What isn’t as well known, though, is the rate of obstructive sleep apnea in patients with major depressive disorder. That lack of information compelled investigators to study this trend in a population of patients they were already studying.

The original study aimed to determine if treating patients’ insomnia and depression together would reduce suicidal thoughts. Anyone identified as “at risk 

for obstructive sleep apnea (OSA)” was excluded. The researchers therefore intentionally removed anyone from the study deemed as potentially having sleep apnea, including obese patients or anyone with restless leg syndrome. Despite having OSA as an exclusion criterion for the original study, researchers discovered many study participants who didn’t exhibit common or expected telltale signs of sleep apnea did, in fact, have sleep apnea. 

The researchers examined 125 people with depression in this clinical trial. Of those participants, 14 percent, or 17 people altogether, had sleep apnea that was not previously diagnosed or identified as potential high risk; six of those people were women. They weren’t obese, and they didn’t complain about daytime drowsiness. The only common link was they all suffered from insomnia.

These individuals didn’t “fit the usual profile of obstructive sleep apnea, which includes males who are overweight, snore and complain of daytime sleepiness,” said Dr. W. Vaughn McCall, the lead researcher of the study. “We were completely caught by surprise that people did not fit the picture of what obstructive sleep apnea is supposed to look like.”

This discovery reinforces the need for doctors to suggest women get an evaluation from an accredited sleep center to rule out sleep apnea as an underlying cause and contributing factor for depression.

5. Sleep Apnea Is Connected to Restless Leg Syndrome

Restless leg syndrome is a neurological disorder characterized by an overwhelming urge to move the legs, accompanied by unpleasant sensations in the legs. Although neither disorder directly causes the other, sleep apnea and restless leg syndrome are often found together, and restless leg syndrome is twice as likely to occur in women than men

6. Sleep Apnea May Increase Cancer Risk in Women

A 2019 study found a link between sleep apnea and cancer when it examined more than 20,000 documented cases of sleep apnea in Europe. Two percent of the women with sleep apnea also had cancer. Even with the researchers calculating other cancer-related risk factors like age and weight, the correlation between sleep apnea and cancer was higher than normal. This connection was not as strong in men. 

7. Sleep Apnea Can Raise Your Risk of a Heart Attack

Snoring and sleep apnea are linked to a greater ventricular mass in both men and women. The greater the ventricular mass, the harder the heart has to work. The harder your heart works, the greater the chance of a heart attack. As mentioned earlier, both men and women have an increased risk of a heart attack if their sleep apnea is untreated, but this study also found that obstructive sleep apnea was more likely to increase ventricular mass in women than in men. 

8. There’s a 1 in 4 Chance Women Will Develop Sleep Apnea During Pregnancy

Sleep apnea and general sleep issues are more common during pregnancy. Nearly 25 percent of women will snore for the first time in their lives when they’re pregnant. 

During pregnancy, estrogen and progesterone levels increase and lead to greater fluid retention. Increased fluid retention creates uncomfortable swelling. This is why so many women experience swollen ankles and congestion during pregnancy. These hormonal changes also increase the likelihood their throat muscles will relax during sleep. The relaxed throat muscles create partial airway blockages. These prevalent risk factors are likely why more than one out of four women will develop sleep apnea during pregnancy. 

9. Women with Polycystic Ovary Syndrome Are Twice as Likely to Develop Sleep Apnea

Polycystic ovary syndrome (PCOS) is a common hormonal disorder often characterized by irregular menstrual cycles, elevated levels of the hormone androgen and enlarged ovaries. Women with PCOS are twice as likely to develop sleep apnea. PCOS also increases the risk of type 2 diabetes and cardiovascular problems, both of which can be made worse by sleep apnea. 

10. Sleep Apnea During Menopause is Common

As mentioned earlier, estrogen helps keep the throat muscles firm. Declining estrogen levels in women can therefore potentially increase the likelihood of sleep apnea. During menopause, estrogen levels naturally drop, and those decreased levels increase women’s risk of sleep apnea.  Additionally, menopause is linked to weight gain, and excess weight around the neck increases the risk of sleep apnea. 

11. Hypothyroidism Increases Sleep Apnea Risk 

Women are 10 times more likely to develop hypothyroidism than men. Hypothyroidism is often caused by an auto-immune disorder, and 75% of Americans with autoimmune diseases are women

Hypothyroidism can cause the tongue to swell and disrupt the muscles in the upper airway. Additionally, hypothyroidism decreases the body’s ability to respond to the fact that the body isn’t getting enough oxygen during apneas, which makes these two disorders a dangerous pairing. 

Better Sleep Is Possible for Women With Sleep Apnea 

Although women are less likely to develop sleep apnea than men, they are more likely to go undiagnosed. Women are also not as prone to exhibit some of the more generally recognized symptoms of sleep apnea like snoring, which reduces their likelihood to seek out an evaluation and diagnosis. 

Women’s sleep apnea symptoms also often manifest as insomnia or depression which often leads to a misdiagnosis from a family physician, with symptoms being addressed while the root cause is left untreated. 

If you’re a woman who is dealing with symptoms such as morning headaches, unusual bouts of depression, insomnia, PCOS or hypothyroidism, you should express your concerns with your doctor or seek an evaluation from a sleep specialist. These may be symptoms of sleep apnea.

Women experiencing menopause are especially vulnerable and at higher risk for sleep apnea diagnosis, in addition to other common uncomfortable symptoms and sleep issues. To ensure you sleep better during this period of your life, rule out sleep disrupting sleep apnea and discover How Menopause Affects Your Sleep along with tips on how to minimize its effect on your sleep at bedtime. 

If you’re experiencing any of the health challenges or symptoms listed above or suspect you may have obstructive sleep apnea, contact Sleep Centers of Middle Tennessee today for your consultation.

 

 

 

References

  1. Wimms, Allison et. al (2016) Obstructive Sleep Apnea in Women: Specific Issues and Interventions. BioMed Research International. 2016, 1764837: Retrieved on November 6, 2019 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5028797/ 
  2. Veasey SC (2003) Serotonin agonists and antagonists in obstructive sleep apnea: therapeutic potential. American Journal of Respiratory Medicine 2(1) 21-9: Retrieved on November 6, 2019 from https://www.ncbi.nlm.nih.gov/pubmed/14720019
  3. Luyster, Faith et. al (2010) Comorbid Insomnia and Obstructive Sleep Apnea: Challenges for Clinical Practice and Research. Journal of Clinical Sleep Medicine, 6(2): 196–204: Retrieved on November 4, 2019 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2854710/
  4. McCall, William et. al (2019) Prevalence of obstructive sleep apnea in suicidal patients with major depressive disorder. Journal of Psychiatric Research, 116 147-151: Retrieved on November 4, 2019 from https://www.sciencedirect.com/science/article/abs/pii/S0022395619302018?via%3Dihub
  5. Pataka,Athanasia et. al (2019) Cancer prevalence is increased in females with sleep apnoea: data from the ESADA study. European Respiratory Journal,  2019 53:1 900091: Retrieved on November 4, 2019 from https://erj.ersjournals.com/content/53/6/1900091
  6. Holger, Hetterich, et. al (2018) Snoring poses greater cardiac risk to women. Presented at 104th Scientific Assembly and Annual Meeting of the Radiological Society of North America. November 29, 2018: Chicago, IL
  7. Kumarendran, Balachandran et. al (2019) Increased risk of obstructive sleep apnoea in women with polycystic ovary syndrome: a population-based cohort study. European Journal of Endocrinology, 180(4): 265–272: Retrieved on November 4, 2019 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6410684