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January 10, 2024

Sleep apnoea in women: symptoms, causes and treatment

Women & Sleep Fatigue Sleep issues Sleep test Snoring Symptoms

Think that obstructive sleep apnoea (OSA) only affects middle-aged men? Think again! Women can have OSA too – in fact, recent studies have suggested its prevalence in women aged 20 to 70 may be as high as 50 per cent1. What’s more, women often face a different set of challenges to their male counterparts when it comes to the condition, which we’ll explore in this article – along with these other topics:

What is OSA?

Before we get into the details, here’s quick explanation of what the common sleep disorder obstructive sleep apnoea – often shortened to sleep apnoea (or sleep apnea if you’re American!) – actually is.

When you go to sleep your muscles relax, including those in your nose and throat. Sometimes these muscles relax so much that they block your airway, stopping you breathing in sleep. If this lapse in breathing lasts for 10 seconds or more, it’s known as an apnoea.

If an apnoea occurs your brain triggers you to wake up briefly to gasp for air before falling back to sleep, As this can happen more than 50 times an hour, you can see why a sleep disorder like sleep apnoea can disrupt your rest and leave you feeling pretty rough the next day – among other symptoms…

How does sleep apnoea affect women?

While women do experience the ‘classic’ symptoms of sleep apnoea, such as loud snoring, making choking sounds, or having difficulty with breathing during sleep (often first noticed by the partner of the person who’s snoring!), other symptoms of OSA that are more common in women include2:

  • Insomnia
  • Restless legs
  • Depression
  • Excessive daytime sleepiness
  • Headaches (particularly morning headaches) and muscle pain
  • Weight gain

Not only can women display different signs of sleep apnoea to men, they also tend to show more symptoms of mild sleep apnoea than men do. This was the finding of a study3 led by Alison Wimms PhD, who set out to discover the effect of CPAP treatment (more on this later!) on women with mild OSA.

The study found:

  • Women had a worse daytime sleepiness score on the Epworth Sleepiness Scale (a measure of how sleepy people feel during the day) than men
  • Women also had a worse score on the Fatigue Severity Scale (a method of assessing the impact of fatigue) than men
  • Women’s mental and physical health quality of life scores were lower
  • They also had higher levels of anxiety, depression and insomnia

What are the causes of OSA in women?

People can have sleep apnoea for a wide variety of reasons, but, generally speaking, the risk of OSA is increased by:

  • obesity or being overweight, particularly if you have a large neck circumference4
  • being older: sleep apnoea can occur at any age – even in children – but the risk increase with age and especially if you are over 65
  • taking sedatives, such as sleeping tablets or tranquilisers6
  • smoking or drinking alcohol in the evening7,8
  • having family members with sleep apnoea9
  • having nasal congestion (from allergies, for example)
  • certain physical characteristics, such as a large tongue10

In addition, there are some risk factors that are more specific to women…

Pregnancy and obstructive sleep apnoea

Pregnant women are more at risk of sleep apnoea, with as many as one in five women affected during pregnancy11.

This may be due to a variety of pregnancy-related changes in the mother’s body. For example, higher levels of certain hormones can increase nasal congestion or cause the muscles in the airway to become more relaxed. In addition, excess weight gain could play a role, along with the growing uterus (womb) placing pressure on the expectant mother’s lungs.12

Because stopping breathing in sleep can cause lower oxygen levels for both the pregnant mother and her baby, it’s important to take any difficulty with sleeping or snoring (or any other signs of sleep apnoea) seriously during pregnancy and seek medical advice as soon as possible.

Menopause and sleep apnoea

After the menopause, women’s risk of sleep apnoea rises to around the same level as in men13. Menopause may also affect the severity of sleep apnoea, with 14 per cent of women aged from 55 to 77 having a severe form of the condition14.

Again, as with OSA in pregnancy, changing hormone levels may be at least partly to blame – for instance due to hormonal changes, post-menopausal women tend to have a higher percentage of body fat than younger women15, and this excess weight is more likely to be carried around their upper body, potentially affecting the airways16.

Can sleep apnoea cause high blood pressure in women?

Sleep apnoea is often linked high blood pressure (hypertension)17. Persistent high blood pressure can put your heart and other organs under strain and potentially increase the risk of heart attack or stroke. In pregnant women, OSA may also increase the risk of pre-eclampsia – a condition involving high blood pressure, which can cause complications during pregnancy18.

Meanwhile research has shown that perimenopausal women (women around eight to 10 years before menopause) with sleep apnoea have daytime higher blood pressure and are prescribed more blood pressure medications compared to women who don’t have sleep apnoea19.

Is sleep apnoea dangerous?

As we’ve seen above, while obstructive sleep apnoea is a common form of sleep disorder, if left untreated it can have negative effects on health. As well increasing the risk of high blood pressure, heart disease and stroke17, OSA can affect other medical conditions such as type 2 diabetes – nearly one in two people with the condition also have sleep apnoea20.

People with untreated sleep apnoea have even been found to have more road accidents than those without it21.

However, it’s not all bad news for women with sleep apnoea! While women may appear to experience greater negative effects of OSA than men3, it’s also been shown they experience great positive effects from receiving CPAP therapy3… but before they can benefit from treatment, they need to be diagnosed!

How to diagnose sleep apnoea in women

Women tend to be diagnosed with sleep apnoea less often than men – with up to 90 per cent of women with moderate to severe OSA undiagnosed22. Even when women are diagnosed with OSA one study showed that, in the year after diagnosis, only 58.3 per cent of women with sleep apnoea were actually treated for their condition23.

Why might this be? The answer could that women’s typical OSA symptoms can be mistaken for other conditions. For example, difficulty sleeping, tiredness, morning headaches and insomnia can all be associated with depression, or put down to changes due to pregnancy or menopause – ironic as they are times in a woman’s life when sleep apnoea may be more likely!

The way that women report concerns about their sleep habits may also have a bearing. For example, compared to men, women may:

  • use different words to men to describe their symptoms,
  • feel embarrassed to admit they snore
  • have a higher tolerance of sleepiness24
  • attend healthcare appointments alone25 so their doctor doesn’t hear reports of snoring and other nighttime symptoms from a partner

All this means that if you’re a woman who’s struggling with sleep it’s really important to arm yourself with information: be aware of the symptoms and risks of OSA so you know when to speak to your healthcare provider – taking our sleep assessment is a good place to start (as is reading this article)!

Sleep apnoea tests

If you suspect you may have sleep apnoea, the next step is to visit your doctor to discuss your concerns. They will ask questions about your symptoms, so it might be a good idea to jot these down in advance so you don’t forget anything! If your doctor also suspects sleep apnoea, they will probably refer you to a sleep specialist at a sleep clinic, or arrange a home sleep test.

A visit to a sleep clinic will usually involve an overnight stay, where your sleep will be monitored via a variety of sensors. Similarly, an at-home test will involve monitoring your sleep overnight with a device that records information about your sleep, which your specialist will show you how to use.

The main thing these tests will try to determine is your Apnoea-Hypopnoea Index (AHI). This measures how many apnoeas you have per hour of sleep, and also whether you have any hypopnoeas, where breathing reduces by more than 30 per cent for 10 seconds or more, rather than stopping entirely26. Your specialist will then use this information to grade the severity of your sleep apnoea. In adults, five to 15 pauses in breathing/apnoeas equate to mild sleep apnoea, 15 to 30 indicate moderate sleep apnoea, and more than 30 means severe sleep apnoea27. Typically, women have a lower AHI than men3.

It’s important you know this information, as it will affect the type of treatment you receive.

Treating sleep apnoea in women

If you are diagnosed with OSA you may be encouraged to make some lifestyle changes28 – such as losing weight, stopping smoking or cutting down on alcohol – all which may help ease your symptoms while your treatment plan is put in place.

In mild to moderate cases, sleep apnoea is sometimes treated with a small oral appliance called a mandibular advancement device (MAD). It can also be used for severe cases of OSA as a second line of therapy if PAP therapy doesn’t suit them29. The device is worn inside the mouth during sleep and holds the lower jaw forward, widening the space in the throat behind the tongue. This helps stop the tissues in this area vibrating (causing snoring!) and keeps the airway clear.

OSA treatment with a CPAP machine

However, CPAP machines provide the most common treatment for OSA. CPAP stands for continuous positive airway pressure, and CPAP machines work by delivering a steady, continuous stream of pressurised air to a mask that you wear while you sleep. Breathing in this stream of air helps keep your airways open, preventing apnoeas.

Because women experience sleep apnoea differently to men, Resmed CPAP machines and masks have been designed to reflect these differences.

For example, it has been shown that women have higher rates of stopping CPAP therapy early30. Our devices can be tailored to the particular therapy needs of women via the AutoSet for Her algorithm. This specifically treats and responds to female breathing patterns, helping to make therapy more comfortable, so hopefully women will continue using it for longer.

Another example is that women may also be more sensitive to high air pressure or sudden changes in pressure while having CPAP therapy, so AutoSet for Her addresses this by offering gentler, more gradual increases in air pressure.

In addition, features such as humidification can help make CPAP therapy more comfortable by helping to prevent a dry mouth or nose.

Benefits of CPAP therapy for women

Being treated for sleep apnoea has lots of benefits for your health and wellbeing, such as more energy31, an improved mood32 and a clearer mind32. Start and sticking with CPAP therapy can also reduce your risk of cardiovascular disease by 64% (compared those who aren’t treated)33 and lower your blood pressure34.

And, as we alluded to above, the really good news for women who are treated with CPAP therapy is that they seem to experience greater improvement in their symptoms than men.

Going back to Alison Wimm’s study that we mentioned earlier, it found that among CPAP users, women had greater improvements in both their daytime sleepiness and vitality than men3.

Don’t just take our word for it – you can see the experiences of other women who have been treated for sleep apnoea with CPAP machines in our Patient Stories. We hoped they inspire you to start your own journey to better sleep!

Please refer to the user guides for relevant information related to any warnings and precautions to be considered before and during use of the products.

This blog post contains general information about medical conditions and treatments. It is not intended to be a substitute for professional medical advice, diagnosis or treatment. The information is not advice, and should not be treated as such. You must not rely on the information on this website as an alternative to medical advice from your doctor or other professional healthcare provider.

If you have any specific questions about any medical matter, you should consult your doctor or other professional healthcare provider. If you think you may be suffering from any medical condition, you should seek immediate medical attention. You should never delay seeking medical advice, disregard medical advice, or discontinue medical treatment because of information on this website. The views expressed on this blog and website have no relation to those of any academic, hospital, practice, or other institution with which the authors are affiliated and do not directly reflect the views of Resmed or any of its subsidiaries or affiliates.

References
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