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Women and sleep apnea

We all know someone who snores, snorts, or gasps for air during their sleep. The night air is filled with the “work” of breathing. This clinical picture is common for people with sleep apnea. Who immediately comes to mind when you think of sleep apnea? Some people may imagine an middle aged, overweight man. However, sleep apnea, the condition where breathing stops during sleep, can be diagnosed in just about anyone: children, teens, men and women.

Let’s learn more about this sleep apnea in women. Shedding some light on the risks and effects of sleep apnea can help you take greater control over your sleep health.

Symptoms of sleep apnea in women

When people have pauses or stop breathing during sleep, this is called sleep apnea. Obstructive sleep apnea, or OSA, happens when a partial or complete blockage in the throat occurs. When we sleep, we lose muscle tone. The muscles in our throat relax so much that it causes the airway to close. When the airway closes, not enough oxygen gets into the body.

Drops in oxygen levels alert the brain that something isn’t working as it should. As a result, the brain wakes the sleeping person up so the airway can be reopened and the person starts breathing again. This becomes a problem when the sleeping person is woken up over and over again, sometimes dozens of times an hour.

Imagine waking up 30 times in one hour because of something frightening. The body responds to to OSA that same way, by going into “fight or flight” response. Repeated awakenings lead to a deficit in deep, restorative sleep in addition to increased blood pressure, cognitive problems and the body’s ability to use sugar properly.

Common sleep apnea symptoms in women include:

  • Feeling tired all the time
  • Noticeably loud snoring (although not always in women)
  • Weight gain
  • Feeling agitated and foggy
  • Gasping for breath during sleep
  • Unexpectedly falling asleep during the day (it normally takes 10-20 minutes to fall asleep)
  • Hypertension

Underdiagnosis and misdiagnosis of female sleep apnea

For adolescent girls, weight gain during the teen years brings an increased risk of sleep apnea. Because sleep apnea contributes to poor quality sleep, this can trigger behavioral, cognitive, metabolic, and cardiovascular problems that may present themselves during adolescence or surface later.

With female patients, occurences of sleep apnea are often underdiagnosed or undiagnosed altogether because women may present symptoms that aren’t seen as “typical” for sleep apnea. As noted, some women only mildly snore and may not have complete closure of the airway, but the daytime symptoms are similar.

Women may say they are depressed, fatigued and have insomnia. Some may complain of restless legs.  And since men generally have a higher instance of sleep apnea than women, physicians may not be exceptionally vigilant in screening for it. It is reported that 90% of severe sleep apnea cases among women are not diagnosed.

It is important to recognize these disparities in order to create better diagnostic and treatment options for women. But there has been some progress. Over the years, treatment for women with sleep apnea has become more nuanced and specified, like the adjustments that have been made involving the continuous positive airway pressure machine, or CPAP.

CPAP is a special breathing machine that keeps your airways open when you lie down to sleep. Often, a female patient requires a lower of level of airway pressure for her CPAP than a male patient would, and medical professionals are taking a woman’s specific anatomical needs into account when prescribing CPAP. Changes in CPAP masks, like smaller sizes that fit women’s faces, are also on the market to better suit their needs.

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Pregnancy and sleep apnea

All kinds of physiological changes happen during pregnancy. A woman’s sense of smell can become keener, shoe sizes can grow, and the risk for female sleep apnea increases.

Researchers in a recent study learned that 3.6 percent of 3,264 women in early pregnancy develop sleep apnea while 8.3 percent of 2,512 women in mid-pregnancy have sleep apnea, an almost two-fold increase. Generally, it is known that women have increased difficulty sleeping, especially during the third trimester, thus screening for sleep disorders is not commonly done, therefore sleep apnea is likely to be missed.

In a study of first-time pregnancies, the researchers found that sleep apnea increases a woman’s risk for hypertension and gestational diabetes. There is also a link between sleep-disordered breathing conditions like sleep apnea and preeclampsia. Preeclampsia is a complication that occurs during pregnancy that increases the blood pressure and possibly damages organs, particularly the liver and kidneys.

Although obesity is a risk factor for all ages and genders in developing sleep apnea, women who start their pregnancy at a higher BMI are at higher risk for developing sleep apnea as they carry their baby. Sleep apnea during pregnancy is usually treated with a CPAP.

Sleep apnea in women and menopause

While the overall incidence of sleep apnea is higher in men than women—the ratio of women to men with sleep apnea is known to be 1:2-1:3. That gap narrows as women age, particularly after menopause.

Sleep apnea during menopause may contribute to increased cardiovascular disease risk in women at later stages of life. And sleep apnea in menopausal women is a risk factor for the onset of cognitive decline.

Progesterone is known to be a respiratory stimulant and increases the muscle tone in the airway. The loss of progesterone after menopause is thought to contribute to the increase in sleep apnea. In addition, hormones play a role in fat distribution with more fat in the upper body, compared to premenopausal. This increase in weight and fat distribution is a likely cause of increased sleep apnea.

Improve sleep, improve health

The unique physiological experiences and social expectations of women put them at risk for sleep apnea throughout their lives. Both quality and quantity of sleep are important. If you are feeling unrefreshed when you wake up and you think you are getting the right amount of sleep, you may be waking up from sleep apnea and not know it. If you feel tired, fatigued or are falling asleep when you don’t want to, it’s time to ask your doctor about it!

For more helpful information on women and sleep apnea, check out this excellent report from the Society for Women's Health Research.

Robyn Woidtke, MSN, RN, RPSGT, had her entry into the sleep medicine world through the neonatal field and conducting SIDS research at Stanford. In addition to her sleep background, she has extensive clinical affairs experience in medical device product development, clinical marketing, and the integration of sleep testing for clinical research professionals. Robyn is certified in Clinical Sleep Health and has been published in numerous respiratory, sleep, and clinical research journals. She has a Masters degree in Nursing and an undergraduate degree from The George Washington University.

July 20, 2018