Sleep Apnea in Women: The Symptoms That Get Missed

Sleep apnea in women is under-diagnosed. Part of the reason is that women often describe it differently. Instead of "my husband says I snore and stop breathing", the complaint is more often "I sleep badly", "I wake with headaches" or "I am exhausted all the time". These are easy to put down to stress, children or age, and the real cause is missed.

Symptoms women more often report

• Trouble sleeping, waking many times or lying awake, which can look like insomnia
• Tiredness and low energy rather than falling asleep during the day
• Morning headaches
• Low mood, anxiety or irritability
• Poor concentration and memory lapses
• Waking with a racing heart or a feeling of breathlessness
• Restless legs or disturbed, unrefreshing sleep

Snoring may be quieter or less often noticed, especially if no one shares the room or the partner is a deep sleeper. Witnessed pauses in breathing are reported less often in women, even when they are happening.

When the risk goes up

• Menopause. Female hormones appear to help keep the airway open. After menopause the risk of sleep apnea rises noticeably, which is why new snoring or poor sleep around this time deserves attention rather than being put down to "the change".
• Pregnancy, especially in the last three months. Snoring that starts in pregnancy, or high blood pressure in pregnancy, is worth mentioning to the obstetrician.
• Polycystic ovary syndrome (PCOS), which is linked to a higher risk of sleep apnea.
• Weight gain, an under-active thyroid, and a family history of sleep apnea.

Why a basic test can under-count in women

In many women the breathing episodes are shallower and shorter, and they happen most in dream (REM) sleep. They often end in a brief awakening of the brain without a large drop in oxygen. A test that records only breathing and oxygen can miss some of these; a test that also records brain waves can score them.

So if a basic home test comes back "normal" or "mild" but the symptoms are strong, it is reasonable to ask your doctor about a fuller study, such as a Level 2 home polysomnography, which you still do in your own bed. For most women, a home sleep study is a sensible first step.

Why it is worth finding

Untreated sleep apnea is linked to high blood pressure, heart rhythm problems, diabetes and depression. It also wears down day-to-day life: work, patience, driving and relationships. Treatment, most often a CPAP machine, usually improves sleep and energy within weeks. Modern CPAP machines are quiet, and there are smaller masks and nasal pillows designed for comfort, including for people who find masks claustrophobic.

What to tell your doctor

Doctors can only work with what they hear. Mention all of these, even if they seem unrelated:

• How you sleep, and how you feel in the morning
• Headaches on waking
• Any snoring, even if light, and whether anyone has heard you gasp
• Menopause, pregnancy or PCOS
• Blood pressure, thyroid and mood problems

A two-week sleep diary makes the conversation much easier.

Frequently asked questions

Do women get sleep apnea as often as men?

It is more common in men, but it is far from rare in women, and the gap narrows after menopause. Many cases in women are simply never tested for.

Can sleep apnea cause insomnia?

It can. Repeated breathing pauses wake the brain many times a night. Some people experience this as difficulty staying asleep. The two conditions can also exist together.

I am pregnant and have started snoring. Should I worry?

Snoring is common in pregnancy, but loud snoring with tiredness or high blood pressure should be discussed with your obstetrician, who can decide whether a sleep test is needed.

Sleeping badly and always tired? See the sleep study options and prices in Chennai, or call us to talk it through.