Sleep apnoea in women: symptoms, causes and treatment

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…

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 evening^7,8
• 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.

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.

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!