In my blog series on sleep problems in women over 40, I mention Obstructive Sleep Apnea (OSA). OSA has really caught my attention recently, and I’ve done a deep dive into the research on it. I’ve learned that it occurs in women of all ages and all sizes, far more often than we realize. For women, sleep apnea is a serious problem that often goes undiagnosed. In my work with patients, I am seeing red flags for sleep apnea on a weekly basis.
What is Obstructive Sleep Apnea (OSA)?
OSA is the most common form of Sleep Disordered Breathing (SDB). It means either a collapse of your airway, called apnea, or episodes of stopped breathing, called hypopnea. OSA is measured as mild, moderate or severe, depending on how many episodes occur per hour:
Sleep apnea is one of the major causes of disturbed sleep in the general population.
Women get sleep apnea too!
Yes, we do get OSA. However; it is vastly underdiagnosed in women. It’s often stereotyped either as a man’s condition, or caused by obesity. I hope to shed some light on these stereotypes. In the United States, 26% of women are at high risk for OSA. The risk increases during hormonal changes, including both pregnancy and menopause.
It is true that as your BMI (body mass index, an indication of fat) goes up, so does your risk of OSA. But skinny women also get sleep apnea! These are the women who may not get diagnosed.
When men go to the doctor with symptoms of fatigue, they are often investigated for OSA. When women go to the doctor with symptoms of fatigue, OSA is almost never on the radar, unless they are obese. Doctors may think about thyroid problems, or depression, or low nutrient status. After all, there are many reasons for fatigue.
If the reason for your fatigue or insomnia is sleep apnea, nothing else will fix it other than addressing your sleep apnea.
Women are underdiagnosed and misdiagnosed – why?
- Women report more general symptoms than men, such as insomnia, restless legs, depression, headaches, anxiety, nightmares, palpitations, and hallucinations. Men tend to report snoring and awareness of apnea.
- We may be embarrassed by our snoring and not mention it.
- Women are more likely to go to the doctor alone, whereas men often attend with their partner. Therefore, a woman’s snoring may not be reported by her partner.
Research shows that women have lower referral rates to sleep clinics, and are underrepresented in clinical studies.
Symptoms of sleep apnea in women
This study showed that the common OSA symptoms in women are:
- Habitual snoring (61%)
- Body movement (60%)
- Restless legs syndrome (RLS) symptoms (33%).
- Sleep onset insomnia (32%)
- Daytime sleepiness (24%)
- Insomnia during the night (19%)
- Observed apnea (7%)
Snoring was the most frequent symptom, whereas observed pauses in breath were the least frequent symptom. This means that if women are not observed with apnea, and they have one or more of these other symptoms, they should be checked.
The greater health risks beyond the symptoms
Sleep apnea is not something to take lightly! It can cause chronic and serious health risks:
- Systemic inflammation (C-reactive protein, tumor necrosis factor α, and interleukin-6).
- Increased risk of heart failure, and a higher risk of atrial fibrillation, independent of weight.
- A higher risk of adverse pregnancy outcomes.
- High blood pressure.
- Atherosclerosis (coronary artery plaque from oxidative stress and free radicals that damage arterial linings).
- A risk of strokes, especially in women aged 35 or younger.
Facts you should know about sleep apnea in pregnancy
1. It may interfere with your baby’s social development at age one.
2. It’s is associated with increased pregnancy-related morbidity, preeclampsia and eclampsia, pulmonary embolism, and cardiomyopathy.
3. Pregnant women with apnea have a higher risk of gestational hypertension, and are more likely to have a c-section delivery.
4. During pregnancy, women with hypertension and diabetes are at a higher risk for sleep apnea and should regularly be screened.
5. Obesity exacerbates the adverse effects of OSA, including a fivefold increase in hospital mortality.
6. Sleep apnea increases during pregnancy. 10% of pregnant women can develop it.
7. Pregnant women with apnea have an increased risk of low birth weight, preterm labor, and small infants.
Sleep apnea ramps up in menopause
Sleep apnea raises hugely after menopause. 47% to 67% of postmenopausal women have sleep apnea. Women tend to gain weight after menopause, and this results in a higher BMI, larger neck circumference, and higher waist-hip ratio. Our upper airway changes in shape after menopause, and results in compromised breathing during sleep.
However, body weight does not appear to be the only factor responsible for this condition. Despite a comparable body mass index, postmenopausal women had more severe sleep apnea when compared to premenopausal women. Also, it’s worth mentioning that postmenopausal women can have bedwetting, or “nocturnal enuresis” as a symptom.
In the next post, I discuss diagnosis and treatment of OSA. It’s not as archaic as you might think! There are more options than sleep clinics, CPAP machines, and surgeries, so stay tuned.