Sleep apnoea is often thought of as a condition that primarily affects middle-aged, overweight men who snore loudly and experience daytime sleepiness. However, women also suffer from sleep apnoea, though their symptoms tend to be more subtle and are frequently misdiagnosed as other conditions such as insomnia, depression, or anxiety.
Women’s sleep apnoea often presents differently due to hormonal influences, unique sleep-disordered breathing patterns, and a higher likelihood of having Upper Airway Resistance Syndrome (UARS) rather than full obstructive sleep apnoea (OSA). These differences can lead to delayed diagnosis and untreated symptoms, increasing the risk of long-term health complications.
1. Upper Airway Resistance Syndrome (UARS): A Common but Overlooked Condition in Women
Many women with sleep-disordered breathing don’t fit the classic OSA profile and may instead have Upper Airway Resistance Syndrome (UARS). This condition is characterized by airway narrowing that increases breathing effort but does not always lead to full airway collapse or significant oxygen desaturation—key factors in traditional OSA diagnosis.
How UARS Differs from OSA:
- Milder Breathing Disruptions:Unlike OSA, which involves complete airway blockages, UARS is characterised by a subtle narrowing of the upper airway, leading to increased airway resistance which causes frequent sleep disturbances without significant blood oxygen losses.
- Less Snoring:Women with UARS may not snore loudly, making it less obvious that they have a sleep disorder.
- Frequent Nighttime Awakenings:UARS sufferers often wake up feeling as if they can’t breathe properly, but these episodes are short-lived and subtle, making them harder to detect.
- Chronic Fatigue Rather Than Sleepiness:Instead of excessive daytime sleepiness (a hallmark of OSA in men), women with UARS are more likely to report unrefreshing sleep, persistent fatigue, and brain fog.
- Increased Sensory Sensitivity:Many women with UARS experience light or noise sensitivity, dizziness, or symptoms resembling chronic fatigue syndrome or fibromyalgia.
Why UARS Is Underdiagnosed:
- Sleep apnoea screening studies (level 3 or 4 sleep studies) focus on detecting oxygen desaturation, which is not a prominent feature of UARS. Sometimes even level 1 or 2 polysomnography studies don’t mark the subtle airway obstructions known as RERAs. Home Sleep is very proud to specialise in the accurate reporting of RERAs and detection of UARS.
- Symptoms of fatigue, anxiety, and headaches are often mistaken for other conditions.
- Lean women with UARS do not fit the typical OSA profile, so doctors may overlook sleep-disordered breathing as a cause of their symptoms.
If left untreated, UARS can progress to full obstructive sleep apnoea, increase the risk of hypertension and contribute to chronic sleep deprivation.
2. The Role of Hormones in Women’s Sleep Apnea
Hormonal changes play a crucial role in how sleep apnea develops and presents in women. Estrogen and progesterone influence muscle tone in the airway, breathing patterns, and sleep stability. As these hormones fluctuate, the risk of sleep apnoea changes throughout different stages of a woman’s life.
Menopause and Sleep Apnea: Increased Risk After Midlife
- Before menopause, women have approximately half the risk of OSA compared with men due to the protective effects of estrogen and progesterone, which help keep airway muscles strong.
- After menopause, as estrogen and progesterone decline, airway muscles become weaker, and the likelihood of airway collapse during sleep increases.
- Weight gain, a common effect of menopause, also contributes to narrowed airways and increased sleep apnea risk.
- Postmenopausal women with untreated sleep apnea are more likely to suffer from hypertension, heart disease, and memory problems.
Pregnancy and Gestational Sleep Apnea
Some women develop gestational sleep apnoea (GSA) during pregnancy, even if they had no prior sleep issues. This occurs due to:
- Increased fluid retention, which can cause airway swelling.
- Weight gain, which can narrow the airway and restrict breathing.
- Hormonal shiftsthat influence respiratory patterns.
- Nasal congestion, a common pregnancy symptom, making breathing more difficult.
Symptoms of Gestational Sleep Apnoea:
- New or worsened snoring(often loud and persistent)
- Frequent awakenings, gasping, or choking during sleep
- Daytime fatigue and difficulty concentrating
- Morning headaches
- High blood pressure or increased swelling (edema)
Risks of Untreated Gestational Sleep Apnoea:
- Higher risk of gestational hypertension and preeclampsia
- Increased chances of preterm birth and low birth weight
- Higher likelihood of C-section deliveries
- Increased risk of gestational diabetes
Many women experience improvement in symptoms after childbirth, but those who had gestational sleep apnoea may be at higher risk of developing chronic obstructive sleep apnea later in life.
3. Subtle and Atypical Symptoms in Women
Because sleep apnea is classically associated with loud snoring, gasping for air, and extreme daytime sleepiness, women’s more subtle symptoms are often overlooked. Instead of the hallmark signs seen in men, women with sleep apnoea may experience:
1. Insomnia and Difficulty Staying Asleep
- Many women with sleep apnea struggle with falling or staying asleep, leading to misdiagnoses of primary insomnia rather than a breathing disorder.
2. Fatigue and Unrefreshing Sleep Rather Than Sleepiness
- Instead of feeling the need to nap excessively, women are more likely to experience chronic fatigue, brain fog, and lack of energy, which may be mistaken for depression or anxiety.
3. Mood Changes, Anxiety, and Depression
- Poor sleep due to undiagnosed sleep apnea can cause irritability, mood swings, and symptoms that mimic mental health disorders.
- Many women with sleep apnea are misdiagnosed with depression or chronic fatigue syndrome rather than receiving appropriate treatment for their sleep disorder.
4. Restless Legs and Frequent Nighttime Awakenings
- Women with sleep apnea often experience restless leg syndrome (RLS) or wake up frequently to use the bathroom (nocturia).
5. Morning Headaches and Brain Fog
- Sleep apnea causes low oxygen levels at night, leading to morning headaches, poor concentration, and difficulty focusing during the day.
Why Women Are Often Misdiagnosed
Since many women do not present with classic OSA symptoms, they are often misdiagnosed with:
- Chronic fatigue syndrome
- Generalized anxiety disorder
- Depression
- Insomnia
- Migraines or tension headaches
Unfortunately, this means that many women go years without a proper diagnosis, suffering from sleep disturbances that could be easily treated.
How to Get Properly Diagnosed and Treated
If you suspect you may have UARS or sleep apnea, it’s important to advocate for a comprehensive sleep study (polysomnography), especially if:
- You experience unrefreshing sleep, insomnia, or chronic fatigue.
- You have worsening sleep symptoms after menopause or during pregnancy.
- You have been diagnosed with anxiety or depressionbut find that treatments don’t fully resolve your symptoms.
Treatment Options for Women
- Continuous Positive Airway Pressure (CPAP):The most effective treatment for OSA and UARS.
- Oral Appliance Therapy:Helps reposition the jaw to keep the airway open, especially for UARS.
- Positional Therapy:Sleeping on the side instead of the back can reduce airway collapse.
Lifestyle Adjustments: Weight management, nasal breathing exercises, and avoiding sedatives can improve symptoms.
Conclusion
Sleep apnea in women often presents differently than in men, with subtle symptoms, hormonal influences, and an increased likelihood of UARS. Because of these differences, many women remain undiagnosed or misdiagnosed, leading to unnecessary suffering. Recognizing the unique presentation of sleep apnea in women is key to getting proper diagnosis and treatment, ultimately improving overall health and quality of life.
If you experience chronic fatigue, restless sleep, or unexplained mood changes, consider discussing sleep apnoea with your doctor or call Home Sleep directly for a high-quality sleep study conducted in the comfort of your own home—it might be the missing piece of your health puzzle.