Obstructive sleep apnoea in women: What you need to know

Quick takeaways

• Sleep apnoea is often underdiagnosed in women because symptoms can look different – many women experience fatigue, insomnia, or mood changes rather than frequent snoring.¹
• Hormone changes during pregnancy, menopause, or due to conditions like polyendocrine metabolic ovarian syndrome (PMOS) could increase the risk of developing obstructive sleep apnoea (OSA).^2,3,4
• Untreated sleep apnoea can affect heart health, blood sugar, and mood, so early testing and treatment are important.^5,6,7
• CPAP therapy, lifestyle changes, and other treatments can help women manage symptoms, improve sleep quality, and support overall health.^8,9

It’s a common myth that sleep apnoea only affects men. In reality, it can affect almost anyone. In fact, obstructive sleep apnoea (OSA) risks are rising for women.

Nearly 1 billion people globally are affected by obstructive sleep apnoea (OSA).¹⁰ Obstructive sleep apnoea is a condition where your upper airway becomes blocked repeatedly during sleep, making it harder for air to flow. These blockages can reduce or completely stop the flow of air, causing your breathing to pause throughout the night.¹¹

By 2050, the number of women living with obstructive sleep apnoea (OSA) is expected to increase by 65% – more than three times the increase seen among men. Researchers attribute the rise in sleep apnoea among women to factors like current underdiagnosis and ageing.¹²

One of the challenges in diagnosing and managing OSA as a woman is that it can look different from sleep apnoea in men.¹³ Getting the right diagnosis is important because untreated OSA may affect your overall health and quality of life.¹⁴

This guide provides some information about obstructive sleep apnoea in women. However, it’s for educational purposes only and is not a substitute for medical advice. If you suspect you may have sleep apnoea, speak with a doctor about getting tested.

What is obstructive sleep apnoea (OSA)?

Obstructive sleep apnoea, or OSA, occurs when airflow to your lungs is blocked during sleep. It usually happens due to a full or partial collapse of your airway.¹¹ Tissues in your throat collapse as you sleep, causing blockages. The air can’t move as easily, so breathing becomes shallow or more laboured. In some cases, breathing stops completely for seconds at a time.⁴

How sleep apnoea symptoms look different in women

If you picture someone living with sleep apnoea, what do you see? Are they older? Are they a man? Do they snore in their sleep? Are they struggling with other health problems?

While it’s true that people who snore, are older, have other medical conditions and are men may be at risk of sleep apnoea, they’re not the only ones.^15,16 Sleep apnoea can, and does affect people of all ages, races, genders, shapes and sizes. That means no one is immune to developing sleep apnoea.

Unfortunately, sleep apnoea can be harder to spot in women, as symptoms of OSA in women may be mistaken as side effects of an ageing body or a busy lifestyle.¹⁷

According to studies, 202 million women across the globe have obstructive sleep apnoea.¹⁸ However, women may not be properly diagnosed until later in life, sometimes after they go through menopause.¹³

Common symptoms in women

Many women believe that being tired is a normal way of life. They may put their exhaustion down to busy days, stressful situations or having young children, which reduces the chance they’ll report their symptoms.

Many people associate obstructive sleep apnoea with loud frequent snoring that keeps you or your loved ones awake. However, women may report symptoms such as¹:

• Daytime tiredness
• Insomnia
• Nightmares
• Depression
• Anxiety

Why sleep apnoea is harder to diagnose in women

Typically, a diagnosis of obstructive sleep apnoea begins when someone reports symptoms to their doctor. Often, a bed partner may start the process after noticing their loved one’s frequent snoring or pauses in breathing. Since the signs of sleep apnoea can look different in women, they may not always recognise or report them. Instead, signs like tiredness, mood changes or trouble concentrating are sometimes mistaken for stress or depression.¹⁹

Some doctors may not recognise how sleep apnoea symptoms can differ in women. Traditional screening tools were largely developed around symptoms more common in men, like snoring, so they don’t always capture the full picture when screening women with sleep apnoea.¹

Risk factors and women’s health

In addition to challenges in diagnosing sleep apnoea in women, some risk factors are unique to women.

Hormones and sleep apnoea

Hormones like oestrogen and progesterone are linked to lung and airway function.²⁰ When hormone levels change, such as during a woman’s menstrual cycle, sleep quality is impacted, and sleep apnoea risk may increase.²¹

Studies have looked at whether hormone replacement therapy might help lower sleep apnoea risk in women who are in perimenopause or who have already gone through menopause. Researchers haven’t reached a consensus, as there’s not enough information yet, but it’s an ongoing field of study in sleep apnoea treatment for women.^22,23

Life stages that increase risk

Some life stages unique to women can increase the risk of sleep apnoea, temporarily or permanently.

Pregnancy

Pregnancy can increase the risk of obstructive sleep apnoea as weight gain and fluid changes in the body cause the airway to narrow.^3,24 Among higher-risk pregnant women, an estimated 15% to 20% have obstructive sleep apnoea (OSA).³

Studies indicate that around 15% of pregnant women have OSA – particularly in later trimesters. Research suggests that OSA during pregnancy may be associated with a higher risk of pregnancy-related conditions, such as high blood pressure, diabetes or pre-eclampsia. OSA may also contribute to a higher likelihood of medically necessary caesarean sections and post-caesarean section wound complications.²⁵

Pregnancy-related sleep apnoea often improves after delivery. However, it can be a signal that a woman is at risk of OSA in the future.²⁶

Menopause

During menopause, hormone changes can impact breathing functions, increasing the risk of OSA in women.²⁷ In fact, after menopause, a woman’s risks of OSA may increase to close to the risk for men.²

However, postmenopausal women may attribute sleep apnoea symptoms like poor sleep quality to ageing and menopause, making sleep apnoea difficult to diagnose.²⁸

Polycystic metabolic ovarian syndrome (PMOS)

Research shows that obstructive sleep apnoea (OSA) affects about 37% of women with polycystic ovary syndrome, now known as Polyendocrine metabolic ovarian syndrome (PMOS), compared to about 6% of women without PMOS. This uptick may be linked to hormone changes and a tendency to carry more weight around the belly, which can make breathing during sleep more difficult.⁴ PMOS may also be associated with OSA occurring at a younger age.

Physical factors

General physical factors related to how women’s bodies differ from men can influence obstructive sleep apnoea (OSA) risk and how the condition shows up. For example, body fat is distributed differently in women’s bodies, which can impact how the airway functions.¹³ And on average, many women have smaller neck sizes than men, which may be related to differences in the shape and size of the airway.²⁹ These differences may influence breathing and increase the likelihood of airway collapse or blockage.³⁰ A smaller airway, for instance, may be more easily blocked by surrounding tissue.³¹

Other health conditions that often overlap

Studies indicate that women are more likely than men to have related or overlapping health conditions, which can make diagnosing sleep apnoea less straightforward.¹ These conditions include:

• Thyroid problems³²
• Autoimmune disorders (the immune system attacks the body by mistake)³³
• Fibromyalgia (a long-term condition that causes widespread pain in the body)³⁴
• Irritable bowel syndrome (IBS) (a gut condition affecting digestion and causing belly pain)³⁵
• Migraines³⁶
• Depression and anxiety¹

Always talk to a doctor if you are experiencing ongoing fatigue, snoring or poor sleep so you can rule out various issues and get help finding answers about your symptoms.

How sleep apnoea affects women’s health

Untreated sleep apnoea can lead to negative health effects, including a higher risk of diabetes, stroke, heart disease and other conditions.^37,38

Health risks linked to women

When it comes to heart health, women tend to have a lower risk level than men.³⁹ However, untreated sleep apnoea can raise the risk of heart conditions in women.⁷ It may also make it harder for the body to manage blood sugar levels, which can contribute to conditions like diabetes.⁶

Studies show a link between sleep apnoea and mood or memory challenges in women.⁵ In addition, some studies suggest possible connections between untreated OSA and hormone-related conditions, such as infertility.⁴⁰

Diagnosing sleep apnoea in women

Because many current screening tools are geared towards symptoms more commonly seen in men with sleep apnoea (like snoring) they may miss women’s symptoms. It’s important to look beyond these symptoms for issues like unexplained fatigue, problems sleeping and mood changes that aren’t related to another condition.¹

Sleep studies may help accurately diagnose sleep apnoea in women.⁴¹ That’s why it’s important to talk to your doctor about your symptoms. They can help decide if a sleep study is a good idea for you and prescribe the right kind of sleep test.

Your doctor may recommend a home sleep test (HST) if you’re showing symptoms of a sleep disorder and have not been diagnosed with any other chronic medical conditions. HSTs can be conveniently completed from the comfort of your own bed, reducing the amount of time you have to wait to get tested. Your doctor may recommend an in-lab sleep study, or polysomnogram (PSG), if you have a more complex medical history and may benefit from comprehensive sleep monitoring. PSGs are usually conducted overnight in a sleep lab, where a trained lab technician can monitor your sleep.⁴¹

Sleep apnoea treatment options for women

Continuous positive airway pressure (CPAP) is highly effective and is the most used and understood method for treating OSA.⁹ CPAP therapy is a drug-free sleep apnoea treatment with no medication-related side effects. When used as directed, it can help alleviate obstructive sleep apnoea (OSA) symptoms after the first night of use.⁴²

Oral appliances, which position the lower jaw and tongue to reduce airway blockage, may help in some cases.⁸ The same is true for positional therapy, which encourages a person to sleep on their side instead of on their back.⁴³

Lifestyle approaches, including weight management, developing better sleep routines, regular exercise and stress management, can also help reduce risk factors for sleep apnoea.^8,44 Because numerous conditions commonly overlap in women with OSA, addressing insomnia, mood disorders and other issues alongside CPAP therapy may be beneficial.^45,46

What’s changing in research?

Doctors and others are learning that sleep apnoea can look different in women, and new screening tools are being developed to help spot it sooner.⁴⁷ This progress means more women may get diagnosed with OSA earlier and find relief faster. Treatments that take hormone changes and women’s health issues into account are also increasingly recognised as important, and awareness campaigns focusing more on women’s sleep health are bringing a lot of these considerations to light.¹

While medical science and sleep apnoea treatment continue to improve, the best thing you can do is be proactive about your own health. Talk to your doctor about your symptoms. Even if you think you’re just “normally tired,” a conversation with your doctor can help you understand whether you might be dealing with sleep apnoea.

If you’re concerned about the quality of your sleep, take our online sleep assessment today.

This blog post contains general information about medical conditions and treatments. It is not intended to be a substitute for professional medical advice, diagnosis or treatment. The information is not advice, and should not be treated as such. You must not rely on the information on this website as an alternative to medical advice from your doctor or other professional healthcare provider.

If you have any specific questions about any medical matter, you should consult your doctor or other professional healthcare provider. If you think you may be suffering from any medical condition, you should seek immediate medical attention. You should never delay seeking medical advice, disregard medical advice, or discontinue medical treatment because of information on this website. The views expressed on this blog and website have no relation to those of any academic, hospital, practice, or other institution with which the authors are affiliated and do not directly reflect the views of Resmed or any of its subsidiaries or affiliates.

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