Purpose of a Sleep Study

The purpose of a sleep study is to help doctors diagnose sleep disorders. There are two types of sleep studies available. One is an at-home sleep study primarily used to diagnose sleep apnea. The other, more common sleep test is polysomnography. A polysomnography is performed in a sleep lab. It also diagnoses sleep apnea and other sleep disorders like insomnia.

During an in-lab sleep study, you’ll be hooked up to several different sensors while you sleep. These sensors gather data that your doctors use to diagnose sleep apnea. The data includes

• Heart rate
• Oxygen levels
• Brain waves
• Eye movement
• Breathing patterns

All these things give your doctors a better idea of what’s happening while you sleep. They can then take that information and decide whether you have sleep apnea.

Signs That You Need a Sleep Study

The best way to know if you need a sleep study is to keep track of your symptoms. If you think you have sleep apnea, write down how you feel daily.

Make notes about:

• What time you go to bed
• What time you wake up
• How tired you feel during the day
• If your partner says you snore or wake up in the night

You can also keep track of other physical symptoms of sleep apnea, like headaches, waking up with a dry mouth or sore throat, and high blood pressure. Pay attention to your mood swings and mental health as well.

Take this journal to your doctor to talk about sleep apnea. Make sure you tell them everything and ask any questions. Let them know you’re concerned about sleep apnea. They’ll start with an examination of your airway. This will involve feeling the airway and taking images with X-rays or a CT scan. Then, they’ll use this information to decide if you need a sleep study.

What is Sleep Apnea

Before we can understand sleep apnea in women, we need to take a look at what sleep apnea is in the first place. 

Sleep apnea is a sleep disorder where your breathing is interrupted. When you sleep the soft tissues in the back of your mouth and throat relax. Most of the time air is able to pass through. For some people, however, the airway collapses too much. This makes it difficult for air to pass through. Your body senses that it’s not getting enough air, so it wakes up to reopen the airway. 

This can happen several times a night. These episodes are brief and you don’t usually notice when they happen.

Symptoms of sleep apnea include:

• Daytime sleepiness
• Snoring
• Morning headaches

Most people aren’t aware that they have sleep apnea. But they will notice the side effects. People with sleep apnea often have a hard time concentrating, experience mood swings, and have less energy during the day. 

Why Sleep Apnea is More Common in Men

As we’ve stated already, sleep apnea is more common in men. Part of this is because men’s anatomy makes them more prone to problems with their breathing.

Obesity and the size of the airway are common risk factors for sleep apnea. And they’re also part of the reason why sleep apnea is more common in men.

The size of men’s airways set them up to develop sleep apnea more often than women. Men have more tissue in the back of their mouths and throats. This means their airways are more easily blocked. 

The way men and women gain weight also plays a role. Men also carry excess weight in their chests and necks. Excess weight in these areas blocks the airway, making it difficult to breathe. This is also why men tend to snore more than women. 

What Sleep Apnea in Women Looks Like

While men do have sleep apnea more, women are still able to develop the condition. Unfortunately, sleep apnea in women often goes undiagnosed. Many times it’s mistaken for another condition. The truth is sleep apnea in women tends to look different than it does in men. 

Sleep Apnea During REM vs NREM Sleep

In men, sleep apnea can present itself during any stage of sleep. It happens in both REM and NREM sleep. 

REM sleep is the deepest sleep, where we usually have dreams. NREM sleep happens before REM sleep. Made up of 3 stages NREM sleep helps your body start to slow down before REM sleep. The final stage of NREM sleep is known as deep sleep. It’s crucial for repairing your body and brain.  

Sleep apnea affects men throughout their entire sleep cycle. The impact it has on NREM sleep is part of why sleep apnea is such a health risk. It keeps your body from repairing itself, leading to problems later in life. 

However, most of the time,  women experience sleep apnea during REM sleep. It’s very rare for women to have sleep apnea episodes during NREM sleep. REM sleep only takes up 20% of our sleep cycle. So, women have fewer total sleep apnea episodes than men. 

Sleep Apnea Symptoms in Women

Sleep apnea symptoms in women are also different from those in men.

They still may have some of the classic sleep apnea symptoms we mentioned earlier. But women also have other symptoms that are important to look out for including:

• Insomnia
• Restless sleep
• Restless leg syndrome
• Feeling irritable during the day

Women who have sleep apnea are also more prone to developing depression or anxiety. 

Sleep Apnea in Women is Often Misdiagnosed

Because of these differences, sleep apnea in women is often misdiagnosed. 

In order to be diagnosed with sleep apnea you need to have more than 5 episodes per hour of sleep. This causes a problem when diagnosing sleep apnea in women. Since women experience episodes only during the shortest stage of sleep, they naturally have less than what they need to be properly diagnosed. 

Women are also more likely to fully wake up from sleep in order to reopen their airways. Because of this, the oxygen level drops that happen during sleep apnea are less severe in women. Again, this can make it difficult to diagnose sleep apnea in women. 

And since women experience different symptoms, they are often diagnosed with other problems. They end up being treated for depression, anxiety, and other sleep disorders like insomnia, instead of sleep apnea. 

Risks of Underdiagnosing Sleep Apnea in Women

Even though men are more prone to developing sleep apnea than women, we still need to take our female patients seriously. Not properly diagnosing sleep apnea can have a major impact on women’s health.

Not treating sleep apnea has an effect on mental health. Women with sleep apnea tend to experience mood swings, irritability, and have a hard time paying attention to things throughout the day. Sleep apnea can also lead to depression and anxiety. 

Sleep apnea also increases the risk of:

• Cardiovascular problems
• Asthma
• Chronic kidney disease
• Liver problems
• Diabetes
• Cancers

Sleep apnea can cause problems during pregnancy as well. 

This is why it’s so important for physicians to take sleep apnea in women seriously. Although it’s more common in men, it can still happen in women. And if it’s not properly diagnosed and treated, it can have a serious impact on the health of our female patients. 

Our job as physicians is to get to the root of our patient’s problems. In order to do that, we need to investigate every option before offering treatment. And for women who are having a hard time getting the sleep they need, we need to consider the possibility of sleep apnea.

What Causes Snoring?

Before we look at why men snore more than women, we need to understand how snoring happens in the first place. 

As you fall asleep the muscles in your upper airway start to relax. For some people, those muscles block the upper airway. When air passes through it makes that tissue vibrate. And that’s how you get the snoring noises. 

Why Do Men Snore More?

Now let’s talk about why men snore more than women. As we stated above, the main reason men snore more is because of their biology.

More Tissue and Space in the Airway

The first reason why men snore more than women is that they have more space and tissue in their upper airways. 

All people have a space in the back of their mouths called the oropharynx. When you lie down the tissue in the upper airway collapses into this space. For men, this space is larger. And they have more tissue to fill it. When they lie down their airway is blocked more than it is in women. So, air has a harder time getting through while they’re sleeping. 

The size of this tissue and their airway also makes men snore louder.

Men Carry Weight in Their Chests 

Obesity is a common cause of snoring in men. Men and women carry excess weight differently. Women carry it on their hips and thighs. Men, however, carry weight on their chests and necks. 

When men are overweight it creates fat deposits on their necks. This excess fat can block their airways when they lie down. Extra fat can also push against the chest, which decreases lung capacity. Reduced lung capacity causes the upper airway to collapse. Then, the air has a harder time getting through, which leads to snoring.

Hormones Play a Role

Finally, hormones are another reason why men snore more than women. 

Both men and women have hormones that contribute to whether they snore or not. For men, testosterone has been linked to increased snoring. Studies have found that there is a connection between the male hormone and the airway collapsing. However, these studies have not been able to show why they’re connected.

Women’s hormones actually help them snore less. Progesterone, a hormone that increases during pregnancy, promotes steady ventilation. Better ventilation causes a drop in airflow, which makes the airway less likely to collapse. Estrogen makes the tongue easier to contract. That reduces the likelihood of it falling back into the airway. As these hormones decrease during menopause, however, women may find that they start snoring more.

What Can Men Do to Reduce Snoring?

If your partner has been complaining about your snoring there are a few things you can do about it. 

First of all, if you snore a lot we encourage you to go see your doctor. Snoring isn’t always a sign of a serious issue. But it can be a symptom of obstructive sleep apnea. If this is the case, your doctor can help you develop a treatment plan, which will help you breathe better and reduce snoring.

If your snoring is not caused by sleep apnea there are some lifestyle changes that you can make. You can try sleeping on your side instead of your back. This keeps gravity from pulling your tissue into your airway. Nasal strips can also help keep everything open for air to pass through.  You can also try to quit smoking, as smoking is a risk factor for both sleep apnea and snoring.  

We’ve already discussed how obesity is a common cause of snoring in men. Losing weight can be difficult but it can help reduce your snoring.

What is Sleep Apnea?

As we’ve already stated, sleep apnea happens when your breathing is interrupted while you sleep. This interruption happens due to a blocked or narrow airway. 

When you sleep the muscles in your throat naturally relax. Most of the time your throat stays open enough for air to pass through. But for some people, the muscles relax too much. It then becomes difficult for you to breathe. 

Your body responds by waking up momentarily to reopen the airway. You may wake up with a gasp and the quickly go back to sleep. These episodes happen so fast that you don’t even notice most of the time. They also happen several times a night, which is why they have such an impact on the quality of your sleep. 

Most people who have sleep apnea aren’t aware of it. They may notice the symptoms, like how tired they are. But they don’t always make the connection between those symptoms and sleep apnea.   

How Sleep Apnea Affects Relationships

Sleep apnea can have a major impact on all areas of your life. Not treating sleep apnea can lead to serious health issues such as heart attack, stroke, and high blood pressure. You’re also at greater risk of developing Alzheimer’s and dementia.

Sleep apnea can also put a strain on your relationships. This is due to the effects sleep deprivation has on your mental and emotional health.

Sleep Deprivation and Relationships

In order for your brain to function well you need to get enough sleep every night. Sleep is how our body rebuilds and repairs. Your brain has cells called glial cells. Glial cells function as a filtration system for the brain. They work primarily when you’re sleeping. Because sleep apnea constantly interrupts your sleep the glial cells don’t work the way they need to. This leads to a lot of mental and emotional health problems. 

Sleep deprivation can cause problems such as:

• Low energy
• Brain fog
• Daytime sleepiness

Being tired all the time can also lead to mood disorders. You’ll find yourself feeling easily stressed and irritable. You may snap more at your partner and the other people in your life. Low energy makes it harder for you to help out around the house, which can lead to arguments between you and your spouse. 

Sleep Apnea Affects You and Your Partner

Of course, if you have sleep apnea you’ll notice these side effects in your own life. But sleep apnea can affect your partner as well. 

Snoring is one of the main symptoms of sleep apnea. And the noise from snoring can keep your partner up all night. The sudden gasps when your body wakes up throughout the night can also disturb your partner’s sleep. So, if you notice them becoming more irritable they’re probably suffering from sleep deprivation as well. 

Over time the lack of sleep can breed resentment in your partner. They may not know you have sleep apnea either. All they know is how hard it is to sleep.

Sleep Apnea Effects on Intimacy

Sleep apnea can also have an effect on intimacy. 

If you’re tired all the time you probably don’t feel like being romantic with your partner. The irritability can make it difficult as well.

But it’s not just low energy and mood swings that make intimacy difficult. Studies have shown that sleep deprivation can cause sexual dysfunction in both men and women. 

A healthy sex life is an important part of your relationship. And a lack of intimacy can weaken an already strained relationship.

That’s why it’s so important to get your sleep apnea diagnosed and treated. It doesn’t only affect you. It impacts your partner as well.

What Can You Do?

Now that you know how sleep apnea affects relationships, let’s talk about what you can do about it. 

The first thing you can do is be honest about what’s going on. If you think you might have sleep apnea you need to communicate that with your partner. Tell them how you feel. Don’t use it as an excuse, but help them understand why you’re so tired all the time. 

Then, you need to get help. Sleep apnea is not the kind of thing you can leave untreated. As we’ve already mentioned, sleep apnea can lead to several major health concerns like heart attacks and strokes. And of course, you’re probably already seeing the impact sleep apnea can have on your relationship. 

If you don’t want things to get worse you need to get treatment. 

Treatment options for sleep apnea include: 

• Lifestyle changes
• CPAP machine
• Oral appliances 
• Surgery 

The kind of treatment you need will depend on your case. You’ll need to get a diagnosis from a doctor who specializes in treating sleep apnea. They’ll most likely schedule a sleep study so they can get a better idea of what the problem is.  

What If Your Partner Has Sleep Apnea?

So, what if your partner is the one with sleep apnea? How can you be supportive and still get the sleep you both need?

Well, the first step is to put yourself in their shoes. You may be frustrated with how tired you are. You may be feeling impatient with their mood swings. But you also have to understand that if they have sleep apnea, it’s not something they can control until they get help. They’re also tired and frustrated. So the most significant thing you can do to help them is try to be empathetic. When you talk to them don’t try to blame them or get angry. Be gentle and let them know you care about them and their health. 

You need to encourage them to go see a doctor. They need help with their sleep apnea. And that help can only come from a doctor who specializes in sleep apnea. Go with them to their appointment for support and to help ask questions. Talk with them about their treatment options and be willing to help in any way you can.   

Once your partner is able to get treatment for sleep apnea, both of you will be able to sleep better at night.

AHI scores represent the average number of apnea and hypopnea events you have per hour. Hypopneas happen when your breathing becomes shallow. Apneas happen when your breathing stops altogether. Any time either of these happens for longer than 10 seconds it’s counted as an event in your AHI score. The total number of these events is then divided by the number of hours you were asleep during the test. 

What Do AHI Scores Mean? 

As we already noted, the sleep apnea AHI score tells us both if you have sleep apnea and also how severe it is.  Anything less than 5 events per hour is considered normal.  Between 5 and 15 events per hour is mild. Between 15 and 30 events per hour is moderate. And anything over 30 events per hour is considered severe. 

Tongue stabilizing devices (TSDs) help keep your tongue in a forward position. When you sleep the muscles in your airway relax. This can cause your tongue to fall backward. Most of the time this isn’t a problem. But if you have excess tissue on your tongue it can block the airway. TSDs have a part that wraps around the tongue and keeps it from falling backward.

Pros of Oral Appliances

Oral appliances are a common alternative to CPAP machines. People tend to be more willing to use them over their CPAP machine. And there are plenty of pros of oral appliances to treat sleep apnea.

Easy to Use

One of the main benefits of oral appliances for sleep apnea is that they are easy to use. They don’t come with the masks, hoses, and machines that CPAPs do. So naturally, they are easier to set up and use. Instead of having to hook everything up, all you have to do is pop it in your mouth and go to sleep.

They are also easier to clean. With a CPAP machine you have to clean the mask, hose, and filters regularly. But you just have to clean your oral appliance like you would an orthodontic mouth guard. You can clean it quickly right after you take it out every morning.

More Comfortable

One of the other common benefits of oral appliances is that they’re more comfortable than CPAP machines. CPAP machines have masks that either cover your nose or mouth. They can be clunky and make some people feel claustrophobic.

You may have had to wear an orthodontic mouthpiece when you were a teenager. An oral appliance for sleep apnea is not much different. They’re also custom-made to fit in your mouth.

More Convenient

For a lot of people, convenience is a major benefit of oral appliances. They come in a small carrying case. This makes them a great option for people who travel a lot.

Cons of Oral Appliances

Now let’s take a look at some cons of oral appliances. Even though they’re great for some people, they’re not always right for everyone.

Cause TMJ Problems

The biggest thing to think about when it comes to oral appliances is how it can affect your jaw joint. This side effect is most common with MADs. Since they push your jaw forward it can cause extra stress on your jaw joint.

If you already have issues with your jaw joint you may want to reconsider oral appliances as a treatment option. When you talk to your doctor make sure to mention any issues with your TMJ. They should inspect your jaw joint to make sure an oral appliance won’t make things worse.

Less Effective Than CPAP

Even though they are more comfortable than CPAP machines, oral appliances aren’t always as effective.

That’s why they’re usually only recommended to people with mild sleep apnea. If you have more severe sleep apnea, an oral appliance won’t do much good. In some cases, we may want to use an oral appliance along with CPAP therapy for patients who require higher levels of pressure.