Sleep Apnea in WomenAn Underdiagnosed Condition
by Dr. Scott Bolding
When most people hear the words sleep apnea they often picture a man with a CPAP machine strapped to his face. That’s because sleep apnea is most common in men. Men are diagnosed with sleep apnea twice as much as women.
This doesn’t mean that women can’t have sleep apnea. In fact, recent research tells us that sleep apnea in women may be more common than we thought. Studies show that while 1 in 5 women has sleep apnea, 90% are undiagnosed.
While sleep apnea is still more common in men, it’s important for us to understand how sleep apnea shows up in women. Continuing to miss the signs of sleep apnea in women can have serious consequences.
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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
- 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:
- 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
- Chronic kidney disease
- Liver problems
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.
Deshong, A. (2022, December 16). Sleep Apnea in Women. The Sleep Doctor. https://thesleepdoctor.com/women/sleep-apnea-in-women/
Groth, L. (2022, June 24). Sleep Apnea In Women May Be Undertreated. Forbes Health. https://www.forbes.com/health/body/sleep-apnea-symptoms-in-women/
Sleep Apnea Symptoms in Women. (2021, June 25). Houston Sleep Solutions. https://houstonsleepsolutions.com/blog/sleep-apnea-symptoms-in-women/
Sleep Apnea Does Happen in Women
Even though men experience sleep apnea more often, women can still have it. In fact, sleep apnea in women tends to be underdiagnosed. This is due to the fact that sleep apnea in women shows up differently. Women have different sleep apnea symptoms than men. They also experience sleep apnea episodes only during the shortest phase of the sleep cycle. These things together make it difficult to diagnose sleep apnea in women.
But that doesn’t mean we shouldn’t take women who think they have sleep apnea seriously. And at PRECiDENT, you can expect our specialists to do just that. If we think you might have sleep apnea, we’ll examine your airway and schedule a sleep study. After the sleep study, we’ll be able to figure out if you have sleep apnea or not. Our goal through this whole process is to diagnose your problem and offer the right treatment.