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Signs of Sleep Apnea in Women: Key Symptoms

Oct 21 2020
7 min read
Woman having trouble sleeping close-up with arm on forehead.

Odds are, you’ve heard about sleep apnea and worried about your husband or father...

...the loud snorer who’s perhaps carrying extra pounds and conks out on the couch at every opportunity. You may have even urged him to go to the doctor to ask about sleep apnea.

Sleep apnea is typically thought of as a man’s disease—it’s more common in men than women—but in fact many women suffer from this sleep disorder, especially after age 50. Of the 18 million Americans with sleep apnea, one in four is a woman over 65. Unfortunately, in women the condition often goes undiagnosed by doctors. Where once only one woman was diagnosed with sleep apnea for every eight or nine men diagnosed, recent studies show that the condition is actually only two or three times more common in men. Despite these findings, experts say women with sleep apnea are still less likely to be diagnosed.

This is a big problem when you consider the health implications of untreated sleep apnea: The airway collapses during sleep, blocking the flow of air to the lungs and causing repeated pauses in breathing throughout the night. Oxygen levels in the blood in turn drop, eventually leading to cell damage. Down the line, sleep apnea puts both women and men at risk for high blood pressure, heart disease and diabetes.

There’s new evidence that the condition may be even more dangerous for women. A recent study at UCLA found that the body’s autonomic responses, which help to control functions like blood pressure and heart rate, are even more diminished in women with sleep apnea than in men with the condition.

Considering the risks are so serious, why are doctors missing sleep apnea in some women? There are several explanations:
There’s a bias in favor of men with apnea. Many physicians simply aren’t as likely to suspect sleep apnea in women as they are in men. If the condition isn’t even on a physician’s radar (and he doesn’t know how women’s symptoms are different; more on that below), a doctor will be less likely to think of apnea as a possible diagnosis.

Women have different symptoms than men. While men tend to have “classic” signs of sleep apnea—including snoring and excessive daytime sleepiness—women may have insomnia, restless legs, morning headaches, fatigue, mood disturbances or other symptoms that can easily be confused with other conditions.

Women are more likely than men to notice their bed partners’ abnormal sleep. When was the last time your husband told you that you snored or stopped breathing for seconds at a time throughout the night? Men tend to be sounder sleepers than women, making it less likely that they’ll pick up on anything unusual in your sleep patterns.

Women with sleep apnea often have more subtle breathing disturbances than men. This makes the condition tougher to diagnose, and it might also be why your bed partner hasn’t heard your light snoring or breathing pauses while you sleep.

Signs it Could be Sleep Apnea

Considering how often this condition can be overlooked in women, it’s important to pay attention to the signs yourself. Talk to your doctor if:
You’re overweight or obese. Fat deposits around your upper airway can obstruct your breathing, leading to sleep apnea.

You’ve reached menopause. Hormonal changes and an increase in abdominal fat make postmenopausal women three times more likely to develop sleep apnea as younger women.

You’re always tired. If you wake up with headaches and constantly feel fatigued despite getting plenty of sleep each night, it could be a sign that your sleep is interrupted by periods during which you’ve stopped breathing, causing you to wake up to gasp for air—something that you might not even remember happening.

You snore or wake up with a dry mouth. If your bed partner hasn’t complained about nighttime noise coming from your side of the bed, an especially dry mouth in the morning could mean you are, in fact, snoring—a known risk factor for sleep apnea.

You’re overwhelmed or depressed. Changes in your mood can be a direct result of not getting enough shut-eye due to sleep apnea, but they can easily be confused with other causes, too. Because these symptoms are not specific to sleep apnea, women are less likely than men to be referred to a sleep clinic for further evaluation.

How to Prevent and Treat Sleep Apnea

There are a number of lifestyle changes that can help women (and men) prevent, treat and even cure apnea:

At the top of every physician’s list: lose weight if you’re carrying too much. Experts say this not only prevents the condition, but can also cure it. That’s because less fat in the neck allows your airway to remain open while you sleep. Poor sleep is also tied to being overweight, so losing some pounds and getting more and better-quality rest could in turn help you slim down even more.

Another step you can take to prevent and treat sleep apnea is to steer clear of nightcaps. Alcohol relaxes the breathing muscles and makes it more likely that your airway will collapse, so make sure that your last drink is at least two hours before you hit the sack. And if cigarettes are one of your vices, you’ll want to take steps to quit smoking. In addition to causing any number of health woes, cigarette smoking leads to swelling in the upper airway, making sleep apnea (and snoring) worse.

If you typically sleep on your back, you might try training yourself to sleep on your side—some people (though not all) find that it’s a better position for keeping their airway open. Gravity works against you if you sleep on your back, increasing the likelihood that the top of your airway will collapse, causing an obstruction.

Whether you’re convinced sleep apnea has been keeping you from getting quality sleep or just one or two of these warning signs resonate with you, consider keeping a diary in which you record your bedtime, how well you think you slept, how many times you woke up during the night, your fatigue levels throughout the day and any other symptoms. After a week or so, see if you spot any patterns that might be worth bringing up with your doctor at your next appointment.

While what’s troubling you may not be sleep apnea, painting as clear a picture as possible—and even just mentioning your concerns about the possibility of sleep apnea—can go a long way toward helping your doctor provide a diagnosis that could change your health for the better.