By Diva Dressing 
Sleep apnea, a potentially serious sleep disorder characterized by repeated interruptions in breathing during sleep, affects millions of people worldwide. Yet, despite its prevalence, sleep apnea remains significantly underdiagnosed in women. This disparity in diagnosis stems from a combination of biological differences, gender-specific symptoms, and cultural perceptions about sleep disorders. The consequences of untreated sleep apnea are severe, contributing to a host of health problems, including cardiovascular disease, diabetes, and mental health disorders. Raising awareness about the unique ways sleep apnea manifests in women and improving diagnostic protocols are crucial steps in addressing this underdiagnosed condition.
Sleep apnea is a condition that occurs when the muscles in the throat relax during sleep, causing temporary blockages in the airway. These blockages lead to pauses in breathing, often for 10 seconds or longer. The most common form of sleep apnea is obstructive sleep apnea (OSA), in which the soft tissues in the throat collapse and block airflow. Another, less common form is central sleep apnea (CSA), where the brain fails to signal the muscles to breathe.
The telltale signs of sleep apnea in both men and women include:
- Loud snoring
- Gasping for air during sleep
- Waking up feeling short of breath
- Excessive daytime sleepiness
- Morning headaches
However, the presentation of these symptoms can vary between men and women, leading to a lower rate of diagnosis in women.
Why Is Sleep Apnea Underdiagnosed in Women?
Atypical Symptoms in Women
One of the primary reasons sleep apnea is underdiagnosed in women is that their symptoms often differ from the classic signs seen in men. While men are more likely to experience loud snoring and noticeable interruptions in breathing during sleep, women may present with subtler or atypical symptoms. For example, women with sleep apnea may experience:
- Insomnia: Difficulty falling or staying asleep, rather than excessive snoring.
- Fatigue: Women may report chronic fatigue or tiredness without daytime sleepiness.
- Mood Changes: Women are more likely to experience anxiety, depression, or irritability as a result of sleep apnea.
- Frequent Nighttime Urination: Known as nocturia, this symptom can lead to multiple trips to the bathroom during the night.
- Morning Headaches and Migraines: Headaches upon waking can be a more common symptom for women with untreated sleep apnea.
These less obvious symptoms often lead healthcare providers to misdiagnose sleep apnea in women as anxiety, depression, or another sleep disorder such as insomnia. As a result, the true underlying condition, sleep apnea, may go unrecognized for years.
Hormonal Factors
Hormones play a significant role in sleep apnea, and hormonal fluctuations in women can influence the development and severity of the condition. Estrogen and progesterone, for example, are thought to have a protective effect on the airway muscles, making younger women less likely to develop sleep apnea. However, after menopause, when levels of these hormones decline, the risk of sleep apnea in women increases. Postmenopausal women are two to three times more likely to develop sleep apnea than premenopausal women. Unfortunately, because sleep apnea is often associated with men and postmenopausal women’s symptoms are subtler, this group remains overlooked in the diagnostic process.
Cultural and Societal Factors
Cultural and societal norms can also contribute to the underdiagnosis of sleep apnea in women. Historically, sleep apnea has been viewed as a “man’s disease,” in part because men are more likely to report loud snoring, which is a classic symptom. Women may be less likely to report snoring or may downplay their symptoms, as they might not recognize them as indicative of a serious medical condition. Additionally, healthcare providers may be less likely to consider sleep apnea when evaluating women for sleep-related complaints, especially if their symptoms don’t fit the traditional profile.
Body Weight Bias
Sleep apnea is often associated with obesity, and while body weight is a risk factor, it is not the only factor. Many healthcare providers may overlook sleep apnea in women who are not overweight, assuming that only obese individuals are at risk. However, sleep apnea can affect women of all body types, particularly postmenopausal women, regardless of their weight. This bias can further delay the diagnosis and treatment of the disorder.
Consequences of Untreated Sleep Apnea in Women
The failure to diagnose and treat sleep apnea in women can lead to a range of serious health consequences, many of which are preventable with early intervention. Untreated sleep apnea can contribute to:
Cardiovascular Problems
Sleep apnea is strongly linked to an increased risk of cardiovascular issues, including high blood pressure, heart disease, stroke, and heart failure. Women with untreated sleep apnea are at a higher risk of developing hypertension, especially if the condition is left untreated for an extended period.
Diabetes
Sleep apnea can worsen insulin resistance, increasing the risk of developing type 2 diabetes. Women with sleep apnea may also experience weight gain and metabolic disturbances, further exacerbating their risk of diabetes and other metabolic disorders.
Mental Health Issues
Chronic fatigue, poor-quality sleep, and disrupted breathing at night can lead to significant mental health challenges, including depression, anxiety, and mood disorders. Women, in particular, may be misdiagnosed with depression or anxiety when the underlying issue is undiagnosed sleep apnea. Addressing sleep apnea can significantly improve mental well-being and quality of life.
Cognitive Decline
Untreated sleep apnea can lead to cognitive impairments such as memory problems, difficulty concentrating, and slower reaction times. Over time, these cognitive issues can worsen, affecting a woman’s ability to function in daily life and increasing the risk of accidents or injuries.
Reduced Quality of Life
The chronic fatigue, irritability, and mood swings associated with sleep apnea can severely impact a woman’s quality of life. Women may struggle with their careers, relationships, and personal well-being as they grapple with the effects of untreated sleep apnea.
Improving Diagnosis and Treatment of Sleep Apnea in Women
To address the underdiagnosis of sleep apnea in women, several steps need to be taken:
Increased Awareness Among Healthcare Providers
Healthcare providers need to be educated about the gender differences in sleep apnea symptoms. By recognizing the atypical presentation of sleep apnea in women, doctors can more accurately diagnose and treat the condition. This includes asking patients about less obvious symptoms such as insomnia, fatigue, and mood changes, even if snoring is not present.
Sleep Studies and Home Testing
If sleep apnea is suspected, a sleep study or polysomnography is the gold standard for diagnosis. For women who may be reluctant to undergo an overnight sleep study in a lab, home sleep apnea testing can be a more accessible and comfortable option. These at-home tests monitor breathing patterns, oxygen levels, and other vital signs during sleep, making diagnosis more convenient.
Tailored Treatment Approaches
The most common treatment for sleep apnea is continuous positive airway pressure (CPAP) therapy, which involves wearing a mask that provides a steady stream of air to keep the airway open during sleep. However, adherence to CPAP therapy can be challenging for some women due to discomfort or inconvenience. For these patients, alternative treatments such as oral appliances (which adjust the position of the jaw to keep the airway open), weight management, and lifestyle changes can also be effective in managing sleep apnea.
Hormone Therapy for Postmenopausal Women
For postmenopausal women, hormone replacement therapy (HRT) may help reduce the risk of sleep apnea by counteracting the decline in estrogen and progesterone levels. However, HRT should be discussed with a healthcare provider to weigh the benefits and risks.
Empowering Women to Seek Help
Awareness is key to combating the underdiagnosis of sleep apnea in women. Women should be encouraged to speak openly with their healthcare providers about their sleep quality, even if they do not experience typical symptoms like snoring. Educating women about the potential health risks of untreated sleep apnea and the importance of seeking treatment can help improve diagnosis rates and outcomes.
