You might be aware that sleep apnea – a potentially serious condition where you stop breathing briefly many times a night – is generally reported to be more common in men than sleep apnea in women.
Is this just because sleep apnea symptoms in men are more common? Or because women are less likely to seek help and treatment? And, are there different signs of sleep apnea in men vs signs of sleep apnea in women?
Let’s delve into the differences in sleep apnea between men and women.
Right. And wrong.
Sleep apnea has traditionally been considered a mainly-male disease. Research has previously estimated that sleep apnea symptoms in men occur between three and five times more often than in women.
But that might, at least in part, be due to the diagnostic criteria for sleep apnea being based around male physiology and symptoms. Also because sleep apnea symptoms in men are more obvious, meaning they’re more likely to seek diagnosis and treatment.
We know that medical research is often male-centric and we’ve been slower to understand women’s physiology and hormones. For example, one of the most-used questionnaires to assess how sleep someone is during the day (the Epworth Sleepiness Scale) has not been validated for use with women.
There’s also an embarrassment factor at play: snoring is still considered ‘un-ladylike’, which might deter women from reporting snoring to friends or health professionals.
Some research hasn’t found any difference in the signs of sleep apnea in men vs signs of sleep apnea in women.
Other research has shown that sleep apnea symptoms in men are more likely to those that we think of as ‘classic’ (which is not surprising because these signs have become understood as classic because mainly men have been tested!).
These ‘classic’ signs are snoring and short breathing stops during sleep (which lead to them waking slightly and taking a gasping or choking breath to recover before continuing to sleep). Also daytime sleepiness, including being at risk of falling asleep while at work or behind the wheel of a car.
By contrast, while sleep apnea symptoms in women can include these classic symptoms, women tend to be more concerned with insomnia and disrupted sleep, racing heart beats, general lethargy, headaches and feeling anxious or depressed.
Women and men experience sleep apnea symptoms during different stages of sleep. You might have heard of REM (or rapid eye movement), which is more shallow sleep where our eyes move rapidly. On average, we are in REM sleep for about one fifth of each night.
It seems that women are more likely to experience sleep apnea during REM sleep, meaning they experience fewer apneas across a night. But, according to Dr Christine Won, Director of the USA-based Women’s Sleep Health Program, apneas during REM sleep can last longer, be more severe and prompt the person to wake up more fully.
All this means that, on a sleeping test, women will show as having not a high enough number of apneas (breathing pauses) during a night to be diagnosed with sleep apnea. But those breathing pauses they do have are worse and lead to them being awake for longer.
It may be that women with sleep apnea are more likely to complain of insomnia, depression or restless legs as opposed to the ‘classic’ sleep apnea signs of snoring and the gasping or choking associated with a breathing pause or apnea.
For men, an unwelcome impact of sleep apnea is erectile dysfunction. This is obviously specific to people with a penis. However, sleep apnea also has a negative impact on women’s sexuality too. This is perhaps unsurprising given that the clitoris is just as dependent on good blood flow as the penis (and we all know that not getting enough good quality sleep is a decided turn-off). The good news is that recent research shows that treatment with CPAP can improve this significantly.
Obesity is a key risk factor for sleep apnea for all genders. However, fat distribution around the neck, which contributes directly to sleep apnea, is more common in males.
You might assume that women, who are on average smaller than men and therefore also have smaller airways, are more likely to have that airway block during sleep. On the contrary though, there’s evidence that women’s hormones contribute to keeping their airway muscles stronger.
Hormones are more varied in women than men, both on a monthly basis related to ovulation and menstruation but also across the life cycle. Pregnancy and menopause are two points in a women’s life where sleep apnea is more common.
In pregnancy, this is partly because the embryo in the uterus pushes up the diaphragm, which impacts the lungs. Pregnancy also often results in swelling, including around the neck.
Developing sleep apnea during pregnancy is not just about the woman not getting enough sleep. It can also contribute to the development of high blood pressure and diabetes, and is a risk factor for the baby’s growth slowing down.
As estrogen levels drop, post menopausal women tend to carry more fat, particularly in the upper body which impacts the muscles that work to keep the airway open during sleep. These facts all contribute to menopause being a more likely time that women will develop sleep apnea..
Sleep apnea doesn’t just affect your sleep, it can lead to other serious health consequences.
Because sleep apnea has long been assumed to be primarily a problem for men, there is less research with women. However, recent research is showing that women with sleep apnea are at least, if not more, likely to also have diseases like asthma, diabetes, reflux and cardiovascular issues.
Women with sleep apnea are also more likely to report a worse quality of life than their male counterparts.
There’s also research showing that women with sleep apnea are more likely to develop dementia or other cognitive concerns than women without sleep apnea.
That’s all worth taking very seriously.
Sleep apnea has traditionally been considered a male-dominated condition and it’s vitally important that testing is encouraged for men who snore, experience gasping or choking associated with the breath stopping briefly during sleep, or are sleepy during the day.
It’s also important to recognise that women suffer sleep apnea too and this risk increases around times of pregnancy and menopause. More recent research is beginning to highlight how sleep apnea presents in different ways in women, with the possible outcome that sleep apnea is more common in women than we’ve realised until now.
Regardless of your gender, if you have concerns with sleep (even if signs don’t fit a ‘classic’ sleep apnea pattern) it’s well worth having a sleeping test, which can be as simple as wearing a watch-style device for one night in your own home. Find out more and book your sleep test today.
Wimms A, Woehrle H, Ketheeswaran S, Ramanan D, Armitstead J. Obstructive Sleep Apnea in Women: Specific Issues and Interventions. Biomed Res Int. 2016;2016:1764837. doi:10.1155/2016/1764837https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5028797/