You probably didn’t wake up this morning asking yourself, “Do I have sleep apnea?” But, did you wake up still tired and with a headache? Is your day full of things that need done but you’re too tired and can’t find the energy to get through it? Did you sleep well last night? Have you been having problems with insomnia? Has your partner, perhaps, noticed irregularities in your breathing during the night? You could be experiencing sleep apnea and not realize it. When your a woman, you may go undiagnosed because symptoms of sleep apnea in women appear differently than in men. Why is that?
What is the Cause of Sleep Apnea and How Does it Affect Me
The symptoms and causes of sleep apnea fall into 3 types. The most common type being obstructive sleep apnea (OSA). It occurs when the upper airway completely or partially collapses repeatedly during sleep. This leads to lower blood oxygen levels and can cause you to awaken from sleep. OSA is measured by the number of times per hour the airway collapses, known as rate.
Most people are unaware that women have greater risk for sleep apnea as they get older. Although, it is 2-5 times more common in men, the risk for women increases after menopause. This increase may be due to changes that occur in the upper air way, but could also be due to the hormonal changes associated with menopause.
Symptoms of obstructive sleep apnea reported by women include:
- restless legs
Snoring may also be reported by women but it is less commonly mentioned than in men. Perhaps, because it is more likely for a woman to attend an appointment on her own and not have the input from her partner who would observe the snoring or other symptoms.
A less common type is central sleep apnea. This happens when the muscles that control your breathing don’t get the right signals from your brain. When the correct signal isn’t sent you pause, or lack respiratory drive, for a brief period. This may cause you to awaken short of breath or may prove difficult getting to sleep or staying asleep.
As I suffer from this type of sleep apnea myself, I would describe the way I feel it as feeling very exhausted and not having the strength to immediately draw a breath after I have exhaled. So I pause just a moment and “rest” before I draw air in. This is most prevalent in me during periods when I already feel very exhausted during my waking hours. Maybe I feel exhausted because I have the sleep apnea to begin with. It may not be a medical description but is how I perceive it in myself and it may be different for someone else.
You can also have complex sleep apnea. This is when central sleep apnea remains present after obstructive sleep apnea has been addressed through positive air way pressure which I will talk about shortly.
Why is Sleep Apnea Different for Women
Sleep apnea symptoms in men are reported far more often than in women because women are inclined to have less severe sleep apnea symptoms than men. The rate is fewer and the duration of each event shorter. Women may be less likely to report snoring than men who also report more apneic events and also may experience more fatigue, whereas, men will show more sleepiness during the day. Women can also exhibit more depression or anxiety, which is also more common in women than men without OSA. Finally, because sleep apnea has historically been regarded as a male disorder, we might not be looking for it as much in women. Correspondingly, fewer women may receive correct diagnosis and treatment.
Health Risks for Sleep Apnea – Not Only a Sleep Problem
While there are risks common to both sexes, women may be at an elevated risk of OSA during pregnancy because of a number of factors. Among them is the growing uterus raising the diaphragm and affecting how they breath. Documented substantial increases of snoring and gasping along with observed apneas have occurred in pregnant women. Snoring is considered to be a risk factor for pregnancy induced hypertension and lower growth rate for the baby.
Diagnosing sleep apnea is crucial to avoid the longer term negative impacts it can have. If left untreated, over time, the health risks for sleep apnea can include:
- High blood pressure or heart problems. Hypertension becomes more of a concern because obstructive sleep apnea increases blood pressure and strain on the cardiovascular system due to the sudden drops of blood oxygen levels that occur during episodes while you are asleep. OSA might also increase your risk of stroke and abnormal heartbeats, such as atrial fibrillation, or recurrent heart attack,. If, you have heart disease, multiple episodes of low blood oxygen (hypoxia or hypoxemia) can lead to sudden death from an irregular heartbeat.
- Type 2 diabetes. Your risk of developing insulin resistance and type 2 diabetes is increased when you have sleep apnea.
- Metabolic syndrome. This is a disorder, which includes high blood pressure, abnormal cholesterol levels, high blood sugar and an increased waist circumference, and is tied to a higher risk of heart disease.
- Complications with medications and surgery. Obstructive sleep apnea can also complicate the use of medications and general anesthesia during medical procedures. People with sleep apnea might be more inclined to have difficulty after major surgery because they’re predisposed to breathing problems, particularly when sedated and lying on their backs. It is always important to tell your doctor that you have sleep apnea before surgery and the treatment plan you are on.
- Liver problems. Livers are more prone to exhibit signs of scarring in patients with sleep apnea as well as receive abnormal results on liver function tests.
In addition, one study suggested that women were more likely to develop cognitive impairment or dementia.
New Sleep Apnea Treatment Options
When most people think about sleep apnea treatment the first thing that comes to mind is a CPAP machine and mask, but there are a number of other standard treatments options. In addition, there are new sleep apnea treatment options available that have been developed and approved in recent years.
- Positive Airway Pressure Therapy – In this form of treatment a mask is worn during sleep that keeps the airway open by using pressurized air. The mask may be full face or only a nasal mask and the amount of pressure used may vary for individual situations.
- Oral Pressure Therapy – Rather than a mask, this treatment creates a vacuum using a mouthpiece and tubing to keep the tongue and soft palate positioned so that the airway remains open during sleep.
- Oral Appliances – Sleep apnea dental appliances come from dentists who are specialized in sleep medicine. They position the tongue and lower jaw in a way that increases the size of the airway to help you breathe.They are much like a mouth guard and are common to help people who snore, have mild or moderate obstructive sleep apnea, or do not tolerate positive air pressure treatment.
- Surgery – Surgery may be an option if there are contributing facial deformities and depends on individual anatomy and the surgery type needed.
- Behavioral Treatments – some milder cases of obstructive sleep apnea are known to improve by reducing the use of alcohol and sedatives or losing weight. Even repositioning can be used for people who only exhibit problems while sleeping on their backs.
- Hypoglossus Nerve Stimulation – In 2014 the FDA approved a completely new way to treat obstructive sleep apnea. It involves an outpatient procedure to surgically implant a device under the skin in the neck and chest to stimulate nerves to keep the airway open and is turned on and off by the patient themselves.
- Expiratory Positive Airway Pressure (EPAP) – This method uses a system of valves placed over the nose to maintain pressure to keep the airway open without using a breathing machine. Pressure is maintained by the valves alone.
Taking a Closer Look at Women and Sleep
Although, the occurrence and severity of obstructive sleep apnea in women appears to be less than in men, the effects and health consequences are equal at best, and perhaps worse. OSA is becoming more wide spread today. This is attributed partly to the rise in obesity and partly due to changes allowing for a broader definition of the disorder. This broader definition could help to diagnose and treat more women that may have not been considered before.
Even though your symptoms may not be as strong, or even appear to be exactly the same as those in men, it does not rule out sleep apnea. If, you suspect you could have sleep apnea you should ask your doctor. He or she will discuss your symptoms and may suggest a sleep study. With proper diagnosis you can be back on the path to the rest you need and feel yourself again.