Michael Rack, MD
Doctors and patients alike are beginning to realize that sleep apnea in women is more common than previously thought. Men remain statistically more likely to develop obstructive sleep apnea (OSA), but instead of a ten-to-one ratio of men to women, it’s now thought to be three- or four-to-one. At the same time, women also remain more likely to have sleep apnea misdiagnosed as something else, such as chronic fatigue syndrome, depression or simple insomnia.
OSA occurs when the soft tissues of the throat and at the back of the mouth become overly relaxed at night, to the point where one’s airflow is blocked upon breathing in. This results in a few seconds of not breathing, which may be evidenced by snoring or gasping for breath during one’s sleep, followed by daytime sleepiness. Though women with OSA may have these signs, they seem to appear more often in men. Women with sleep apnea may notice their mouths being very dry in the morning. They may also begin to wake up more often during the night with the need to urinate. This is not due to any real increase in urine production, but because the partial waking that often occurs in OSA allows a person to notice the state of their bladder more than when they are sleeping soundly.
The risk for OSA increases as a woman ages and it is sometimes said that menopause increases the risk for it. However, here again, appearances may be deceiving, with menopause getting the blame for simple changes in soft tissue tone that come with aging. Another risk factor for OSA in women, just as in men, is being overweight or obese. This is simply due to the increased thickness of throat tissues that begin to accumulate fat cells. In some studies, as many as 80% of obese women screened for sleep apnea were found to have the condition. It can also flare up due to the weight gain of pregnancy. Drinking alcohol before bed time also increases the likelihood of OSA, as does smoking.
Though women are still a bit less likely than men to have OSA, it unfortunately appears that their risk of mortality from it is greater than in men. The reason for this is not clear, but it seems to be especially true in regards to heart and circulation problems, i.e., decreased cardiovascular health. It was recently reported that OSA increases the risk of developing so-called ‘soft’ plaques in atherosclerosis (hardening of the arteries), which are more likely to come loose from blood vessel walls and form an embolus, blockage of an artery or vein.
If a woman has sleep apnea, especially if she is overweight or obese, she has a greater risk during pregnancy of developing the life-threatening condition called pre-eclampsia, or of needing to deliver her baby by caesarian section. Since pregnancy itself somewhat raises the risk of OSA, this seems a real life case of double jeopardy! A pregnant woman may also be more apt to attribute daytime sleepiness or fatigue to simply carrying a baby, rather than to other possible causes.
For all these reasons, it is especially important for women to know that they, too, are at risk for sleep apnea. If there are signs of dry mouth, excessive daytime sleepiness, or any reports from her partner that she is snoring, a woman should not hesitate to ask her doctor if she might have sleep apnea. It is diagnosed definitively by performing an overnight sleep study at the hospital. Because OSA can have serious health repercussions if left untreated, insurance companies typically cover both the sleep study and the therapy the condition requires if found. Women and men alike thus have nothing to lose with a sleep study, and may also gain a much better night’s sleep for their efforts.
Guest article by Alex Smith of SleepDisorders.com.