Sleep apnea in women is not always the same as it is in men. For women, tiredness and sleep disturbance can be present even in mild sleep apnea.
Sleep apnea can appear differently in women than it does in men. People are often aware of the stereotype of sleep apnea, particularly in men, with snoring, gasping during sleep and being seen to stop breathing. However, in women sleep apnea can be more subtle, often with just noisy breathing rather than loud snoring and restlessness with tiredness the next day rather than periods of stopping breathing being noted during sleep. In women, 18% of those with moderate to severe OSA don’t snore. These subtle forms of sleep apnea, such as upper airways resistance syndrome, can be harder to diagnose and need specific measures and interpretation of sleep studies to detect.
Sleep apnea in women changes with stage of life
Women prior to the menopause are less likely to have sleep apnea than men. In part this is felt to be due to a protective effect of hormones such as oestrogen on tissue collapsibility in the upper airway as well as the effect of hormones on sleep depth and quality. However, after the menopause women have sleep apnea at a similar rate to men. As such, women can find that they develop both snoring and sleep apnea fairly quickly across the years of the menopause. So it is not uncommon for me to see women in their mid-50s with quite significant symptoms of sleep apnea who have little in the way of symptoms in their late 40s. This is different to men where the development of sleep apnea is a fairly gradual but constant process across life.
Sleep apnoea in women is also different to men, as women, particularly after the menopause, often are lighter sleepers than men. So, relatively minor narrowing of the airway can result in subtle sleep disturbance. For more on the effect of menopause on sleep see this post.
How do sleep apnea treatments differ for women?
As relatively minor airway narrowing can cause symptoms in women, treatments such as mandibular advancement splints can be very helpful, opening the airway sufficiently to minimise the disturbance of sleep. If using other treatments such as continuous positive airway pressure (CPAP) lower pressures can be needed. This has spawned the development of specific CPAP algorithms for women.
- Continuous positive airway pressure (CPAP) – As 40% of people purchasing CPAP machines in the US are women, ResMed and other CPAP manufacturers have been looking at designing specific CPAP devices and masks for women. Whilst ResMed have had a ‘for Her’ mask range for a few years, in the last 12 months they have released a specific CPAP machine for women, the Airsense 10 AutoSet for Her. Compared to standard machines, the ‘for Her’ device begins to increase pressure with a single breath of airway narrowing compared to 3 breaths, doesn’t increase the pressure as quickly and doesn’t go above a pressure of 12cmH2O when treating apneas.
Oral appliances such as mandibular advancement splints (MAS) – I find oral appliances particularly helpful in managing sleep apnea in women. However, as women are generally smaller than men, large or bulky appliances can take up too much space in the mouth and feel uncomfortable. So, when using oral appliances in women, I’ll always refer them to dentists experienced in using a range of types of oral appliances so that an appropriate appliance can be used. Devices such as the Silensor (shown right), can be made to fit even very small jaws. Use of MAS devices in discussed in more detail in this video.
- Other treatments – Other options for treating sleep apnea in women include surgery, nasal EPAP (Provent or Theravent), weight loss and avoiding sleeping on the back.
Related posts & links:
- Upper airways resistance syndrome (UARS) – Blog post
- What is sleep apnea? – Blog post
- Why treat sleep apnea? – Blog post
- Sleep apnea treatments – Video
- Snoring treatments that work – Blog post
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