Sleep Apnea Symptoms in Menopausal Women

The menopause transition brings with it significant changes that can impact many aspects of your daily life. You might already be familiar with the well-known vasomotor symptoms, such as hot flashes, as well as common symptoms like mood swings, and vaginal dryness; not to mention the actual medical indicator of menopause: 12 consecutive months without a menstrual period.¹

However, there could be more subtle symptoms that creep in unnoticed. One often underrecognized issue is disrupted sleep.

You may find yourself experiencing restless nights, poor sleep quality, or waking up feeling unrefreshed. Is it stress, your mattress, a busy schedule? Sometimes, the hormonal shifts experienced during menopause and perimenopause might be at the root of your sleep troubles.

During the menopause transition, your body produces less estrogen and progesterone, two key hormones that help regulate sleep, among other functions.² These hormonal changes can trigger a cascade of symptoms, including sleep disturbances, during perimenopause into menopause.³ The timing and intensity of these symptoms can vary widely depending on your genetics, lifestyle, environment, and even your race or ethnicity.

But what if your sleep issues go beyond the occasional restless night? Could it be caused by something more serious, like sleep apnea?

What is Sleep Apnea?

Sleep apnea is a potentially serious sleep disorder where your breathing repeatedly stops and starts during sleep, depriving your body of vital oxygen. If you snore loudly, wake up gasping for air, or feel unusually tired during the day, you might be experiencing sleep apnea.⁴

Signs of sleep apnea in women are especially important to recognize during times of hormonal change. Although menopause itself doesn’t directly cause sleep apnea, the shifting hormone levels can possibly increase your risk.⁵ If you’ve ever wondered, “can menopause cause sleep apnea?” this might be a good time to chat with your healthcare provider.

There are two main types of sleep apnea:⁶

• Obstructive Sleep Apnea (OSA): This is the most common form. It occurs when the upper airway becomes blocked during sleep, reducing or even stopping airflow. Factors such as obesity, enlarged tonsils, and hormonal changes during menopause and sleep apnea can all contribute to this risk.
• Central Sleep Apnea: This less common type of sleep apnea happens when the brain doesn’t send the proper signals to the muscles that control breathing. It’s often linked to other health conditions that affect your brain’s control over the airways and chest muscles.

The Role of Hormones in Sleep Apnea

Understanding the link between menopause and sleep apnea can be complex. While menopause doesn’t directly cause sleep apnea, the hormonal fluctuations experienced during perimenopause and sleep apnea can increase the risk or worsen existing symptoms. For example, progesterone naturally stimulates breathing, and estrogen helps maintain the elasticity and function of the airway.⁷ As these hormones decline during menopause, your airway may become more susceptible to obstruction during sleep.

Studies suggest that sex hormones influence breathing by acting on receptors in the nervous system, which is essential for regulating respiration. What’s more, sleep disorders, like OSA, can further disrupt your hormonal balance, creating a negative feedback loop where poor sleep impacts other hormones, potentially worsening your symptoms.⁸

The Impact of Weight and Body Composition

Weight gain and changes in body fat distribution are not uncommon during perimenopause and menopause. Extra weight, especially around your mid-section, can crowd your upper airway, making it more likely to collapse during sleep. Additionally, obesity can reduce lung capacity, making breathing more challenging and contributing to sleep apnea symptoms in women.⁹

Menopause and Sleep Apnea

So, can menopause cause sleep apnea? While menopause itself doesn’t directly trigger the condition, the hormonal changes during this transitional period, along with factors like age, body weight, head and neck anatomy, lifestyle habits (such as smoking or alcohol use), family history, and nasal congestion, can all contribute to the development of sleep apnea.¹⁰ These same factors are also at play during perimenopause, which can potentially set the stage for sleep disturbances long before menopause is fully reached.

Sleep Apnea Symptoms in Women

Obstructive sleep apnea (OSA) affects an estimated 936 million adults worldwide aged 30–69.¹¹ Although risk factors like obesity and aging, are well known, women, especially those experiencing perimenopause and menopause, face unique challenges. Hormonal changes during this time can make sleep apnea symptoms in women more pronounced and sometimes trickier to recognize.

In the United States, OSA affects about 33.9% of men and 17.4% of women (using an apnea-hypopnea index greater than 5 as the standard).¹² Women in perimenopause and menopause are often underdiagnosed because many signs of sleep apnea in women can overlap with other menopausal changes. Let’s explore these signs and symptoms further.

Common Signs of Sleep Apnea in Women

Some hallmark signs of sleep apnea include:¹³

• Waking up repeatedly during the night
• Breathing pauses during sleep (often noticed by a partner)
• Unusual breathing patterns (for example, rapid breathing that then slows or pauses)
• Loud snoring
• Waking up feeling short of breath or as if you’re choking
• Persistent daytime fatigue or sleepiness, even after a full night’s rest

Sleep Apnea Symptoms in Women That Overlap with Menopause

Women may also experience:¹⁴

• Morning headaches
• Night sweats
• Mood changes (including depression and anxiety)
• Restlessness during sleep

Because these symptoms overlap with typical menopausal complaints, it can be challenging to tell whether you’re experiencing menopause and sleep apnea concurrently. For instance, night sweats might be attributed solely to menopause, yet they could also be the body’s response to breathing interruptions. Similarly, persistent daytime fatigue and mood changes may stem from hormonal fluctuations or stress but they’re also key signs of sleep apnea.

What to Do If You Notice Signs of Sleep Apnea in Perimenopause or Menopause

If you start noticing signs of sleep apnea, whether it’s loud snoring, gasping during sleep, or persistent daytime fatigue, it’s important to act. Research shows that sleep apnea in women, particularly during perimenopause and menopause, is often underdiagnosed due to overlapping symptoms.¹⁵

Don’t wait for the condition to lead to serious health complications. Be sure to reach out to your healthcare provider to discuss your concerns. They can help determine whether your sleep troubles are related to sleep apnea and guide you through the best treatment options. Sometimes finding the right solution may take a bit of trial and error, but your well-being is worth the effort.

How Is Sleep Apnea in Women Treated?

Once the signs of sleep apnea in women have been identified, treatment options depend on the type and severity of the condition. Your healthcare provider may recommend one or more of the following approaches:¹⁶

• Continuous Positive Airway Pressure (CPAP) Machine: Often the first choice for moderate to severe obstructive sleep apnea, a CPAP machine delivers a steady stream of air through a mask to keep your airway open during sleep.
• Lifestyle Changes: Small adjustments, such as sleeping on your side, maintaining a healthy weight, or managing conditions like high blood pressure, can make a significant difference.
• Oral Appliances: Custom-fitted mouthpieces can help reposition your jaw or tongue to keep your airway clear, particularly in cases of mild to moderate OSA.
• Neuromuscular Electrical Stimulation (NMES) Devices: These devices gently stimulate the muscles in your tongue and upper airway to prevent blockage during sleep.
• Medications: While no medication specifically treats sleep apnea, certain drugs can help manage symptoms or underlying conditions.
• Surgery: In some cases, surgery may be recommended to remove excess tissue, reposition the jaw, or address structural issues in the airway.

How Can Sleep Apnea Be Prevented?

While you can’t prevent every case of sleep apnea in perimenopause and menopause, there are steps you can take to reduce your risk:^{17, 18}

• Maintain a Healthy Weight: A balanced diet and regular exercise can help prevent excess weight gain, which in turn reduces the likelihood of airway obstruction.
• Practice Good Sleep Hygiene: Establish a regular sleep schedule, create a calming bedtime routine, and limit screen time before bed to improve sleep quality.
• Manage Underlying Health Conditions: Keep conditions such as high cholesterol, high blood pressure, and type 2 diabetes under control with the help of your healthcare provider.
• Avoid Smoking and Limit Alcohol: Both bad habits may contribute to sleep apnea.
• Schedule Regular Check-Ups: Routine visits to your healthcare provider can help catch any potential issues early and keep you on track with your overall health.

Sleep Apnea Symptoms in Women Can Be Managed

While navigating the changes of perimenopause and menopause can sometimes feel overwhelming, there’s plenty of hope when it comes to managing sleep apnea. The hormonal shifts during these stages may contribute to, or even worsen, sleep apnea symptoms in women. However, the great news is that once identified, sleep apnea is both treatable and manageable with a personalized approach.

Often, your partner might be the first to notice nighttime symptoms such as loud snoring or pauses in breathing. Sharing the signs of sleep apnea in women can be a valuable part of the conversation with your healthcare provider. Together, you can develop a tailored treatment plan that fits your unique needs, whether that involves lifestyle adjustments, a CPAP machine, or other interventions.

By addressing these menopause and sleep apnea concerns early, you can prevent complications down the road and set the stage for a healthier, longer life. Remember, prioritizing your sleep health is a powerful step towards overall well-being and a brighter tomorrow.

Resources:

1. https://www.nia.nih.gov/health/menopause/what-menopause
2. https://www.yalemedicine.org/news/women-are-your-hormones-keeping-you-up-at-night
3. https://www.hopkinsmedicine.org/health/wellness-and-prevention/how-does-menopause-affect-my-sleep
4. https://www.mayoclinic.org/diseases-conditions/sleep-apnea/symptoms-causes/syc-20377631
5. https://pmc.ncbi.nlm.nih.gov/articles/PMC5323064/
6. https://www.nhlbi.nih.gov/health/sleep-apnea
7. https://pmc.ncbi.nlm.nih.gov/articles/PMC5507108/
8. https://www.sciencedirect.com/science/article/pii/S108707922400100X
9. https://www.sleepfoundation.org/sleep-apnea
10. https://pmc.ncbi.nlm.nih.gov/articles/PMC9862185/
11. https://pubmed.ncbi.nlm.nih.gov/31300334/
12. https://pmc.ncbi.nlm.nih.gov/articles/PMC9862185  
13. https://www.sleepapnea.org/sleep-health/sleep-apnea-in-women/
14. https://pmc.ncbi.nlm.nih.gov/articles/PMC5323064/
15.  https://www.sciencedirect.com/science/article/abs/pii/S0378512219300313 a
16. https://my.clevelandclinic.org/health/diseases/8718-sleep-apnea
17. https://my.clevelandclinic.org/health/diseases/8718-sleep-apnea
18. https://www.nhlbi.nih.gov/health/sleep-apnea/living-with