Before menopause, estrogen protects women from sleep apnea, but not completely. Especially in younger women, sleep apnea is clearly underdiagnosed. It has also been found that women with typical symptoms of sleep apnea are not sent to sleep studies as easily as men with similar symptoms. Women are more easily diagnosed with depression, hypothyroidism or other illness.
The risk of sleep apnea in overweight expecting mothers is increased, but even normal multi–fetal pregnancy does not increase the risk of sleep apnea. A mother’s untreated sleep apnea is a danger to an unborn child. Pregnancy does not affect sleep apnea, but is normally treated with CPAP therapy. Partial night time upper airway obstruction may be more common in pre-eclampsia patients than in healthy pregnant women.
Before the menopause, upper airway obstruction occurs many times more in patients with polycystic ovary syndrome (PCOS) than in other women.
Tanya, 51, is a mother of two children, who has always been normal weight and has been exercising. She was diagnosed with sleep apnea before menopause:
“Sleep apnea was diagnosed in 2006. The first few years I tried position therapy, since 2010 I have used the CPAP machine. The fact is that sleep apnea erupted after two deliveries. The deliveries took place in 1996 and 1998. The identified causes of fatigue and other weird symptoms have never been found in blood tests or in any other way – and I was examined a lot. I think that a change in hormonal activity due to pregnancy has something to do with it. Before I gave birth, I slept, as is the case today, with a continuous night’s sleep of 8 to 9 hours. I have never had night awakenings or headaches in the mornings, not before or after childbirth.
After the births, I slept still 8 to 9 hours – and still without nocturnal awakenings – But the “refreshing ability” of night sleep has undergone a complete change compared to the time before birth. And if I remember correctly, this change happened already after the first birth.
Before I was diagnosed with a sleep apnea, I was in a state of distress, especially heart palpitations, morning tiredness and brain fog. During the day I have never fallen asleep. Breathing was sometimes heavy and I was feeling tired all the time. There was some difficulty with concentration, but sometimes there were some better days.
Sleep apnea has affected my life and a lot – the quality of life and the work capacity have decreased. All of this has happened a little by little. Learning ability and concentration are impaired and there have been problems with coping. There are also days when I just wait for the evening and bed time and hope if the next day would be better.
I didn’t suspect sleep apnea. Coincidentally, a coworker in the same office went to sleep apnea tests and told me about it. Since I had the same kind of fatigue, I realized that should see a doctor. No one had suggested sleep apnea tests to me, because I was slim young woman who was not a typical sleep apnea patient. Until then, I hadn’t known anyone with sleep apnea. Now the family has two other patients, because I talked about the matter.
Position therapy didn’t work for me and it ended when I got a bad panic attack on a long flight. I was totally tired of a long trip and the result was shortness of breath. CPAP treatment has been working relatively well. I use it every night. Recently, I got my apnea mouthpiece, but I don’t have much experience of it yet. They are used in conjunction with CPAP device, the first impression is at least good!
My current situation is variable. There are hardly any such good days that were still 5-10 years ago, ie before the menopause. I still have no overweight. But blood pressure is a bit high and sometimes I have some memory problems. I read somewhere that it is also worth examining the thyroid gland. I went to the doctor last week, for whom I presented the thyroid gland values that were tested in 2009. The doctor said that at least at that time there was a clear hypothyroidism, even though the occupational physician has not noticed it because the values are just within the reference values. I would say to all women that ask for a complete thyroid panel at your doctor, unless your doctor determines it by himself. Unfortunately, my occupational doctor was apparently not up to date. Apparently, I have had a very long-lasting deficient thyroid gland. This is now being investigated.
I have thought about how I cope with work. There are still left more than ten years of work, and now it’s already feeling quite hard. Should I wait for the heart attack, or could I already – when the symptoms increase every year – reduce the workload. I could probably do half a day for the job, but it is not economically possible, because half-pay would have far-reaching implications for the future pension. I really like my job, and I would love to continue working. ”
Gender Differences in Sleep Apnea
Sleep apnea occurs in women and men in slightly different ways. For example women aren’t usually snoring as much as men, but they are more affected by morning headaches than men.
After menopause, women have more sleep apnea than before menopause, as the amount of estrogen in the body is reduced. According to previous conservative estimates, two percent of middle-aged women suffer from sleep apnea that requires treatment. According to the latest estimates, already nine per cent of women who have passed the menopause are affected by moderate or severe sleep apnea. Sleep apnea occurs twice as much in women past menopause age than in women of the same weight before menopause. Most of them are also without diagnosis and treatment.
It is known that the female serum hormone secreted from the ovaries is strongly stimulating the breathing and increases the activity of the upper respiratory muscles and the diaphragm. Estradiol, another female sex hormone, in turn, enhances the effect of progesterone hormone. End of excretion of estrogen and progesterone hormone in menopause depresses the upper respiratory muscles and exposes the upper respiratory tract to stenosis, so partial upper respiratory stenosis is common in women just before the menopause. This does not necessarily involve breathing breaks, they require weight gain. On the other hand, recurring awakenings and waking up occur more frequently in menopausal women, which can lead to instability of sleep time breathing and thus expose to sleep apnea.
Sleep apnea symptoms in women
Like some heart diseases, sleep apnea symptoms in women and men are slightly different. Women don’t fall asleep and snore as much as men, but they are more affected by morning headaches than men. Headaches can occur throughout the day in women, as well as muscle pain. Women also have more insomnia and exhaustion, and they tolerate longer periods of exhaustion, which might turn into a depression before they seek help. Although the woman may go to the doctor on the advice of a spouse because of snoring and breathing breaks, men may not monitor the treatment in the same way as the wives in a similar situation.
Hormone replacement therapy often relieves the symptoms of insomnia and sleep apnea. Instead, sleeping pills often make them worse. If a middle-aged woman does not feel that her menopause hormone replacement therapy is helping enough with her memory problems, feeling of inability, and night sweats, sleep apnea is considered to be one of the possible causes of problems, even if she is not overweight.
In patients with type 2 diabetes, sleep apnea may also be one of the causes of fatigue, poorly responding hypertension or unclear atrial fibrillation. Hypothyroidism can worsen or even cause sleep apnea.
All fatigue is not due to sleep apnea and the treatment of sleep apnea does not correct the symptoms of fatigue or insomnia due to other reasons. However, it should always be considered.
Today, sleep apnea in women is treated like in men. In women, sleep apnea occurs more as a partial stenosis that does not lead to night-time awakenings, leaving the apnea hypopnea index (AHI), which shows the severity of the disease, low. In this case, the breathing becomes heavy over time, but this does not appear in the AHI values. Women’s breathing breaks are also often shorter than men’s. Women, in turn, have more events during REM sleep and airflow constraints, leading to breathing-associated awakenings. For this reason, women’s sleep is therefore more intermittent than men’ s. Women might have symptoms with lower AHI values than men. Women’s symptoms may also seem more complicated than men’s with similar AHI values. Women may also be more sensitive to high pressures and rapid pressure fluctuations, which is not good, for example, when blood pressure is high. If there are no other reasons for a woman’s symptoms of sleep apnea, the CPAP device should be recommended for treatment with even small AHI values. Hormone replacement therapy should not be used solely to treat sleep apnea unless there are other reasons for it.
Recently, efforts have been made to identify the differences in sleep apnea among women and men and to consider whether they should be treated with different devices if differences are identified. One sleep clinic, among other things, performed treatment experiments on the “Autoset for Her” device, where women who had had problems with their previous devices doubled their usage hours. The device’s algorithm, or operating model, is different, and it helps to prevent awakenings caused by large and rapid pressure changes. The pressure on this device does not increase as much as in the conventional one, and the pressure is limited according to the user’s breathing. The pressure also decreases more slowly. Attention has also been paid to the appearance of the device.
Rehabilitation of patients with sleep apnea
Previously, rehabilitation courses were organized for those suffering from sleep apnea and benefited both men and women. Currently, rehabilitation courses are hardly organized. It is hard to see why these rehabilitation and adaptation training courses would not be useful for people with sleep apnea. Contributing to a better understanding of the illness for those who are suffering from it, would also seem to be a profitable investment for society.
Experiences from Rehabilitation Course:
“The course was really good and peer support was really helpful. There, for the first time, a doctor suggested that I really should work less. The course was interesting in how the treatment of sleep apnea can, despite the recommendations, vary widely across the country.”
“Comparing your own antique device to other newer devices can easily be surprising if you have an older machine and the others have new automatic devices. As device development progresses all the time, it seems that old users should also have access to more sophisticated devices without having to buy them at their own expense. ”
“I’ve been thinking the same thing. If I’ve had my sleep apnea diagnosis a year later, I would have had a much more advanced device. I am willing to invest in my treatment economically. At the moment, I’d like to get that “female model”, because recently I have experienced constant pressure device’s more difficult than at the initiation of treatment and AHI values have risen somewhat. Because I travel a lot, I’d love to buy a handy and compact travel device as soon as possible. The total cost of those two devices is quite high.”