Why Sleep Apnoea Looks Different In Women As Thousands Miss Warning Signs

Sleep apnoe is often misdiagnosed in women with depression, anxiety or insomnia due to the similarity of male-pattern snoring and gasping.

Sleep Apnoea is a chronic medical condition that causes breathing stop and restart several times while you sleep. People with this condition typically snore loudly or gasp for air during sleep. Traditionally, obstructive sleep apnoea (OSA) was seen as a male disease, but several studies have pointed out that OSA in women is skyrocketing with significant gender-related differences in terms of symptoms, diagnosis, consequences and treatment.

Why Sleep Apnoea Looks Different In Women?

A study published by the National Institute of Health (NIH) titled 'Sex Differences In Obstructive Sleep Apnoea' states, "Obstructive sleep apnoea (OSA) and obstructive sleep apnoea/hypopnoea syndrome (OSAHS) have long been considered predominantly male-related conditions. The clinical presentation of sleep disordered breathing in females differs from male and can vary with age and physiological status, e.g. menopause and pregnancy."

The findings further showed that females are more symptomatic with lower apnoea-hypopnoea index scores compared to males. Additionally, women appear to have more prolonged partial upper airway obstruction which may result in insomnia as a symptom of OSAHS. This difference in clinical representation is the main factor why females with sleep disordered breathing are often underdiagnosed and undertreated compared to males.

Sleep apnea isn't just a men's health issue; women are affected too, often with different symptoms that can lead to missed diagnoses. Learn more at https://t.co/QIbxR096QS#ApriaHealthcare#Providers#SleepCare#SleepProfessionals#OSA#SleepTherapypic.twitter.com/NyPy5FmdOI Apria (@ApriaHealthcare) August 8, 2025

Symptoms Of Sleep Apnea In Women

Healthcare professionals note that both men and women can suffer from excessive daytime sleepiness (known as hypersomnia), but women are more likely to experience the following symptoms:

1. Insomnia
2. Anxiety
3. Depression
4. Fatigue
5. Snoring
6. Difficulty in breathing
7. Gasping for air during sleep
8. Awakening with a dry mouth
9. Morning headaches
10. Trouble paying attention while awake
11. Irritability

Sleep Apnoea Often Misdiagnosed In Women

This chronic medical condition is often misdiagnosed with depression, anxiety or insomnia in women due to the similarity of male-pattern snoring and gasping. Dr. Sibasish Dey, Head Medical Affairs, ResMed India and South Asia, explains, "Sleep apnea in women is often missed because it doesn't always look the way we expect it to. Most people think of loud snoring, choking during sleep or extreme daytime sleepiness, but many women don't present like that. Instead, they may complain of constant fatigue, poor sleep, headaches, irritability, or even mood changes. Naturally, these get linked to anxiety, depression, or insomnia first. There are also a few practical reasons. Women may not notice or report snoring, and often come to consultations alone, so there is no partner to point out breathing pauses at night. On top of that, there is still a lingering perception that sleep apnea is more common in men, so it is not always the first thing doctors look for. All of this means many women end up being treated for symptoms, while the real issue, poor quality sleep due to apnea, goes undiagnosed."

1000s of women around the peri and post menopausal phase of life have their symptoms of fatigue, insomnia, mood swings incorrectly attributed to the change, rather than Obstructive sleep apnoea, and get shunted around the health service and given a cocktails of medications Rila GP Courses (@Rila_GPCourses) December 10, 2024

How Menopause Increases The Likelihood Of OSA

According to the global health organization about 47 per cent to 67 per cent of postmenopausal women reports to suffer from OSA. "Menopause is actually a turning point when it comes to sleep apnea risk. Before menopause, hormones like estrogen and progesterone help keep the airway stable and support breathing during sleep. As these hormone levels drop, that natural protection reduces. The airway becomes more likely to collapse during sleep, which is exactly what happens in obstructive sleep apnea. At the same time, many women experience weight gain and changes in fat distribution, especially around the neck and upper body, which can further narrow the airway," Dr. Dey said. "To make things more complex, menopause itself brings sleep issues like hot flashes and night sweats. So when sleep quality worsens, it is easy to blame these symptoms and miss an underlying sleep disorder. That is why it is important to look a little deeper when sleep problems begin or worsen during this phase."

"People aged 50+ with sleep apnea have 21% higher odds of hospitalization compared to those without the breathing disorder, researchers report.For this study, they analyzed data from more than 20,000 participants in the Health and Retirement Study. GEM Sleep (@GemSleep) June 5, 2024

Are Younger Women At Higher Risk Of Sleep Apnea?

According to Dr. Dey, the risk of sleep apnoea definitely increases after menopause but this chronic disease is not just a condition seen in older women, as it can affect younger women too which often goes under the radar. He said, "In younger women, hormones like progesterone help support breathing and keep the airway stable, which offers some protection. However, certain factors can still increase risk. These include obesity, PCOS, thyroid issues, and even anatomical differences like a naturally smaller airway and increased chemoreceptor sensitivity. Pregnancy is another phase where risk can increase due to weight gain, fluid retention, and nasal congestion. The challenge is that symptoms in younger women are often subtle. Instead of snoring, they may report fatigue, poor sleep, anxiety, or difficulty concentrating. Because of this, sleep apnea is not always suspected early on. So while post-menopausal women are at higher risk, it is important not to overlook it in younger women, especially when symptoms persist without a clear cause."

Could continuous positive airway pressure be the key to better heart health for high-risk sleep apnea patients? New multi-trial analysis shows promising cardiovascular benefits! Read more in #EHJ. https://t.co/pg1H9kFJIX#cardiotwitter@ESC_Journals@escardiopic.twitter.com/Ra3WIpgTKl EHJ Editor-in-Chief (@ehj_ed) August 7, 2025

Cardiovascular Health And Sleep Apnoea

Untreated sleep apnea can put a surprising amount of stress on the body. When breathing repeatedly stops during sleep, oxygen levels drop and the body keeps getting jolted awake, often without the person even realising it. Dr. Dey states that this constant stress on your body can disrupt your high blood pressure levels, increasing the risk of heart disease, irregular heart rhythms or even stroke. He added, "In some women this risk can sometimes be higher because the condition often goes undiagnosed for longer. By the time it is identified, the impact on the body may already be more advanced. There is also an indirect effect. Poor sleep can lead to fatigue, reduced physical activity, weight gain, and higher stress levels, all of which further increase cardiovascular risk. The good news is that with proper treatment, such as CPAP therapy, many of these risks can be reduced, and overall health can improve."

Drug treatment shows promise for obstructive sleep apnoea according to research presented today at the #ERSCongressRead the full story: https://t.co/446SKQDlg8pic.twitter.com/uigm0jnMl5 ERS (@EuroRespSoc) September 10, 2024

Other Risks Linked To Sleep Apnoea

Healthcare professionals warn that sleep apnea may not seem harmful, but it is becoming a silent danger for many young men and women. According to Luke Coutinho, integrative lifestyle coach, 85 per cent of people who have sleep apnoea do not know they have this chronic medical condition. He says that if this medical condition is left untreated then it can result in several health complications such as:

1. Diabetes
2. Sudden heart attacks
3. Stroke
4. High blood pressure
5. Alzheimer's
6. Atrial fibrillation
7. Blood clot
8. Death

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Steps To Treat Sleep Apnoea

If a woman suspects she may have sleep apnea, the first step is to speak to a doctor and discuss her symptoms in detail. Even if there is no obvious snoring, symptoms like constant fatigue, disturbed sleep, morning headaches, or mood changes should not be ignored. The doctor further added, "If sleep apnea is suspected, a sleep study called polysomnography or a home sleep test is typically recommended, depending on the case. A sleep study allows tracking breathing, oxygen levels, heart rate and sleep patterns. Based on the results, treatment is planned such as CPAP therapy, which uses a machine to keep the airway open during sleep. While it may take some time to get used to, it is very effective. Now a days women specific PAP devices are available which may help in better adherence to therapy. Lifestyle changes such as weight management, and addressing factors like nasal congestion are planned concurrently. In certain cases, other interventions may be considered. The key is early diagnosis. Once identified, sleep apnea is very manageable, and treatment can make a significant difference to overall health and quality of life. It's time we start asking for sleep screening and sleep test with our doctors."

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