Snoring in Women- Is it really a fact?
I\’m sure just about everyone is somewhat familiar with snoring. You probably know at least one person who snores. It could be your bed partner, your parents, and grandparents, even uncle or aunt who may snore at various sound levels. Some laugh and make jokes about it, but it can be a symptom of a serious disorder called obstructive sleep apnea (OSA). And if it is obstructive sleep apnea, then it is no laughing matter, and that individual needs to get evaluated by a sleep specialist.
Snoring and sleep apnea are generally considered to be conditions predominantly affecting men. However, more recent research has recognized that snoring and sleep apnea in women is not as rare as was once thought. More recent studies on general populations have reported male: female prevalence ratios for sleep apnea are around 2:1.Some studies have found that men are twice as likely to be referred for a sleep study than women. Nearly half of women snorers do not report their symptoms to their doctor, often due to embarrassment or shame. Undiagnosed sleep apnea is far more prevalent in women than men. One study found that sleep apnea was undiagnosed in more than 90% of women with moderate to severe sleep apnea. Nearly half of all middle aged men snore, but women tend to snore later in life with an increased prevalence after menopause at around 50-60 years of age.
Risk Factors of Snoring in Women
Like in men, the symptoms of snoring and sleep apnea in women have an adverse effect on neurological and psychological function resulting in poor work performance, difficulty in concentrating, memory impairment, headache, nausea, impotence and decreased libido.
Symptoms of Snoring and OSA in Women
Typical symptoms of sleep apnea, snoring, apneas, choking and restless sleep, are similar in both men and women. Atypical symptoms such as daytime fatigue, headaches, insomnia, tension, depression and the use of sedatives are more frequent in women than men and may divert clinicians to diagnose and treat for other conditions. For example, because women are more likely to report insomnia and depression they are more likely to be treated for these symptoms rather than the underlying cause of their sleep apnea.
Obesity in women
Female hormones may have a protective effect on the upper airway dilator muscles as they are believed to protect the airway from obstructing during sleep. Some studies in post menopausal women found modest improvements in snoring and sleep apnea with estrogen alone, whilst others found better improvements with both estrogen and progesterone. Testosterone has been found to increase upper airway collapsibility and the consequent risk of developing snoring and sleep apnea. This may explain in part why there is a male predominance in snoring and sleep apnea.
There is an increasing interest in the association between snoring, sleep apnea and diabetes mellitus. Diabetes is often associated with snoring and sleep apnea, predominantly in overweight males. Snoring women were twice as likely to suffer diabetes as non- snoring women.
Both diabetes and snoring and sleep apnea are influenced by sexual hormones. Snoring and diabetes often increase during pregnancy, after the menopause and in women with poly cystic ovary syndrome (PCOD). The sleep deprivation and cyclic decreases in oxygen levels that occur as a result of snoring and sleep apnea tend to increase insulin levels. It has been suggested that this may be the link between snoring and diabetes as one study reported that insulin sensitivity improved following treatment for snoring and sleep apnea.
OSA and Type 2 Diabetes
OSA is a disorder characterized by snoring, partial or complete cessation of breathing during sleep, reductions in blood oxygen levels, severe sleep fragmentation, and excessive day-time sleepiness. It is associated with cardiovascular conditions, causing hypertension, heart disease, and stroke.
Patients with snoring and untreated OSA have a higher risk of both cardiovascular disease and Type 2 Diabetes. Sleep apnea can be associated with recent weight gain. Tiredness can also cause people to eat for stimulation and skip exercise. Over time, these habits result in obesity, which can worsen sleep apnea, leading to a progression in severity of both conditions.
OSA-sleep deprivation from any cause increases blood glucose, blood pressure, and triglycerides. Snoring and OSA causes higher cortisol levels resulting in resistant hypertension. The reasons for this are complex but seem to include increased sympathetic nervous system activity and adrenal cortisol and catecholamine output.
There is increasing epidemiologic evidence suggesting that habitual snoring and OSA have adverse effects on glucose tolerance, insulin resistance, and the risk of diabetes mellitus, that are independent of the degree of obesity.
Intermittent hypoxia and reduced sleep duration due to sleep fragmentation, as occur in OSA, exert adverse effects on glucose metabolism. The interactions among the rising epidemics of obesity, OSA, and type 2 diabetes are likely to be complex and involve multiple pathways. Insulin resistance is the hallmark of type II diabetes. Insulin resistance is strongly associated with visceral obesity. OSA exhibits pathophysiologic mechanisms that may potentially contribute to the development of insulin resistance.
In patients with hypothyroidism, sleep disordered breathing appears to be common, yet in patients with snoring or sleep apnea, hypothyroidism is also very uncommon. Thyroxin therapy showed a reduction in snoring and excessive daytime sleepiness in hypothyroid sleep apnea patients.
Pregnancy Snoring and Diabetes
Sleep apnea was associated with a doubling of the incidence of gestational diabetes and a fourfold increase in the risk of pregnancy-induced hypertension. As you know obesity is a major risk factor for sleep apnea. Pregnancy can worsen sleep apnea, especially during the third trimester when a woman’s weight is greatest. When a mother’s oxygen level drops at night, it may also affect the oxygen level of the fetus. That is why it’s important for a pregnant woman with sleep apnea to be treated with CPAP during her pregnancy.
The body also secretes more hormones such as cortisol and epinephrine, and the body responds by producing more glucose coupled with a decreased sensitivity to insulin, which can lead to diabetes.
If sleep apnea is present in pregnancy, treatment in the form of nasal CPAP should be used and the blood pressure and blood sugar should be closely monitored. The most effective treatment for sleep apnea is an apparatus called nasal CPAP, which delivers air through a mask while the patient sleeps, keeping the airway open.