Snoring & Sleep Apnea in Women
Do women Snore? Yes indeed not as bad as men, but what if they snore like a small vicious dog, it is obnoxious.
Women can, and do, snore. Snoring can affect women of all ages, although there’s an increased prevalence after menopause and it can also be experienced in pregnancy. Most women find it deeply embarrassing and unladylike if they snore too. The problems can run deeper than a loss of sleep for them or their partner. The embarrassment it causes can be serious and lead to a lowering of self-esteem, or the fracturing or fear of relationships. There is no need to live with the condition or the associated embarrassment, and there is help at hand. Read on about this complex problem of snoring in women.
Why is snoring and sleep apnea not easily recognized in women?
More recent studies on general populations have reported male: female prevalence ratios for sleep apnea are around 2:1.
Nearly half of women snorers do not report their symptoms to their doctor, often due to embarrassment or shame.
The few population studies that have included women, show 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.
Symptoms 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.
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.
Obesity in women
Obesity seems to be the dominant factor for the occurrence of sleep apnea in women when matched with males for age and degree of sleep disturbance. One study reported that women had a higher BMI index than men at each level of RDI (respiratory disturbance index). There is evidence that obesity is greater in premenopausal women compared to postmenopausal women with sleep apnea. It has also been reported that premenopausal women have more severe apnea compared to postmenopausal women with the same BMI.
There is a relationship in overall neck size and airway obstruction, and men have a higher proportion of fat around the neck area compared to the rest of the body, than do women. Men tend to have a greater volume of fat in the soft palate and the upper part of the tongue whereas women tend to have greater fat deposition in the lower part of the airway. Women also tend to have less upper airway anatomical abnormalities and require greater fat infiltration before they have a reduction in airway space.
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 found hormone replacement therapy showed modest improvements in snoring and sleep apnea with estrogen alone, whilst others found better improvements with both estrogen and progesterone.
Testosterone on the other hand, 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.
Excessive daytime sleepiness, fatigue, decreased libido, depressed mood, headache, impaired concentration and obesity are all symptoms associated with snoring and sleep apnea.
But they are also symptoms of hypothyroidism. Hypothyroidism in snoring women is statistically higher than it is in men. This may be another reason why snoring and sleep apnea in women are confused or misdiagnosed.
In patients with hypothyroidism, sleep disordered breathing appears to be common, yet in patients with snoring or sleep apnea, hypothyroidism is very uncommon. The reasons why this should be are still unclear. There does appear to be a positive link between obesity and hypothyroidism.
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. However, one study of women aged 25-79 years found diabetes in snoring women independent of age, obesity or smoking status.
Snoring women were twice more likely to suffer diabetes than 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 Polycystic Ovary syndrome. 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.
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