Sleep Apnea in Women: Uncovering Hidden Symptoms and Rising Risks Afte

This article explores new research highlighting the hidden epidemic of sleep apnea in women, who are ten times less likely to receive an accurate diagnosis than men. By investigating why women's symptoms often differ from the classic sleep apnea presentation, recent studies uncover critical insights into how misdiagnosis occurs. This blog reveals the important yet subtle symptoms that often go unnoticed, and describes techniques for creating a supportive sleep environment to foster improved health and wellbeing.

Understanding the sleep apnea stereotype

Obstructive sleep apnea (OSA) is a serious public health burden, and is the most common form of sleep disordered breathing. Approximately 20% of adults are affected by mild OSA, and 1 in 15 individuals experiencing severe symptoms. It is well established that disrupted sleep can lead to serious health consequences, and there is a clear association between OSA and hypertension, cardiovascular morbidity, traffic accidents, cognitive decline and an impaired health-related quality of life overall.

For decades, sleep apnea has been thought to be predominantly a male health disorder. While research shows men are more than twice as likely to be affected by sleep apnea than women, the diagnosis rates between genders reveal a deeper problem: women are 10 times less likely to be diagnosed than men.

Although the reasons for this striking disparity in diagnosis are not entirely clear, it is likely that two key factors contribute. These include the differences in how women present clinically, as well as frequent underrecognition of female OSA symptoms by healthcare providers.

Scientific insights: Unpacking the gender gap

Research suggests the underrecognition of women’s sleep apnea may be due to two main factors. Firstly, their symptoms tend to differ slightly from those commonly recognised in men. While men typically report loud, persistent snoring, breathing apneas, and daytime exhaustion; for many women, experiences of snoring and apneas appear to be less common or even absent.

Instead, women commonly describe other symptoms such as restless legs, heart palpitations, irritability, mood changes, headaches, nightmares, and insomnia. Since these symptoms deviate from the standard clinical profile, women are less frequently referred for sleep studies, perpetuating a cycle of misdiagnosis.

More concerningly however, is the recent finding that even when women do present with a classical presentation such as evidence of loud snoring, men are still 10 times more likely to receive a diagnosis of sleep apnoea than women, while women’s symptoms are instead regularly diagnosed as anxiety, depression, or stress. Unfortunately, this significant misdiagnosis for women’s sleep apnea has severe and far-reaching consequences including serious long-term health implications.

The health implications of missed diagnoses

The consequences of overlooked sleep apnea extend far beyond daytime fatigue and brain fog. Untreated sleep apnea which causes persistent and repetitive sleep disruptions significantly increases the likelihood of developing chronic health conditions. These include cardiovascular risks such as hypertension and stroke, metabolic disorders such as diabetes, altered immune responses, as well as cognitive decline.

Biology behind the bias

While the biological basis for the differences in sleep apnea symptoms between men and women is not entirely clear, it is thought to be underpinned by a complex interplay of anatomy, hormonal regulation, and physiology.

Physiological and hormonal differences almost certainly play an important role. Prior to the onset of menopause, women's upper airways are generally shorter and more stable, primarily due to the hormones estrogen and progesterone which maintain airway muscle tone.

However, evidence suggests that changes in hormone levels in postmenopausal women lead to a reduction in muscle tone in the neck, which increases the risk of airway obstruction during sleep. Indeed, menopause itself is now recognized as an independent risk factor for sleep apnea. As such, it is clear that women’s risk of sleep apnea evolves over time, and responds dynamically to hormonal fluctuations alongside physiological changes.

Therapeutic and holistic treatment options

The effective treatment of sleep apnea often involves considering the best personal solutions to improve sleep. While standard therapeutic interventions include Continuous Positive Airway Pressure (CPAP) or oral appliances, both methods have distinct benefits and considerations.

Creating a sleep-supportive environment

Evidence suggests that optimizing your sleep space can play a significant role in mitigating sleep disruptions. Indeed, thoughtful adjustments in your bedroom or to your sleep routine itself can significantly improve sleep quality.

For those with sleep apnea, solutions aimed at improving sleep might include adjustable bed bases, CPAP pillows, and Wedge or Neck Support pillows. Research also indicates that supportive pillows, including those made of natural latex, can provide resilient, supportive cushioning and exceptional breathability, which helps to maintain a cooler sleeping environment. This reduces the risks of poor positioning and overheating, enhancing sleep.

For others looking to optimize their sleep health, evidence suggests that maintaining optimal bedroom humidity can help, while air purifiers can help to reduce allergens and nighttime congestion, facilitating easier breathing. Recent and novel advancements into sleep research have also revealed a link between morning bright light exposure, and blue light filtering and improved sleep outcomes.

While sleep-supportive environments are largely specific to individual preferences, it is clear that small environmental changes can yield meaningful improvements in sleep quality, leading to long-term health benefits.

Conclusion

Sleep apnea in women remains a concerningly overlooked health issue, with profound implications for long-term health and wellbeing. Since women's symptoms often diverge from the typical well-recognized clinical profile, a wider recognition and understanding of this profile will be essential to improving diagnosis and treatment. Increased awareness, accurate diagnostics, tailored therapies, and supportive sleep environments can collectively mitigate the health risks associated with sleep apnea, leading to better long-term health outcomes for women, as well as an improved quality of life.

References

https://pubmed.ncbi.nlm.nih.gov/15481275/

https://www.atsjournals.org/doi/pdf/10.1164/ajrccm.161.5.9904121

https://journals.sagepub.com/doi/full/10.1177/2470289718787107

https://www.sciencedirect.com/science/article/pii/S0954611104001064

https://www.neurology.org/doi/abs/10.1212/wnl.0000000000001566

https://www.nature.com/articles/s41433-020-01132-2

July 12, 2025