Men with obstructive sleep apnea (OSA) commonly experience symptoms like loud snoring and gasping for breath due to breathing pauses, according to Mayo Clinic. Women, however, don’t always share these obvious symptoms of OSA. For that reason, it may be harder to detect OSA in women.

Here, we’ll look at what can affect a woman’s risk for sleep apnea and nine symptoms of OSA in women.

Risk Factors for Sleep Apnea in Women

According to the Sleep Foundation, sleep apnea is estimated to impact between 10 percent and 15 percent of females. But recent studies suggest that OSA and other sleep-related breathing disorders are more common among women than previously thought.

For people of any sex, certain factors increase the risk of OSA, such as:

• Obesity
• Family history of OSA
• Chronic (ongoing) nasal congestion
• Smoking
• Drinking alcohol or taking sedatives before bed
• Certain medical conditions like high blood pressure, type 2 diabetes, or heart disease

Mayo Clinic reports that men are two to three times more likely to develop OSA than premenopausal women. This difference appears to be due to the hormones estrogen and progesterone — which occur in higher amounts in women before menopause. Estrogen and progesterone influence sleep and are thought to be protective against sleep apnea in younger women, according to the journal Sleep & Breathing. But this protection appears to be lost with the hormonal changes that occur during menopause.

Other causes of changing hormones can also impact sleep apnea risk, including:

• Menstruation — Progesterone is higher in the luteal phase (after ovulation), which may help keep the upper airway more open. Some people may notice sleep apnea symptoms are worse during the first half of the menstrual cycle, when progesterone is lower.
• Pregnancy — Hormonal changes can cause airways to swell and narrow and breathing to become unstable while the uterus pushes up into the lungs. Some research suggests that around 27 percent of pregnant people develop sleep apnea, although other studies have found lower numbers.
• Polycystic ovary syndrome (PCOS) — PCOS is a medical condition in which women have lower levels of progesterone and higher levels of androgens (also called male sex hormones). This hormone imbalance increases the risk of airway collapse during sleep.

Hormonal causes, such as the menstrual cycle, may lead to sleep apnea that comes and goes. This, together with less obvious signs of sleep apnea, can make it hard to identify OSA in women. This challenge can lead to delayed diagnosis and treatment.

Common Sleep Apnea Symptoms in Women

OSA is more common in men than women, so much of the research into OSA has focused on how the condition affects males. But newer studies have found that the sleep disorder often presents differently depending on a person’s sex. In particular, women with OSA may have more generalized symptoms, such as morning headaches and mood changes, according to the Sleep Foundation. These less common symptoms of sleep apnea can make OSA harder to identify among women and impact quality of life.

Symptoms of sleep apnea can vary from person to person, but some are more commonly seen in women. Untreated sleep apnea can lead to complications like heart failure, so talk to your healthcare provider if you experience OSA symptoms. If your doctor suspects sleep apnea, they may recommend that you do a sleep study to evaluate how you breathe while sleeping.

1. Morning Headaches

According to some studies, morning headaches, older age, and a larger neck circumference are linked to sleep apnea in women. Morning headaches are estimated to occur in around 18 percent of people with sleep apnea.

Researchers aren’t exactly sure why some people with OSA experience headaches. It’s possible sleep apnea headaches are caused by low oxygen levels during sleep or by interrupted sleep. Pain from a sleep apnea headache is often felt on both sides of the head and described as a feeling of pressure rather than pulsing or throbbing. These headaches occur 15 days or more each month and can last as long as four hours.

2. Insomnia

Insomnia — not being able to fall asleep or get back to sleep after waking — is more common among women, according to the Sleep Foundation. In fact, women are thought to be around 40 percent more likely to experience this sleep disruption than men. For women, in particular, having insomnia is also linked to sleep-disordered breathing like OSA.

Breathing issues can cause someone to wake up during the night, but they can also make it hard to fall back asleep. It’s thought that this difficulty getting back to sleep afterward may be due to the body’s stress response to not being able to breathe.

3. Anxiety and Depression

If you have anxiety or depression, interrupted sleep can make these symptoms worse. Because of this, these mental health conditions are commonly reported by women with sleep apnea, according to the National Heart, Lung, and Blood Institute.

Having sleep apnea also appears to put women at higher risk of experiencing anxiety and depression. One study that compared female and male adults with OSA found that female adults with the sleep disorder were almost four times more likely to develop depression and more than twice as likely to develop anxiety over the nine-year follow-up.

OSA may also cause other mood changes, such as irritability.

4. Daytime Tiredness

The sleep disruptions that come with sleep apnea may leave you feeling unrested when you get out of bed in the morning. Without a good night’s sleep, you may experience low energy levels while awake or even excessive daytime sleepiness that gets in the way of daily tasks. Some women describe this feeling as fatigue (extreme tiredness that doesn’t improve with rest) rather than sleepiness.

5. Frequent Wake-ups or Trips to the Bathroom During the Night

Waking up often during the night can also be a sign of sleep apnea, especially in females, according to Sleep & Breathing. This symptom can easily go unnoticed, especially in women who wake up feeling like they need to use the bathroom. But the need to urinate more than once during the night occurs in about half of those with OSA.

Breathing disruptions that occur during sleep apnea can impact certain hormones in charge of regulating urine. In addition, people who wake up more often due to fragmented sleep are able to more easily notice that they have to use the bathroom.

6. Snoring

Obvious signs of sleep apnea like snoring can affect anyone. According to the Sleep Foundation, snoring is more commonly reported by men, but it also occurs in women with the condition. Some women may not report that they snore if they feel embarrassed or if their bed partner doesn’t tell them about it.

Snoring is common among both men and women with sleep apnea. Women are especially likely to snore once they reach 50 years old. In addition, women who snore while pregnant or when going through menopause appear to have an increased risk of developing OSA.

7. Trouble Concentrating

Women are more likely than men to have issues with their memory and ability to focus — referred to as cognitive impairment — due to OSA, and having sleep apnea increases your risk of depression. People living with depression can have issues with both processing and consolidating their memories.

Some evidence suggests that people with OSA may have more difficulty forming semantic memories (memories related to facts and general knowledge) than those without the sleep disorder. This is likely due to OSA disrupting the sleep cycle and preventing the brain from getting the quality sleep it needs to consolidate memories.

8. Shortness of Breath or Dry Mouth Upon Waking

Waking up short of breath is another symptom common to people of any sex. People with OSA may also find that they wake up with an unusually dry mouth. This can happen because someone with sleep apnea is more likely to breathe through their mouth than their nose. Mouth breathing for long periods of time can dry up saliva inside the mouth. One treatment option for OSA, continuous positive airway pressure (CPAP), can also dry out the mouth.

9. Unexplained Weight Gain

Living with obesity increases your risk of developing sleep apnea. But having OSA can also make you more likely to gain weight. Poor sleep can disrupt the body’s internal clock, which helps to regulate appetite, blood sugar, and fat storage in the body. Because sleep apnea regularly disrupts sleep, it can interfere with these processes making you feel hungrier and gain weight more easily. Sleeping poorly can also make it hard to find the energy to exercise, leading to weight gain.

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