Long perceived as a male disease, sleep apnea also affects millions of women. Among them, the pathology is quieter, more insidious, and therefore too often ignored. Result: chronic fatigue, mood disorders, cardiovascular risks and complications during pregnancy sometimes set in without anyone making the connection with sleep. Three periods of female life should be of particular concern: pregnancy, menopause and polycystic ovary syndrome.
A poorly known disease… and poorly identified in women
Obstructive sleep apnea-hypopnea syndrome, or OSAHS, is manifested by repeated stops or slowdowns in breathing during the night. With each episode, the oxygen in the blood drops. The heart races and the brain causes a micro-awakening to restart breathing. The person does not remember it, but their sleep becomes fragmented, non-restorative, and their body subjected to constant stress.
Contrary to popular belief, almost as many women as men are affected. Especially for mild to moderate forms. However, they are much less diagnosed. This invisibility is explained by the fact that female apnea does not resemble the classic picture of the obese and sleepy snorer. Women rarely complain of hypersomnolence and sometimes snore little, which deceives those around them and doctors alike.
Inserm also emphasizes that women experience both underdiagnosis and a delay in diagnosis. When they live as a couple, their snoring and pauses in breathing are less often noticed by their partner. Their symptoms, often more discreet, are also less well perceived by themselves, even though the severity can be comparable to that observed in men.
Result: fatigue, irritability, anxiety or insomnia are attributed to stress, overwork or hormones, and not to sleep.
Pregnancy, a time of great vulnerability
During pregnancy, the body undergoes profound changes, and these changes can affect nighttime breathing. The airways become narrower, the tissues relax and hormonal variations modify the regulation of breathing. The risk of apnea increases over the months, to the point of affecting nearly one in three pregnant women at the end of pregnancy.
This situation is not trivial. Sleep apnea promotes hypertension and gestational diabetes, two complications that can put mother and baby at risk. However, a tired pregnant woman is often considered “normal”, which delays the identification of a disorder that is nevertheless treatable.
Menopause, when hormonal protection disappears
Before menopause, female hormones play a protective role in breathing during sleep. After the cycles stop, this protection collapses. The tissues of the throat become softer, respiratory regulation changes, and the risk of sleep apnea increases sharply. Postmenopausal women are two to three times more likely to develop OSAHS than younger women.
The trap is that the signs of apnea are confused with those of menopause: broken nights, persistent fatigue, headaches upon waking up, irritability or mood disorders. Many women think they are simply experiencing their “new normal”, when in reality their sleep is disturbed by dozens of nighttime micro-awakenings.
PCOS, a favorable environment for sleep breathing disorders
Polycystic ovary syndrome, which affects around 10% of women of childbearing age, is accompanied by hormonal imbalances and often weight gain. These factors change the way the airways behave during sleep and increase the risk of apnea, sometimes from a young age. In these young, sometimes thin and very active women, the diagnosis is even more often missed.
Why it is dangerous to let apnea take hold
When sleep apnea is left untreated, the body experiences dozens or even hundreds of small oxygen deprivations every night. In the long term, this promotes hypertension, cardiovascular disease, diabetes, memory and concentration problems, as well as depression. In women, it can also worsen pregnancy complications and accelerate the development of metabolic diseases with age.
Signs that should alert
In women, sleep apnea can manifest itself by:
- Snoring, sometimes discreet;
- Rough or irregular breathing during the night;
- Restless and unrefreshing sleep;
- Waking up with headaches;
- Persistent fatigue during the day;
- Concentration or memory problems;
- Unexplained mood changes, anxiety or depression;
- A frequent need to urinate at night.
Effective diagnosis and treatments
The diagnosis is based on a gold standard test, polysomnography, which records breathing, oxygen, heart and brain activity during sleep. Once the disorder has been identified, the solutions are numerous and effective: lifestyle adaptation, dental orthoses, night ventilation devices, or even surgery in certain cases. Because women or men, a reality persists: this nocturnal respiratory disorder can be detected and treated.