The most common association with sleep apnoea is to an obese, snoring man with a partner who has to nudge him to sleep throughout the night. Because this portrayal is so widespread, many women and even some doctors overlook sleep apnoea in female patients altogether.
Though, women may suffer from the condition as well; it is estimated that as many as one out of eleven Australian women are affected by it, and the majority of them are completely unaware. Women’s symptoms may appear quite different and, due to that fact, their health issues may easily be attributed to something else and screening methods designed primarily for men could miss them entirely.
If you are a woman who feels tired all the time, has poor sleep quality, gets headaches when you wake up, this article is the right place for you.
What Is Sleep Apnoea?
Obstructive sleep apnoea (OSA) is a condition where the relaxation of throat muscles during sleep causes partial or complete airway blockage leading to breathing difficulties. Either you stop breathing or continue with shallow breathing which significantly reduces your oxygen levels to such an extent that your brain has to briefly awaken you in order for you to be able to breathe again. You normally don’t recall these awakenings but they will prevent sleep from being restful and deep enough.
Sleep apnoea, if not treated, can gradually impair physical well-being, emotional stability, concentration, and cardiovascular system, hence the need to diagnose it early.
Why the Symptoms Look Different in Women
The classic signs are loud snoring, gasping, and a partner noticing pauses in breathing. Many women do have these. But women are more likely to have symptoms that don’t seem to be about sleep at all:
- Constant tiredness or fatigue, even after a full night in bed
- Insomnia, especially trouble staying asleep or waking too early
- Morning headaches
- Low mood, anxiety or irritability
- Poor concentration or brain fog
- A dry mouth or sore throat on waking
- Waking often to go to the toilet
- Restless, broken sleep or jaw clenching
Notice what’s missing from this list: loud snoring. Many women with sleep apnoea snore softly, or not at all.
There’s another difference. Women often describe feeling “exhausted” or “flat” rather than “sleepy.” If you don’t doze off easily during the day, you might assume sleep apnoea doesn’t apply to you. It still might.
Why It Gets Missed
Several things combine to make sleep apnoea in women easy to overlook.
1. The symptoms get blamed on something else. Fatigue, low mood and poor sleep in women are often put down to stress, depression, anxiety, thyroid problems, anaemia, or hormones. These are all real and worth checking, but they can hide an underlying breathing problem. Finding one possible cause doesn’t mean it’s the only one.
2. It doesn’t look like the “classic” patient. If a woman doesn’t snore loudly and doesn’t fit the stereotype, sleep apnoea may not cross a doctor’s mind, and she may not think to raise it.
3. Screening tools were built around typical male symptoms. Common questionnaires lean heavily on things like loud snoring, witnessed pauses in breathing, neck size, and age. Some include being male as a risk factor in their scoring. A low score doesn’t rule out sleep apnoea in a woman with unexplained fatigue.
4. Women often under-report. Many women put up with poor sleep for years, or assume tiredness is just part of busy life, juggling work, family and everything else.
5. Sleep and hormones overlap. Insomnia, night sweats and fatigue can all be caused by hormonal changes too, so breathing problems can slip under the radar.
Hormones, Pregnancy and Menopause
Hormones play a big part in a woman’s risk.
Before menopause, women tend to have a lower risk of sleep apnoea than men, partly because of the protective effect of hormones like progesterone.
After menopause, the risk rises sharply, and may become closer to that of men. Because hot flushes, poor sleep and fatigue are so common during menopause, sleep apnoea can easily be mistaken for “just menopause.”
During pregnancy, weight gain and body changes can make sleep apnoea more likely. Warning signs can include snoring that begins later in pregnancy, ongoing morning headaches, and tiredness that doesn’t ease with rest. If you notice these, mention them to your midwife or GP.
Conditions like PCOS (polycystic ovary syndrome) are also linked to a higher risk.
Sleep Apnoea and Insomnia Often Go Together
A large number of people with sleep apnea also experience insomnia. One of the Australian clinical guidance documents mentions that about one half of individuals with sleep apnea describe symptoms of insomnia. This is important because you might get “just insomnia” as a diagnosis and therefore a breathing problem can be overlooked. Besides, sometimes the treatment has to cover both aspects.
How Sleep Apnoea Is Diagnosed in Australia
Diagnosis starts with a conversation with your GP, and usually involves:
- Questionnaires such as the Epworth Sleepiness Scale, plus screening tools such as OSA50 or STOP-Bang
- A sleep study. This can be a home-based test, where you wear a small monitor overnight, or a more detailed in-lab study
For a Medicare rebate on a home-based sleep study, the guidance for GPs has required a minimum score on the Epworth scale combined with a minimum score on one of the screening tools. These rules can change, so it’s best to ask your GP what applies.
The important thing is this: if you have symptoms but score low on a questionnaire, don’t give up. Questionnaires are a starting point, not the final word. A good doctor will also consider your whole story.
How to Get Taken Seriously
If you think sleep apnoea might be behind your symptoms, these steps can help.
- Keep a two-week diary. Note your bedtime and wake time, how you feel in the morning, headaches, daytime energy and mood.
- Ask someone who sleeps near you if they’ve noticed snoring, restlessness, gasping or pauses in your breathing.
- Be specific. Say something like: “I’m worried I might have sleep apnoea because I’m exhausted all the time, I wake up with headaches, and I sleep poorly.”
- Ask directly. “Could this be sleep apnoea, and would a sleep study be appropriate?”
- Mention your life stage. Pregnancy, perimenopause and menopause are all relevant.
- Follow up. If your concerns are brushed off and symptoms continue, it’s fine to ask again or get a second opinion.
What Treatment Looks Like
Sleep apnoea is very treatable. Depending on how severe it is, options may include:
- CPAP therapy. A small machine and mask that keeps your airway open while you sleep. It’s the most common and effective treatment.
- Oral appliances. A custom mouthpiece, usually made by a dentist, that holds your jaw forward.
- Lifestyle changes. Weight management, regular exercise, cutting back on alcohol and changing sleeping position can all help.
- Treating related issues, such as insomnia, which has its own effective treatments.
Many people notice a real difference after starting treatment, with more energy, better mood and clearer thinking.
The Bottom Line
Sleep apnoea affects everyone regardless of their gender. When the illness strikes in women, they rarely suspect it and just accept their fatigue, insomnia, headaches and low mood as symptoms without knowing what to do. Sleep apnoea is often wrongly associated with stress, hormonal changes or hectic lifestyles. When you find yourself chronically tired and nothing else seems to fit that description, don’t forget to bring it up with your GP.
That’s just a simple fact that there are many people with sleep apnoea at the same time. It can be managed well with proper interventions. You may discover, after finding out the causes and the possible solutions, that your feeling of being so tired all the time is going to change.
This article is general information only and isn’t medical advice. If you’re concerned about ongoing tiredness or sleep problems, speak with your GP.