Menopause and the Higher Risk of Sleep Apnea in Women

Women are protected against sleep apnea throughout much of their lives, but the advent of menopause marks the beginning of an increased risk for the disorder. How does menopause affect the higher risks of snoring and sleep apnea in women? What symptoms that might be attributed to hormonal changes, menopause, or simply “getting older” may be linked to obstructive sleep apnea instead? Learn about these issues and decide whether your sleep needs further evaluation.

Senior man lying on bed and covering his ears with pillow
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What Is Menopause?

By definition, menopause is the absence of menstrual periods in women for 12 consecutive months. It marks the end of fertility and occurs when the ovaries no longer produce the hormones estrogen and progesterone. In the United States, the average age of the onset of menopause is 51 years. In some women, it starts as early as age 40 or as late as age 55. A woman will most likely develop menopause around the same time as her sisters or mother. It may also start artificially early with a hysterectomy and simultaneous removal of both ovaries (oophorectomy).

Symptoms of Menopause Overlap With Sleep Apnea

There are symptoms that occur commonly just before menopause, during perimenopause, or as part of menopause itself. Some of these symptoms include:

  • Irregular periods (varying frequency or intensity)
  • Hot flashes or hot flushes (feeling warm with skin redness and sweating)
  • Trouble sleeping (insomnia, night sweats, daytime sleepiness)
  • Poor concentration or memory loss
  • Mood changes or mood swings (irritability, tearfulness)
  • Vaginal and urinary problems (dryness, infections, incontinence)
  • Decreased sexual interest or discomfort
  • Joint or muscle pain
  • Osteoporosis
  • Weight gain

Interestingly, many of these symptoms can also occur with sleep disorders. Difficulty falling or staying asleep at night may represent insomnia. Frequent nighttime awakenings may also be a sign of obstructive sleep apnea. Moreover, night sweats, daytime sleepiness, depressed mood, and cognitive complaints like poor concentration or problems with short-term memory can also occur in sleep apnea. Because of this overlap, it is important to recognize the additional potential symptoms of sleep apnea.

Further Symptoms of Sleep Apnea

Beyond those symptoms described above, there are other signs of sleep apnea. The most common include loud snoring, witnessed pauses in breathing, and episodes of gasping or choking out of sleep. Just because these aren't observed, doesn't mean that sleep-disordered breathing is not occurring.

These events cause sleep fragmentation and this can lead to unrefreshing sleep, daytime sleepiness, and naps. In addition, dry mouth at night, grinding or clenching of teeth, and frequent urination at night may also occur. Weight gain and loss of muscle tone, a common part of aging, can also make sleep apnea worse.

Too often women attribute their difficulties to hormonal changes or to the fact that they are just getting older. Fortunately, the symptoms that occur due to sleep apnea will resolve with effective treatments like continuous positive airway pressure (CPAP) or the use of an oral appliance.

How Menopause Increases Sleep Apnea

Higher levels of estrogen and progesterone protect women prior to the onset of menopause. These hormones maintain the airway's muscle tone and keep it from collapsing. However, as these levels decline during perimenopause and drop to their lowest levels as part of menopause, the incidence of sleep apnea climbs.

In a study of women of different age groups, the prevalence of moderate to severe obstructive sleep apnea (AHI >15 events per hour) increased from 0.6% in those 20 to 44, to 2% in those 45 to 64, and to 7% in those 61 to 100.

Before attributing this increase to aging alone, consider the role of hormones. The prevalence of sleep apnea was lowest in pre-menopausal women at 0.6%, intermediate in those post-menopausal women on hormone replacement therapy (1.1%), and highest in post-menopausal women not on hormone replacement at 5.5%.

Need for Further Evaluation With a Sleep Study

If you are concerned that some of your menopause symptoms may instead be due to sleep apnea, you should speak with your healthcare provider about getting a proper evaluation. It can be helpful to speak with a sleep specialist and have a diagnosis made with a sleep study.

As mentioned above, there are effective treatments available for sleep apnea that may relieve some of the symptoms that make menopause more difficult than it has to be.

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  • Bixler EO et al. “Prevalence of sleep-disordered breathing in women: effects of gender.” Am J Respir Crit Care Med 2001;163:608–613.
  • Punjabi, NM. “The Epidemiology of Adult Obstructive Sleep Apnea.” Proceedings of the American Thoracic Society. 2008;5(2):136-143.
  • “Menopause.” Office on Women’s Health, U.S. Department of Health and Human Services.

By Brandon Peters, MD
Brandon Peters, MD, is a board-certified neurologist and sleep medicine specialist.