menopause and sleep apnea

Were you diagnosed with sleep apnea once you reached menopause? Did you begin to experience symptoms of sleep apnea once your periods stopped?

Although women can develop sleep apnea prior to reaching menopause, symptoms of this sleep disorder are more likely to appear in women in menopause. Some experts have looked into the relationship between menopause and sleep apnea and here's what we know thus far.

What is sleep apnea?

This sleep disturbance is a potentially serious condition in which a person's breathing stops and starts repeatedly throughout the night. These interruptions can occur several to 30 or more time an hour all night long.

Read about menopause and sleep problems

The most common type of sleep apnea is obstructive sleep apnea (OSA), which occurs when the muscles in the back of the throat relax. This blocks the flow of air into the lungs, which in turn can reduce the oxygen level in your blood. The brain recognizes that you are having difficulty breathing and wakes you up briefly so you can reopen your airway. These awakenings are typically so brief you don't remember them. However, you may also choke or gasp, which may wake you up.

Risk factors for OSA include:

• Overweight/obesity
• Older age
• Family history of sleep apnea
• Presence of certain medical conditions, such as congestive heart failure, type 2 diabetes, polycystic ovary syndrome (PCOS), asthma or other lung conditions, high blood pressure, or hormonal disorders
• Use of sedatives, tranquilizers, or alcohol
• Smoking
• Nasal congestion because of allergies or structural abnormalities
• Having a thick neck (which may be accompanied by narrower airways)

How is sleep apnea associated with menopause?

Men are two to three times more likely to develop sleep apnea than women. However, this changes once women reach menopause. It's been known for a while that the prevalence of obstructive sleep apnea is greater among women in menopause. This has been believed to be linked to fluctuations in hormone balance that occurs beginning in perimenopause and beyond. A group of researchers set out to explore this idea in a population-based study that involved 774 women aged 40 to 67 years from seven countries. The results were published in June 2022.

Here's what the researchers found:

• A doubling of serum concentrations of estrone and progesterone was associated with a 19 percent and 9 percent decreased odds of snoring, respectively.
• Among women who snored, a doubling of concentrations of 17B-estradiol (the main female sex hormone), estrone, and estrone 3-sulfate was associated with an 18 percent, 23 percent, and 17 percent decline, respectively, in the odds of irregular breathing.
• A doubling of progesterone concentration was associated with a 12 percent decreased odds of waking up abruptly with a choking episode.

The authors of the study concluded that middle-aged women who had low serum levels of estrogen and progesterone are more likely to experience snoring and symptoms of obstructive sleep apnea.

Signs and Symptoms of Sleep Apnea

If you sleep you may not know you have sleep apnea. If you have a sleep partner, they may tell you that you snore loudly. Some of the other signs and symptoms of sleep apnea are:

• Loud snoring: although this isn't always a sign of sleep apnea it should be investigated.
• Waking up gasping or chocking. This can be because you have stopped breathing briefly and it's your body's way of restarting your breathing.
• Excessive daytime sleepiness: This can include dozing off at work or while driving.
• Morning headaches
• Dry mouth or sore throat
• Attention difficulties and forgetfulness
• Insomnia
• Mood swings and irritability
• High blood pressure
• Sudden drops in blood oxygen

Read about why does menopause affect my sleep?

How sleep apnea is diagnosed, and what treats it

Sleep apnea is diagnosed with a sleep study, either overnight in a lab or with a home sleep apnea test. It is not something you can grade for yourself. Screening questionnaires such as STOP-BANG are useful, but all they tell you is whether you should be tested. They do not tell you how severe your sleep apnea is, and a low score does not rule it out.

For moderate to severe obstructive sleep apnea, CPAP is the first-line treatment. It is a small machine that holds your airway open with a steady flow of air while you sleep. There are other options, including oral appliances and surgery, and the sleep study is what tells your doctor which one fits.

If you are falling asleep during the day, and especially if you have dozed off at the wheel, get assessed now rather than later. That is not something to work on at home first.

The menopause link here is real. The risk of obstructive sleep apnea rises after menopause, which is one reason snoring and broken nights can turn up in these years for the first time. It is a reason to get tested, not a reason to wait it out.

What helps alongside treatment

None of this replaces a diagnosis or treatment. These are things that can sit beside it and help with some of what makes breathing worse at night:

• Lose weight
• Stop smoking
• Change your sleep position. According to Kirstin Knobbe, MD, a sleep specialist at Banner University Medical Center Phoenix, sleeping on your side with your back mostly straight "is the best sleep position as it reduces apnea severity and snoring." Be sure to choose a pillow that allows you to keep your back and neck straight.
• If you have nasal allergies, a saline nasal rinse can help you breathe more easily at night. One rule matters here and it is not optional: never use untreated tap water for nasal rinsing. Use distilled or sterile water, or tap water that has been boiled for at least one minute and then cooled. The National Center for Complementary and Integrative Health points to two deaths in Louisiana from a brain infection linked to nasal rinsing with untreated tap water. Rinse the device after each use and let it air dry.
• Some yoga poses can improve respiratory strength and improve oxygen levels.
• Researchers have seen a link between low magnesium levels and obstructive sleep apnea. They found that sleep deprivation, which is a consequence of sleep apnea, seems to deplete magnesium levels among people with this sleep disorder.
• If the air is dry, use of a humidifier at night can open your airways, support clearer breathing, and reduce congestion. You might want to add a few drops of peppermint, eucalyptus, or lavender essential oil to the humidifier. These essential oils have anti-inflammatory properties.

A correction we owe you. This page used to recommend butterbur supplements for nasal allergies, with a link to buy them. We have removed the recommendation and the link. Raw butterbur contains pyrrolizidine alkaloids, which the National Center for Complementary and Integrative Health says can damage the liver, the lungs and blood circulation, and may cause cancer. Some countries have withdrawn butterbur products for that reason. If you have been taking butterbur because of this page, stop, and mention it to your doctor.

When to see your doctor

If you have symptoms of sleep apnea, ask your doctor about a sleep study rather than waiting to see whether things improve. The study is what shows whether you have it and how severe it is, and a treatment plan follows from that. If you are dozing off during the day, and above all if it has happened while driving, say so when you call, because that moves you up the list.

Bottom line

Obstructive sleep apnea is more common among women once they reach menopause. If the signs are there, get a sleep study rather than guessing at how bad it is. Treatment works, and the habits above sit alongside it rather than instead of it.