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Natural Awakenings Greater Boston - Rhode Island

Obstructive Sleep Apnea : An Often-Missed Diagnosis in Women

Apr 30, 2019 12:00AM ● By Amparo David

According to the American Academy of Sleep Medicine, it is estimated that as many as 26 percent of adults ages 30 to 70 have obstructive sleep apnea (OSA). Women are less often diagnosed with sleep apnea than men. Though men are only twice as likely to have OSA, they are diagnosed eight times more than women. Women are under-diagnosed and under-served for this condition. With this knowledge, patients and doctors can improve the quality of life for women.

There are a few factors that lead to the underdiagnoses or misdiagnoses of female sleep apnea patients, starting with the perception of what a sleep apnea patient should look like. Many people picture someone with OSA to be an overweight, older male with a thick neck and a loud snore. Though these attributes are risk factors, they do not offer a complete picture of OSA patients. These preconceived ideas about the appearance of an apnea patient may cause a doctor to overlook symptoms when the patient doesn’t fit the stereotype.

The truth is that sleep apnea affects many different people, including those of normal weight, any gender or age, and some who don’t even snore. Women are less likely to report loud, chronic snoring. Their snoring is often much lighter and breathing problems are less noticeable. Apnea events for women are shorter and happen less frequently.

Symptoms for Women with OSA

Women with OSA are more likely to report night time symptoms of insomnia, restless leg syndrome, waking often or frequent trips to the bathroom at night. Daytime symptoms of OSA in women often include mood symptoms, such as feeling depressed, anxious, irritable, impatient and constant fatigue. They may struggle to stay awake or may fall asleep in inappropriate places, like at work or in public. Mental effects of sleep apnea are forgetfulness, foggy thinking and difficulty concentrating.

The source of a woman’s OSA symptoms can be misdiagnosed because of the overlapping symptoms associated with hormone changes and depression. Women are more likely to be prescribed prescription medications (such as antidepressants or hormone replacement therapy) rather than a sleep study for further testing. Complicating matters is women's answers to certain questions may mislead a clinician to assume the problem is insomnia because they report how they feel when they are trying to get to sleep, and it makes it sound like insomnia instead of sleep apnea.

Hormone changes after menopause not only increase the likelihood of sleep apnea, but the symptoms of the OSA are often disregarded as the effects of menopause or simply, “getting older”. Obstructive sleep apnea affects women indirectly as well. Studies have shown that suffering from OSA in one partner is associated with higher levels of stress and depression in both partners. Women may be more sensitive to both soothing and stressful effects of co-sleeping. Spouses of snorers are more frequently affected by sleep-related problems (insomnia, morning headache, daytime sleepiness and fatigue), regardless of sleep situation (co-sleeping or separate bedrooms). Use of CPAP in treating OSA improves the quality of life in both partners.

Dr. Amparo M. David, DMD, has her own practice, Dentistry by Dr. David, located at 563 Main St., Bolton, where she practices general and cosmetic dentistry and orthodontics. She also has completed a residency in dental sleep medicine and sleep apnea and is able to assist some of her patients with this common problem. For more information, call 978-779-2888 or visit

Diagnosis and Treatment of Obstructive Sleep Apnea

If you have symptoms that could be related to sleep apnea, talk to your doctor. Be sure to let them know that you would like a sleep study to rule out a sleep disorder or obstructive sleep apnea. If you do receive a diagnosis of obstructive sleep apnea, some treatment options may include CPAP, a sleep apnea oral appliance, orofacial myofunctional therapy, nutrition and weight loss, release of tethered oral tissues, an evaluation with an ENT, laser therapy for lax palatal tissue (Nightlase), vitamin supplementation or any combination of these treatments.