Sleep Apnea Symptoms in Women: How They Differ and Why It's Often Overlooked

Sleep apnea is characterized by repeated interruptions in breathing during sleep, leading to poor sleep quality and various health issues. The most common type, obstructive sleep apnea (OSA), occurs when the muscles in the throat relax excessively, blocking the airway. This results in disrupted sleep patterns, loud snoring, and episodes of gasping or choking during sleep.

One of the main reasons sleep apnea is often overlooked in women is that the symptoms can differ significantly from those seen in men. For example, while loud snoring and observable apneas (breathing pauses) are common in men, they are less frequent or less prominent in women.

When loud snoring does occur in women, it can still be a sign of sleep apnea and should prompt evaluation by a healthcare provider. However, many women with sleep apnea do not snore at all.

More often, symptoms in women are subtler and less “classic,” which contributes to delayed or missed diagnosis.

These symptoms may include:

1. Fatigue and Insomnia: Unlike men, who often report excessive daytime sleepiness, women with sleep apnea may be more likely to experience chronic fatigue or difficulty staying asleep. This can be mistakenly attributed to stress, depression, or other non-apnea sleep disorders.
2. Headaches: Morning headaches are a common symptom in women with sleep apnea. These headaches are caused by blood oxygen deprivation during sleep and a subsequent increase in blood pressure.
3. Mood Disturbances: Women with sleep apnea often report mood swings, irritability, trouble concentrating, and symptoms of anxiety and depression. These symptoms can be misdiagnosed as solely psychological and mental health issues, even as extreme as PTSD. However, this leads to a delay in recognizing the underlying sleep disorder.
4. Frequent Nighttime Urination (Nocturia): Women with sleep apnea may wake up frequently during the night to urinate. This symptom is less commonly reported by men and can easily be attributed to other health issues.
5. Lowered Pain Threshold: Research suggests that women with sleep apnea may have a lower pain threshold, leading to increased sensitivity to pain and chronic pain conditions.

Some women also report physical nighttime symptoms—such as night sweats, leg cramps, or restless legs—that reflect fragmented sleep rather than classic breathing-related signs.

Early signs of sleep apnea in women often show up gradually and may be easy to dismiss at first. Rather than appearing as dramatic breathing interruptions, they tend to present as subtle but persistent changes—such as worsening sleep quality, increasing daytime fatigue, or shifts in mood or cognitive sharpness that don’t resolve with rest.

When these changes develop over time or begin to interfere with daily life, they can signal the early stages of sleep apnea and warrant closer attention, even if classic symptoms are absent.

Sleep apnea risk factors common to men and women

Some risk factors for obstructive sleep apnea are shared across all people, and some are unique to women. Understanding these can help in early identification and management of the condition.

Some risk factors common to both men and women include the following:

• Excess weight, especially around the neck and throat, as measured by increased neck circumference, can increase the likelihood of airway obstruction during sleep.
• Family history is another important factor. If sleep apnea runs in your family, you may be more predisposed to developing it.
• Certain sleep positions, such as sleeping on your back, can cause the tongue and soft palate to relax and obstruct the airway, increasing the risk of obstructive sleep apnea.
• The use of alcohol or other sedatives can lead to the relaxation of tongue and throat muscles and increase the likelihood of airway obstruction.
• Smoking is another risk factor, as it can cause inflammation and fluid retention in the throat, leading to airway obstruction.
• Age: Although sleep apnea can occur at any age, it becomes significantly more likely starting in middle age.

Sleep apnea risk factors unique to women

Risk for women is especially connected to age because menopause drives hormonal changes, which further accelerate obstructive sleep apnea risk. Pre-menopause, men have an increased likelihood of sleep apnea, but this difference largely disappears post-menopause.

Other hormonal changes due to pregnancy and conditions like polycystic ovary syndrome (PCOS) can also elevate sleep apnea risk.

By being aware of these risk factors, women can take proactive steps to manage their health and reduce the likelihood of developing sleep apnea.

The underdiagnosis of sleep apnea in women can be attributed to several factors:

1. Atypical Symptoms: As mentioned, women often present with symptoms that are not most commonly associated with sleep apnea, making it harder for healthcare providers to recognize the condition.
2. Misconceptions Among Healthcare Providers: There is still a prevailing stereotype that sleep apnea is a "man's disease." This bias can lead healthcare providers to overlook the possibility of sleep apnea in female patients, especially if they do not exhibit "classic" symptoms such as loud snoring or observed apneas.
3. Hormonal Differences: Hormonal changes throughout a woman's life, including during pregnancy and menopause, can influence sleep patterns and exacerbate sleep apnea. However, these changes are often attributed to the hormonal shifts themselves rather than a sleep disorder.
4. Lack of Awareness: Many women are not aware that their symptoms could be related to sleep apnea. This lack of awareness can delay seeking a diagnosis and treatment.

When sleep problems persist or feel out of proportion to what you’d expect, it may indicate an underlying sleep disorder rather than temporary poor sleep.

Rather than focusing on any single symptom, it’s more helpful to ask whether ongoing sleep disruption is affecting your daytime functioning. It hasn’t improved despite addressing common explanations like stress, hormones, or lifestyle changes.

Sleep apnea becomes more likely when those concerns occur alongside known personal risk factors, including:

• Changes in weight or body composition
• Family history of sleep apnea
• Hormonal shifts related to menopause, pregnancy, or conditions like PCOS
• Regular alcohol or sedative use
• Sleeping primarily on your back

Ultimately, sleep apnea cannot be confirmed solely by symptoms. A sleep study — conducted either at home or in a sleep laboratory — is the only way to determine whether breathing interruptions occur during sleep and whether treatment is necessary.

Ignoring sleep apnea can lead to a cascade of health issues that significantly impact a woman’s well-being. One of the most serious consequences is cardiovascular disease. Sleep apnea can increase the risk of heart disease, high blood pressure, and stroke, making it crucial to address the condition promptly.

Type 2 diabetes is another potential consequence. The disrupted sleep patterns and oxygen deprivation associated with sleep apnea can impair glucose metabolism, increasing the risk of developing diabetes. Cognitive impairment is also a concern, as sleep apnea can affect memory, concentration, and overall cognitive function.

Mood disorders are common among women with untreated sleep apnea. The condition can exacerbate symptoms of depression and anxiety, further diminishing the quality of life. Excessive daytime sleepiness is another hallmark of untreated sleep apnea, leading to fatigue that can interfere with daily activities.

Recognizing these potential consequences underscores the importance of seeking sleep apnea diagnosis and treatment to protect health and well-being.

At Daybreak, we understand the unique challenges women face in getting an accurate diagnosis of sleep apnea. That’s why we offer a complete and convenient at-home sleep study and diagnosis, as well as a sleep apnea mouthguard treatment option. Our approach allows you to monitor your sleep in the comfort of your home, providing an accurate representation of your sleep patterns and making it easier to identify issues like sleep apnea.

Treating sleep apnea can involve both lifestyle changes and medical interventions and should be tailored to the individual’s needs. One of the most common treatments is continuous positive airway pressure (CPAP) therapy. This device delivers a constant flow of air pressure to keep the airway open during sleep, significantly improving sleep quality and reducing apnea episodes.

Oral appliances (such as the ones provided by Daybreak), such as mandibular advancement devices, are another option. These devices gently advance the lower jaw, keeping the airway open and reducing snoring and apneas. Lifestyle changes can also play a crucial role in managing sleep apnea. Weight loss, regular exercise, and quitting smoking can all help reduce the severity of the condition.

In some cases, surgery may be necessary to remove excess tissue or correct anatomical abnormalities contributing to sleep apnea. Procedures can range from minimally invasive techniques to more complex surgeries, depending on the individual’s specific needs.

Finally, lifestyle changes can be highly effective as well, especially in mild sleep apnea or moderate sleep apnea cases. Weight loss and exercise can be highly effective in individuals with a higher BMI, and changing sleep position away from supine (sleeping on the back) can make a big difference for almost anyone. If a person consumes alcohol (or other sedative) on a regular basis, reducing their intake almost always yields positive results.

By exploring these OSA treatment options and finding the right path, women can effectively manage sleep apnea and improve their overall health and quality of life.

Sleep apnea is a serious sleep disorder that can have significant consequences for women’s health. By understanding the risk factors, consequences, and treatment options for sleep apnea, women can take proactive steps to protect their health and improve their quality of life. If you suspect you may have sleep apnea, a sleep study (either an at-home sleep study or in-lab) is an excellent first step towards better health.

At Daybreak, we are committed to helping women navigate the complexities of sleep apnea with comprehensive at-home diagnosis and treatment options. Don’t let sleep apnea go undiagnosed and untreated - complete our 30-second assessment to take control of your health and well-being.