The Quiet Sleep Thief You’ve Probably Never Considered
A common factor sabotaging midlife women’s sleep and future health
Christine, a postmenopausal woman in her early sixties, was getting a dental checkup when she received news that took her by surprise.
“Your airway is narrow,” the dentist said. “I think you should get a sleep test.”
Thinking this was a snoring man’s disease, she was shocked to discover she had mild sleep apnea.
Could this be behind her fatigue and morning headaches?
Every midlife woman needs to know sleep disordered breathing silently steals your sleep, and not enough people are talking about it.
Since we recently discussed heart disease differences between the sexes, let’s touch on sleep differences.
What’s really going on
In Christine’s view, sleep apnea was something that affected big, snoring men. She barely snored and had always been a good sleeper, even though lately she wasn’t feeling well rested.
We may not realize it, but our upper airway muscles are busy at work helping us swallow, speak, and breathe in a coordinated way. And like other muscles, they can get weak.
Sleep disordered breathing happens when our airway gets partially or completely blocked.
When we lay down to sleep, the soft tissues in the upper airway can change shape because of dilator and constrictor muscles.
The inability to recruit and coordinate these dilator muscles completely during sleep can cause the airway to narrow, resulting in arousal to keep us safe.
One of the most import is the tongue dilatory function—the genioglossus muscle (CG) - which helps to pull the tongue forward, so it doesn’t block the airway.
Christine didn’t realize that aging pause put her at risk for reduced activity of dilator muscles resulting in her narrow airway.
Differences between men and women
Women with sleep disordered breathing are less likely to report snoring and are more likely to complain of fatigue, low energy, depression/anxiety, morning headaches, nightmares, and insomnia.
According to sleep studies, women have a lower apnea-hypopnea index (AHI) and their episodes are shorter. Despite this lower AHI, the negative impact on health is considered the same.
Women are also at higher risk for upper airway resistance syndrome (UARS) which is when there are no apneas but an increased resistance in the upper away, causing arousal, low/normal oxygen saturation, and poor sleep (see differences below)
While men have sleep apnea more than women, after 50 women start catching up. This may at least partially be because of menopause as both estrogen, but especially progesterone, plays a role in respiratory function. However, the effects of hormone therapy remain unclear in research.
More midlife women have it than you think
The prevalence of sleep apnea varies with studies, but in postmenopausal women it ranges from 47 to 67%!
And it’s likely higher in women with insomnia.
A 2002 study with 394 postmenopausal women (55-70) with insomnia for six months examined sleep disordered breathing.
Besides the sleep test, subjects kept a 7-day sleep log, had cardiorespiratory monitoring during sleep, and ENT evaluation of their airway.
Only 68 of them had normal breathing during sleep, with most—82% - having sleep apnea (194) or UARS (62).
Thanks to the in-depth exam, they spotted more sleep breathing problems. For instance, a sleep test would miss 33% of them.
Other studies show a 29-67% link between insomnia and sleep apnea. And the gold standard treatment for insomnia, cognitive-behavioral therapy, has shown greater improvements when OSA treatment is included.
Yet 90% of women remained undiagnosed.
Understanding risk factors
Although aging pause itself is a risk factor for sleep disordered breathing, some of us may be more at risk.
For instance, in the study just mentioned, those with sleep disordered breathing were more likely to grind their teeth, have their wisdom teeth out earlier in life, have childhood asthma, and have upper respiratory allergy like allergic rhinitis.
Also important is the anatomical structure of the jaw and upper airway. Mouth breathing at night, whether due to nasal obstruction or habit, also contributes to airway narrowing and sleep apnea.
Aging and those weakened airway dilator muscles, snoring, lower hormones, large neck circumference (>16 inches in women), alcohol consumption, getting up frequently at night to urinate, and weight gain (more of a factor in men) are also risk factors.
Are the health consequences different for women?
Sleep disordered breathing negatively affects health for a variety of reasons. First, is the lighter, less deep sleep that occurs, which also affects quality of life.
We sleep better when we get enough oxygen. Once this is threatened, our nervous system goes on high alert. This makes sleep is less refreshing, and night wakings more frequent.
Second is the low oxygen levels or intermittent hypoxia that occurs. To compensate, the body modulates hypoxia-inducible factors (HIF) factors to help the body get used to lower oxygen environment.
The problem is, disruption of HIFs factors increase oxidative stress, disrupting the One Heath Principle.
The link between sleep apnea and cardiovascular disease is undeniable, but most of this research is on men.
Research shows that women may be more likely to develop cognitive issues and be at higher risk of dementia with sleep disordered breathing. This occurs more frequently the lower oxygen saturation declines.
A 2024 study in Sleep Advances looking at over 18,000 people with sleep disordered breathing showed that at every age level with known or suspected sleep apnea, women were more likely than men to be diagnosed with dementia.
And while this risk decreased in men with age, it increased with women with age.
Treatment differences
CPAP is the gold standard treatment for sleep-disordered breathing, but it is not always approved for mild cases, which are more common in women.
Another treatment option is a mandible advancement devise which is customized to fit in your mouth, helping to depress the tongue and open the airway. This device has proven more effective for mild-to-moderate sleep apnea. And women have been shown to do better on it.
Losing weight helps (but is always tricky), but it may be less effective for women than men.
Last and most intriguing is strengthening the muscles in both the upper and lower airway, referred to as “respiratory muscle therapy.”
Myofunctional/oropharyngeal exercises have been the focus of most research, strengthening the tongue and upper airway muscles.
Studies show this helps, but not as a stand-alone treatment. We need more options, or we need to start sooner.
From treatment to prevention
I’m a big prevention person and the sooner we protect airway health, the better. Ideally childhood, but at the very least midlife.
I interviewed breathing practitioner Louise Oliver who helps women change their breathing during the day, which she’s found helps them breathe better at night. Take a listen.
We’ve known that people who sing or play reed wind instruments have a reduced risk of sleep disordered breathing, as stated in this review:
This further supports the recent hypothesis that certain exercises that improve oral and oropharyngeal muscle tone will reduce airway collapsibility during sleep and decrease tongue fat deposition potentially playing a role as a treatment alternative for OSA
We really need more research, but until that comes, we need to know WE ARE ALL AT RISK.
“I have interacted with many people suffering from sleep apnea,” said Sheila, diagnosed with sleep apnea at a young age. “We don’t all fit in a box. We come from many socio - economic and educational backgrounds. From different age groups and sexes.”
Take control of your sleep health
There are simple things we can do to get checked out and strengthen our airway.
If you have any of these symptoms—especially being tired despite getting sleep and/or insomnia — get tested and visit an ENT to check any issues with your airway.
Snoring is a sign of a partially blocked airway and always merits testing.
Consider trying tools like mouth tape to help, but remember, getting checked first is the key. Why not consult a breathing practitioner like Louise Oliver?
And if you suffer from nasal allergies, exploring immunotherapy could make a world of difference.
You can also try products like REMplenish, a straw designed to strengthen your airway muscles as you drink water throughout the day. And don’t forget the power of strengthening your diaphragm—vital for better breathing, sleep quality, and overall health.
READ: Transform Your Health in Just 5 Minutes a Day
Too many women overlook the impact of a compromised airway on their sleep. But this is the sleep thief we often don’t see coming. It’s time to change that.
Let’s prioritize airway health in every conversation about sleep. Take action. Get tested. Start strengthening your airway.
But most of all, we need more awareness. And we need it now.
nformation in this post is meant to educate and not replace medical advice. Talk it over with your healthcare provider!