Women’s Sleep Apnea Symptoms You Might Be Missing

Sleeping lightly? Have trouble focusing? Dr. Audrey Wells of Super Sleep MD points out that some women’s sleep apnea symptoms can be more subtle than men’s

If you’re female, the sleep apnea you might be experiencing could look completely different from what you’d expect. In fact, it might not involve obvious snoring, the classic symptom that most people—male and female—associate most strongly with obstructive sleep apnea (OSA).

This difference in how sleep apnea presents itself in women versus men is a critical health issue that can leave women undiagnosed and untreated. Understanding these differences could be the key to finally getting the restorative sleep your body needs and deserves, and to improving your overall health.

Photo: Karollyne Videira Hubert/Unsplash

Sleep apnea research has historically centered on men, partly due to what researchers considered complicating factors or influences attributed to women’s hormonal fluctuations. This male-centered approach has created significant gaps in our understanding of how sleep disorders manifest in women, from the design of screening questionnaires to sleep-test interpretations to treatment options.

The result? Women often don’t recognize their symptoms as potential signs of sleep apnea because they don't match the “textbook” male presentation of loud snoring and gasping for air.

“As with a heart attack, women and men can have totally different expressions of how they experience sleep apnea symptoms,” explains Dr. Audrey Wells. Wells, who is board-certified in sleep medicine and obesity medicine and is founder of Super Sleep MD, says she sees this disparity regularly in clinical practice. This analogy is particularly apt: just as women’s heart attack symptoms were long overlooked because they differed from men’s, women’s sleep apnea symptoms deserve the same recognition and clinical attention.

The Subtle Signs of OSA in Women

For women, especially those in midlife and beyond, sleep apnea symptoms tend to be more nonspecific and can easily be mistaken for other issues. Here are some signs to watch for:

Light, restless sleep

“Women may describe light sleep instead of waking up gasping for breath, for example,” said Dr. Wells. If you frequently feel like you’re sleeping lightly or find yourself tossing and turning throughout the night, this could be a sign that your breathing is being disrupted.

Self-reported Insomnia or long stretches of sleeplessness during the night

Rather than having trouble falling asleep initially, Dr. Wells said, many women with sleep apnea experience extended periods of wakefulness in the middle of the night. “They might describe a prolonged nighttime awakening, and that's their primary frustration, instead of trouble getting to sleep at the beginning of the night,” Dr. Wells said. “Women also will tell me they have insomnia, but that can mask as something else. It can be a movement disorder or a problem with breathing.”

Morning fatigue and daytime sleepiness or “brain fog”

Because women’s nighttime symptoms are often more subtle, daytime effects can be more prominent indicators. These can include

●      Persistent morning fatigue after seemingly adequate sleep time

●      Difficulty concentrating or “brain fog”

●      Mood changes or irritability

Women’s sleep apnea symptoms tend to be more non-specific that men’s, Dr. Wells says. But classic sleep apnea symptoms like snoring or gasping during sleep can affect women as well as men, so it’s still good to be mindful of those, too.

Factors Affecting Sleep Quality

While hormonal fluctuations throughout a woman’s lifespan—including menstrual cycles, pregnancy, and perimenopause and menopause—certainly affect sleep quality, social factors play a significant role, too, including

●      Caregiving responsibilities that create unpredictable and fragmented sleep

●      Cognitive burden from managing household and family logistics

●      Stress that can keep minds active during nighttime awakenings

●      “Revenge bedtime procrastination,” when one stays up late to claim personal time they couldn't find during the day

These psychosocial factors can contribute to sleep problems, and they can complicate the recognition of underlying sleep disorders like sleep apnea.

When to Seek Help

Don’t wait for those “classic” symptoms to seek medical evaluation. Consider professional help if

●      Sleep issues persist for more than three months

●      Daytime function is impacted due to sleep problems

●      You have any signs of sleep apnea, including snoring, gasping, or high blood pressure, especially if you’re in perimenopause or menopause

●      You’re experiencing what feels like chronic insomnia

Sleep should be screened periodically, similar to other preventive health measures like colonoscopies or mammograms. There’s a wide range of treatment options available, but they require proper diagnosis and personalized approaches. And sometimes “layering” more than one therapy can be more effective, so Dr. Wells suggests consulting a board-certified sleep medicine physician to determine the course of action that’s right for you. You can find a directory of accredited sleep centers at the American Academy of Sleep Medicine’s sleepeducation.org/sleep-center. 

Make Sleep a Priority: It’s Essential Healthcare, Not a Luxury

Dr. Wells says it’s time to reframe how we all think about sleep. “I’m always a big advocate for women to really see sleep and sleep health as a form of self-care,” Dr. Wells said. This isn’t about indulgence; it’s about recognizing sleep as a fundamental biological need and essential healthcare. Prioritizing a healthy sleep strategy is one of the best choices you can make for your physical and mental health. Your sleep quality has the power to improve your daily well-being and protect your health and independence in the long term

“Women don’t have the same sleep symptoms that men do, but their symptoms are just as valid,” Dr. Wells explained. “I would really just open an invitation up for all women to see what can be done about improving their sleep quality.”