Sleep apnea is significantly underdiagnosed in women, and the menopause transition is a key risk period.
Why menopause increases risk: Progesterone is a natural respiratory stimulant. When progesterone levels drop after menopause, the brain's drive to breathe during sleep decreases. This makes the airway more likely to collapse, especially during REM sleep.
Prevalence: Affects up to 20% of women aged 50-70. The SWAN Sleep Study found that postmenopausal women had 2-3x higher risk of sleep-disordered breathing compared to premenopausal women.
Why it is missed in women: Women rarely present with the classic symptom of witnessed snoring. Instead, they report: fatigue, morning headaches, depression, brain fog, and insomnia. These are often attributed to menopause itself.
Diagnosis: Home sleep apnea testing is now widely available. An overnight oximetry or polygraphy study is sufficient for diagnosis.
Treatment: CPAP remains the gold standard. It dramatically improves sleep quality, daytime energy, blood pressure, and cognitive function. Weight loss and positional therapy can help mild cases.