The Menopause

Why is sleep apnoea more common in menopause?

Night sweats, stress, and lower melatonin levels can play havoc with our sleep during menopause. But our chances of developing sleep apnoea also increase at this time of life too.

Sleep apnoea is a disorder where we repeatedly and briefly stop breathing during sleep. One study revealed that sleep apnoea becomes more common in women after menopause, with up to two-thirds of post-menopausal women experiencing the condition.

Getting treatment goes beyond ensuring a good night’s rest – sleep apnoea can also increase our risk of developing serious health conditions, including stroke, heart disease, diabetes and clinical depression.

What is sleep apnoea?

There are three types of sleep apnoea, with obstructive sleep apnoea (OSA) being the most common.

“OSA is where the airway becomes blocked, and breathing can stop briefly during sleep, only to suddenly restart again when your brain realises it’s missing oxygen,” explains Dr Zoe Schaedel, a menopause and sleep expert. She says it’s natural for our throat muscles to relax during sleep, but sleep apnoea causes them to close completely.

Not everyone with sleep apnoea is aware of pauses in their breathing. Some wake up fully, whereas others don’t.

“Either way, each time your breathing stops, this will lead to a micro-arousal reducing the quality (and quantity) of your sleep,” says Dr Kat Lederle, a sleep and circadian rhythm specialist.

Experts believe that up to 90% of people with sleep apnoea don’t know they have it – meaning it goes untreated. However, other symptoms and signs could offer clues that something is awry. These include:

Snoring, choking, or gasping during sleep
Having a dry mouth in the morning
Nightmares
Increased anxiety or low mood
Daytime fatigue, even after spending a full night in bed
Brain fog and poor concentration
Headaches
Loss of libido

Unfortunately, many of these overlap with menopause symptoms. “Many women struggle for years without a diagnosis,” says Zoe.

Why does menopause increase our sleep apnoea risk?

Earlier on in life, men are known to experience sleep apnoea in higher numbers compared to women.

“The risk of sleep apnoea is similar between two genders after the menopause,” says Dr Susanna Ng, a consultant in respiratory and sleep medicine.

So what’s happening during this midlife transition to drastically impact our sleep and breathing? Two key factors may be at play…

Hormones

The first – and most notable – is the impact of hormonal changes. Susanna says that oestrogen and progesterone are considered to have a ‘protective effect’ on our upper airways, keeping them open during sleep.

“The decline in these hormones during menopause is associated with increased collapsibility of the airway as the muscles become less responsive,” she explains.

Research shows that women who experience hormone-related menopause symptoms are at higher risk of sleep apnoea. For instance, one study revealed that women with severe night sweats and hot flashes were associated with a mid-to-high risk of OSA.

A large study of over 50,000 women also found that those who experienced early menopause or surgical menopause had a greater risk of OSA – with the researchers highlighting the role that abrupt hormonal changes can have in the development of apnoea.

Weight

The second factor that can increase the likelihood of sleep apnoea is our weight.

By the end of menopause, the average woman will weigh an additional 10kg, with visceral fat accounting for 10-15% of their total body weight (an increase from 5-8% pre-menopause). Kat says obesity is a common factor in the development of sleep apnoea, as increased weight can encourage the muscles in our upper airway to collapse.

Susanna adds that, during menopause, our fat distribution changes. “More fat accumulates around the abdomen and neck, contributing to airway collapsibility and obstruction,” she says.

Why it’s important to treat sleep apnoea

Sleep apnoea is associated with some serious health concerns, meaning it’s essential to treat.

“It is a major risk factor for cardiovascular disease, increasing the likelihood of high blood pressure, heart attacks, and stroke,” says Zoe. Heart disease is the leading cause of death among women in the UK, and having OSA raises heart failure risk by 140% and risk of stroke by 60%.

Zoe also reveals that OSA is also associated with type 2 diabetes (potentially due to the impact of disrupted sleep on glucose metabolism) and depression. Research indicates that those with mild OSA are twice more likely to develop depression, while those with moderate to severe OSA face a 2.6 times greater risk.

Aside from health conditions, sleep apnoea can greatly impact our day-to-day quality of life.

“Because OSA leads to sleep fragmentation, it lowers the quality and quantity of your sleep,” shares Kat. “This impacts your mood and therefore your relationships. It also affects your cognitive abilities, including your attention – this matters for work and your ability to drive safely.”

Experiencing disrupted sleep or feeling excessively tired in the day can be signs that we need to speak with a doctor. Zoe says the disorder is usually diagnosed through a sleep study, which involves monitoring our sleep and oxygen levels overnight at home or at a clinic.

What treatments are available for sleep apnoea?

“To treat this condition appropriately, a correct diagnosis is very important,” says Susanna.

The main and most effective approach involves using a continuous positive airway pressure (CPAP) machine. “CPAP is the gold standard treatment of sleep apnoea,” states Susanna. “It prevents the airway from narrowing and obstructing breathing.”

CPAP treatment involves wearing a mask over the nose or nose and mouth, with air delivered to the mask from the machine via an attached hose. “Using the device, the person will not snore or stop breathing,” Susanna says.

Another popular approach involves the use of ‘oral appliances’.

“These specially designed mouthpieces help reposition the jaw to keep the airway open,” says Zoe. They can be an option for mild-to-moderate sleep apnoea cases. Research suggests that, while oral appliances aren’t as effective as CPAP for treating OSA, they’re better tolerated by patients.

Finally, lifestyle changes can make a big difference, too. “Weight loss, regular exercise, avoiding alcohol, and sleeping on your side can significantly improve symptoms,” says Zoe.

Susanna agrees, noting that a patient’s apnoea hypopnea index (the number of times a person stops breathing per hour during sleep) usually decreases following weight loss.

One study linked 10% weight loss to a 26% reduction in the apnoea hypopnea index. “Patients are always recommended to carry out a healthy lifestyle with the aim of approaching a normal and healthy body mass index,” Susanna says.

Words: Chantelle Pattemore