Sleep Apnea in Women

Sleep apnea has long been considered a condition that primarily affects men. While it is true that men are diagnosed at higher rates, research increasingly shows that sleep apnea in women is more common than previously believed — and the gender gap may be smaller than thought because women are underdiagnosed.

The main reason for underdiagnosis is that women often present with different symptoms than the classic sleep apnea profile. While men typically present with loud snoring, witnessed breathing pauses, and excessive daytime sleepiness, women are more likely to report:

• Chronic fatigue rather than classic sleepiness
• Insomnia — particularly difficulty staying asleep rather than falling asleep
• Morning headaches
• Mood changes, including depression and anxiety
• Brain fog and difficulty concentrating
• Restless legs or nighttime restlessness
• Frequent nighttime urination
• Heart palpitations at night

These symptoms overlap with many other conditions, which is why sleep apnea in women is often overlooked. Learn more about these individual symptoms: daytime fatigue, brain fog, and morning headaches.

In addition to the atypical symptoms listed above, women with sleep apnea may experience warning signs that are easy to dismiss or attribute to other causes:

• Waking up feeling unrefreshed despite adequate sleep time
• Difficulty maintaining sleep — waking frequently during the night
• Vivid or disturbing dreams, which can result from oxygen deprivation
• Night sweats not related to menopause
• Dry mouth upon waking
• Acid reflux or GERD symptoms, particularly at night
• Unexplained weight gain or difficulty losing weight
• High blood pressure, particularly resistant hypertension

Many women attribute these symptoms to stress, aging, hormonal changes, or being overworked. While these factors can contribute, a cluster of these symptoms — particularly if they persist — may indicate sleep-disordered breathing.

Hormones play a significant role in sleep apnea risk for women. The female hormones estrogen and progesterone have protective effects on breathing during sleep:

• Progesterone stimulates breathing and helps maintain respiratory drive during sleep
• Estrogen helps maintain muscle tone in the airway
• Both hormones decrease significantly after menopause, increasing sleep apnea risk

Key hormonal life stages that affect sleep apnea risk:

Pregnancy: Weight gain, hormonal changes, and nasal congestion during pregnancy can narrow the airway and increase sleep apnea risk, particularly in the third trimester. Sleep apnea during pregnancy is associated with risks including gestational hypertension, preeclampsia, and gestational diabetes.

Menopause: The decline in estrogen and progesterone after menopause significantly increases sleep apnea risk. Postmenopausal women have 2–3 times higher rates of sleep apnea than premenopausal women. Hot flashes and night sweats during menopause can also be confused with — or worsened by — sleep apnea symptoms.

Polycystic Ovary Syndrome (PCOS): Women with PCOS have higher rates of sleep apnea, likely due to hormonal imbalances, higher testosterone levels, and associated weight gain.

Learn more about sleep apnea and metabolic health in our weight gain guide and diabetes guide.

Women with sleep apnea face significant diagnostic delays compared to men. Studies show that women are more likely to be misdiagnosed with other conditions before eventually being diagnosed with sleep apnea. Common misdiagnoses include:

• Depression or anxiety — because mood changes are a prominent symptom in women
• Insomnia — because women with sleep apnea often report difficulty staying asleep
• Chronic fatigue syndrome or fibromyalgia — because of persistent, unexplained fatigue
• Hypothyroidism — because fatigue, weight gain, and mood changes overlap
• Menopausal symptoms — because hot flashes, night sweats, and sleep disturbances overlap
• Stress or burnout — because the atypical symptoms are attributed to lifestyle factors

Several factors contribute to delayed diagnosis:

• Healthcare providers may not screen women for sleep apnea as readily as men
• Women may not report snoring because they are unaware of it or embarrassed
• Sleep apnea screening questionnaires were developed based on male symptom profiles
• Women may be prescribed antidepressants or sleep medications instead of a sleep study
• The stereotype of sleep apnea as a 'middle-aged overweight man' condition persists

If you are a woman experiencing persistent fatigue, mood changes, sleep difficulties, or other symptoms described on this page — and especially if these symptoms have been attributed to depression, anxiety, stress, or hormones — consider asking your healthcare provider specifically about sleep apnea. A sleep study can determine if sleep-disordered breathing is the underlying cause. You can also start with our sleep apnea assessment.

Understanding the health risks of untreated sleep apnea is particularly important for women, as the cardiovascular and metabolic consequences may be even more significant than in men.