When most people think of loud snorers, an image of a man typically comes to mind, and there is evidence to back this up: men are more frequently diagnosed with sleep apnea, a condition often characterized by loud, persistent snoring. But as it turns out, the reason that men are more frequently diagnosed with this condition is complicated. Why is the science and perception of sleep apnea and snoring in women so out of sync? And how can women find out if they have this condition and get the treatment they need? It would be unfair of us to move forward without acknowledging the fact that there are reasons for this outside of biology.
Healthcare Disparities
Science-backed disparities exist when it comes to medical treatment for men versus women. As one example, women have a 50% higher chance of being misdiagnosed when it comes to heart disease and stroke compared to men. Why? Well, according to University of Leeds professor, Chris Gale, it’s because heart attacks are commonly viewed as a “male issue.”
Unfortunately, even when it comes to “women’s issues,” women are still finding it difficult to receive proper diagnoses for their health ailments. In 2017, 810 women died due to complications with pregnancy — and all of their deaths were considered preventable. Race also plays an important role as well. According to the Center for American Progress, “African American women are three to four times more likely to die from childbirth than non-Hispanic white women.”
The Centers for Disease Control and Prevention found that between 2014-2017, 41.7 non-Hispanic Black women died per every 100,000 live births. For comparison, between that same time frame, 13.4 non-Hispanic white women died per 100,000 live births.
What Causes These Disparities?
Traditional research in the medical field relied on the male body as its subject for decades. It wasn’t until 1993 that Congress turned from policy (a rule adopted by employers) into law (a principle that must be followed by society) that women needed to be included in clinical trials.
Therefore, there is a disconnect between treating a woman who may have slightly different symptoms for a given condition than a male patient who is likely to experience more textbook symptoms.
When it comes to diagnosing a heart attack, for example, men experience a tightness/pain in their chest, neck, back, or arms. They will feel anxious, fatigued, and/or dizzy. Men may even have heartburn or become nauseated while having a heart attack.
Women, however, don’t experience this tightness/pain in their chest for an extended period of time. It lasts for a few minutes, goes away, and then comes back. They’ll have pain or discomfort in their arms, back, neck, jaw, and/or stomach, and may experience shortness of breath. Women are also more likely to experience nausea than men are when having a heart attack.
Study Finds That Women Underreport Snoring
These disparities and other societal stigmas also affect the diagnosis of sleep apnea treatment in women.
According to the National Sleep Foundation, snoring affects 90 million people of all ages and genders, with 37 million experiencing snoring on a regular basis; but one recent study indicated that that number may actually be even higher, particularly because women aren’t accurately reporting their snoring. In the study, individuals referred for evaluation due to a suspected sleep disorder were given a questionnaire to rate the severity of their snoring. Results showed that while snoring intensity, or loudness, did not differ by gender, women significantly underreported the loudness of their snoring: 40% of women reported that they had severe or very severe snoring, but in actuality, 49% did.
And women underreported other aspects of their snoring, as well. Among the women in the study, 88% snored, but only 72% reported that they did so. In contrast, objective snoring and self-reported snoring were nearly identical in men, at 92.6% versus 93.1%.
The authors of the study described the social stigma surrounding snoring in women, which is the likely culprit of the underreporting. Unfortunately, the implications of this stigma mean that women may not reliably answer questions about snoring in a clinical analysis, which likely contributes to the underdiagnosis of sleep apnea in women.
Risk Factors & Symptoms: Sleep Apnea in Men & Women
Differing Risk Factors
It’s essential that the field of dental sleep medicine recognizes the disparities among women and men in order to accurately and effectively treat all patients.
While there are certain factors that increase an individual’s risk of developing sleep apnea regardless of gender, such as obesity, other symptoms and characteristics “typical” of the disorder can greatly vary between women and men. For example, men are placed at a greater risk of developing sleep apnea because of their anatomical structure.
A well-known cause of sleep apnea is excess fat in the throat and bulkier tongues that can block the airway—anatomical characteristics most common in men.
As for women, three common risk factors are polycystic ovary syndrome (PCOS), pregnancy, and menopause.
- PCOS: Hormonal imbalances, increased insulin resistance, and higher levels of belly fat are all potential symptoms of PCOS that can contribute to sleep apnea. While more research is needed, physicians who care for women with PCOS should screen them for sleep apnea, as their chances of developing the sleep disorder are high.
- Pregnancy: Pregnancy increases the risk because of a change in sleep patterns, weight, and anatomy. As anyone who has experienced pregnancy understands, the body has the potential to undergo massive changes, and that includes developing sleep apnea.
- Menopause: 20% of women develop sleep apnea during menopause. The sex hormones estrogen and progesterone are affected during menopause. Estrogen is responsible for the development and regulation of the female reproductive system while progesterone regulates menstrual cycles. During menopause, estrogen and progesterone both decline, disturbing sleep. While the specific reason for the decline in these hormones lead to sleep apnea is still to be determined, it’s important for women going through menopause to discuss sleep disturbances and daytime sleepiness with their doctor, as they may also be suffering from sleep apnea.
Shared Symptoms
Shared symptoms between women and men include: snoring, gasping/choking during sleep, apneas (stop breathing during sleep), need to urinate often during the night, headaches/dry mouth/sore throats in the morning, poor attention span and memory, and fatigue.
Final Thoughts
If you regularly experience any of the symptoms in combination with snoring, you may have sleep apnea, which should be diagnosed by a medical professional. You have only to gain from getting treatment for sleep apnea. Just a few of the benefits include more energy and better concentration, not to mention a decreased risk for a number of serious health concerns including diabetes, stroke, and heart attack.
Sleep apnea is typically treated with a CPAP or an oral appliance, which looks similar to a mouthguard or retainer and is generally described by patients as more comfortable and tolerable than a CPAP. If you’re interested and want to learn more about treatment, contact us today or schedule a free consultation with Sleep Better Georgia to speak with someone who can help you find the answers and treatment you need—regardless of your gender.