Obstructive sleep apnoea is a potentially serious condition that causes breathing to repeatedly stop and start during sleep. But not everyone experiences it the same way. Some people have obvious symptoms. Others may not realise they have it at all.
New research suggests sex may influence how obstructive sleep apnoea shows up, with women more likely to report severe and less typical symptoms than men.
The study, published in Sleep, analysed data from 407 men and women with moderate-to-severe obstructive sleep apnoea. Participants were asked to report their symptoms and rate how intense they were.
Women reported more severe symptoms overall, including some that are not always considered classic signs of sleep apnoea. These included:
- waking during the night
- headaches
- nightmares
- sleep disturbances
- sleep-related impairment
- anxiety
- anger
- fatigue
- cognitive issues
- dissatisfaction with social roles
Researchers did not find major sex differences in symptoms such as snoring, gasping at night, nasal congestion, reflux, or depression.
The findings add to growing evidence that sleep apnoea can look different in women and men.
“Past studies have indicated that women with sleep apnea present with a different constellation of symptoms than men, but these studies have often been limited in that the severity of sleep apnea differed between men and women and the range of symptoms assessed was limited,” says study co-author and sleep and cardiovascular outcomes researcher Dr Sanjay Patel.
This study focused only on people with moderate-to-severe obstructive sleep apnoea and looked at a wider range of symptoms, which gives a clearer picture of how the condition may show up differently.
That matters because sleep apnoea is often associated with loud snoring, choking, or gasping at night. Those symptoms can happen in women, too, but they are not always the main complaint. Some women may be more likely to seek help for fatigue, insomnia, headaches, mood changes, poor concentration, or waking unrefreshed.
If those symptoms are not linked back to sleep breathing, sleep apnoea can be missed.
Below, sleep medicine specialists explain why women may present differently, what symptoms deserve attention and when to speak with a GP.
Why do women experience sleep apnoea differently from men?
Experts say there are likely several reasons.
For one, women may experience sleep disruption from sleep apnoea differently, says Dr Patel.
“It may be that women have different experiences and susceptibilities to having their sleep disrupted from sleep apnea compared to men, and so suffer a broader range of symptoms than men,” he says.
Women’s sleep quality may also be more affected during REM sleep, says sleep surgery specialist Dr David Kent. REM sleep is the stage linked with memory, emotional processing and vivid dreaming. If breathing disruptions happen more during this stage, symptoms such as nightmares, mood changes, fatigue and cognitive issues may be more noticeable.
Sleep medicine physician Dr Aarti Grover says less typical symptoms may also delay diagnosis.
“Instead of classic male patterns of loud snoring and witnessed gasping, women often experience fatigue, depression, and generalized daytime exhaustion, which frequently delays diagnosis,” she says.
If it takes longer for women to be diagnosed, symptoms may worsen over time, Dr Grover says. That may be one reason women in the study reported more severe symptoms.
It is also possible that some symptoms are not caused by sleep apnoea alone.
“Women are at higher risk for other common diseases such as migraines or depression than men,” Dr Patel says. “Future studies treating these men and women for their sleep apnea and seeing which symptoms get better will be important to distinguish between these possibilities.”
The takeaway for clinicians is that sleep apnoea should not be ruled out just because a woman does not fit the classic loud-snoring stereotype.
“It suggests, at a minimum, that we as clinicians have to work harder to extract information about symptoms,” says sleep medicine specialist and neurologist Dr Christopher Winter. “We have to go into the interaction assuming pathology rather than assuming everything is okay, and then confirming our confirmation bias.”
What does this suggest about treating men vs women?
Dr Patel says it is “too early” to know exactly how the findings may change sleep apnoea treatment for women.
“We need to see how women respond to treating their sleep apnea and see if the broader range of symptoms improves,” he says. “If these ‘non-classic’ symptoms improve, then it will mean that clinicians need to think about sleep apnea much more broadly in deciding whether to test and treat women for sleep apnea, rather than focusing solely on the symptoms that are commonly seen in men.”
Dr Kent says the findings highlight the importance of discussing all symptoms with a healthcare provider, not only snoring or gasping.
“It’s important for any clinician to meet patients where they are and focus on not just treating a number but managing the whole host of symptoms that a patient is struggling with,” he says.
That also matters if you are already being treated for sleep apnoea but still feel unwell. If fatigue, headaches, poor concentration, mood changes, or broken sleep continue, go back to your GP or sleep specialist.
There are several treatment options for obstructive sleep apnoea, and it may take time to find the right one.
A CPAP machine, which delivers a steady stream of pressured air while you sleep, is often considered the gold standard for moderate-to-severe sleep apnoea. But Dr Winter says it may not resolve every symptom for every person.
“‘The CPAP works’ is not the same as ‘the CPAP completely got rid of all of my sleep apnea symptoms,’” he says.
It is also possible that something else is contributing to your symptoms. Dr Grover recommends considering other causes of sleep disturbance too, including hormonal changes and underlying depression.
For women, that is especially important in perimenopause and menopause, when sleep disruption, mood changes, night sweats and fatigue can overlap with sleep apnoea symptoms. The best approach is not guessing. It is getting assessed, describing the full symptom picture and asking whether a sleep study is appropriate.
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