Does Menopause Cause Sleep Apnea?

“I keep Waking up every 2 hours in a sweat, with my heart racing and feeling very hot. I also keep having to go to the bathroom every time I wake up.” 
This quote was from Doris, a 51 year-old woman who came to see me not for her menopausal symptoms, but for her severe snoring that was keeping her husband awake. It turned out that Doris had gained about 10 pounds over the past year, and she was also having some signs of menopause: occasional hot flashes, and increasing fatigue. Her mother began have similar symptoms at this age as well. 
There are many good explanations for menopause, but one mechanism that’s related to sleep and breathing has to do with progesterone. This is one of the two female hormones (along with estrogen) that cycles every month, dropping just before a woman’s menses. During pregnancy, progesterone stays high, and drops after delivery. However, during menopause, it declines slowly over many years.
One of the interesting aspects of progesterone is that it’s an upper airway muscle stimulant. It’s been found to increase genioglossus (tongue) muscle activity and tension. In one study, post-menopausal women had lower levels of tongue muscle tone, but after progesterone was given, muscle tone went up significantly. This may explain why menopausal women tend to sleep better after taking progesterone.
With the natural progression of menopause and all its’ expected consequences, it’s not surprising that with added weight and lowered progesterone levels can add to the progression of obstructive sleep apnea. This may also be the reason why menopausal women almost catch up with men with heart disease. As I’ve stated before, poor sleep can aggravate weight gain, and weight gain can aggravate more sleep apnea, which leads to worse sleep.
In addition, notice how some of the features of menopause mirror symptoms of obstructive sleep apnea: frequent awakenings with a racing heart, night sweats, irritability and nighttime urination. In fact, I have seen some young men in their 20s later diagnosed with sleep apnea, and who obviously can’t be going through menopause, still come to see me complaining of these same symptoms. 
In addition, having obstructive sleep apnea may also be a risk factor for some women who develop early menopause. Chronic stress states brought on by repeated episodes of choking at night can lower your reproductive hormone levels. This explains why there are a number of studies showing fertility issues in people with obstructive sleep apnea.
Granted, not all women going through menopause will develop sleep apnea. My guess is that the more susceptible you are (overweight, anatomy from your parents, smaller jaw structures, etc.), the more likely you’ll develop sleep apnea after menopause. Many of the symptoms of sleep apnea and menopause can overlap as well (weight gain, hot flashes, night sweats, mood swings and irritability). This may be one more compelling reason for women to get  evaluated for sleep apnea if they suffer from common symptoms of menopause.
If you’re a post-menopausal woman with obstructive sleep apnea, who kind of symptoms did you have while undergoing menopause? Please enter your responses in the text box below.

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3 thoughts on “Does Menopause Cause Sleep Apnea?

  1. I am a thin post-menopausal woman with a collapsing airway and tongue that drifts back into my throat, diagnosed by an ENT, with mild obstructive sleep apnea diagnosed through a home sleep study provided by my healthcare. Beginning several months before menopause, and continuing for 10 and one half years, I had
    1. reactive hypoglycemia (carbohydrate intolerance) with non-detectable fasting insulin (but not diabetes) all day and at night;
    2. waking at about 3am each night with
    a. racing heart and fast breathing, my sheet and pajamas very wet mainly at the thighs, feeling dehydrated and progressively hungry, pressure points of my body on the mattress slightly painful, feeling alternately too hot or too cold but unable to get the right temperature using the covers, having a stuffy nose more stuffy than it is by day, and unable to go back to sleep until dawn, when all of these things suddenly corrected themselves and I felt pleasantly heavy and comfortable. Even my stuffy nose cleared up completely, with a crackling sound, as the other symptoms also abruptly faded, and then I finally fell asleep – except that most days I had to get up and go to work a half hour after falling asleep so I only totaled about 41/2 hours sleep on average, less if I was stressed out over something;
    3. upper airway resistance was diagnosed 1 year after menopause, later turning into mild sleep apnea;
    4. fatigue affecting my alertness and later progressing to affect my arm and leg muscles.
    5. Last August I was diagnosed with mild COPD and then it was decided that I either don’t have it, or else it was too early to tell if I have it, so it was undiagnosed.

    Then I had a surprising health breakthrough. About 1 1/2 months ago a pulmonologist discussing my tentative COPD told me that my hemoglobin iron had tested below 12, slightly too low, the first week of last April, when I was hospitalised with pneumonia. He suggested that I raise it now. We discussed taking an iron supplement. But I checked my blood tests, all taken previous to that, and found the results had always been high-normal for hemoglobin and hematocrit. However, my ferritin was always in the 40’s, possibly too low for comfort according to new data. So I began taking iron supplements alternate weeks and after 1 month all of the above problems have improved significantly, with the possible exception of sleep apnea. I am now sleeping through to about 5:30am, which is 6 to 7 hours continuously, on most nights, and using my CPAP machine which I have been using nightly since I first got it last April. I love the humidifier on it since it seems to correct my dry stuffy nose that I have had since childhood.

  2. Cindy;
    I know someone whose OSA symptoms and insomnia regressed significantly after a blood transfusion.

    your OSA is not mild, however, if the home study picked it up at all. it’s probably been causing the stuffy nose, and so that’s better with the CPAP. also, there is something called a “crutch reflex” which can cause a stuffy nose when you lay down and go to sleep.

  3. Hi-
    I am in my early 40s. I wake up every night after 3-4 hours feeling like I’m holding my breath with my heart pounding. I had a sleep study, but the facility was not good (AC broken, very hot, they left two-way mic on) and I was too anxious during to sleep and demonstrate the problem. Even if I fall asleep again, the same thing happens. Even when I am highly sedated. Tylenol PM, Trazodone, etc. It has been two years and this is ruining my life. I have never breathed through my nose. The ENT confirms that I have narrowed passages and deviated septum. I also have modified mallampati position 3. The ENT says since I never breathe through my nose, and I used to sleep through the night, so what has changed? Hormones. I had a major drop in progesterone when this started. I did progesterone therapy for a while, but then it was too much. The bloodwork is now in range. I am getting very depressed. So I went to a highly regarded sleep clinic doctor. He wants me to start taking psychiatric meds, do cognitive behavioral therapy. Of course I am depressed, I’m not sleeping! But none of that will work if I’m not breathing. And of course I have insomnia, I don’t want to go to sleep, and it’s hard to get back down after these episodes. He refuses to give me a home sleep study or endoscopy sleep study. I am still not technically overweight, but I’m getting close. Of course I am stressed. Work, finances, relationships. I am desperate to break the cycle. I don’t want to try a whole bunch of mind altering medication that might not solve the problem (psychiatrist: “we don’t really have anything great for insomnia”) and that might have serious side effects. I am surprised that the sleep doctor is refusing to get more information, and surprised that they do not address hormones at all. I am a happy person when I sleep! When I manage to get two sets of 4 hours, I feel great. But this is not practical because it often takes 2 hours for me to get back to sleep, and I have to have no pressure on me. I feel like I am being told to just deal with my insomnia, but I know that something else is going on. I am at a standstill and feeling desperate. This is the medical profession today: take meds and go away. Where is the curiosity and desire to understand the problem and actually help the patient?