“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.