Why Sleep Apnea is More Dangerous For Women

I’ve mentioned before a study showing that going to the bathroom (nocturia) two or more times per night can significantly increase your chance of dying. In going through the data again, I noticed something interesting: Women aged 50 to 64 with nocturia had a 94% increased risk of mortality compared with men of the same age, at 60%. This age group also had much higher mortality rates than younger or much older ages.

So why are middle-aged women at a much higher risk of dying, if they have to urinate in the middle of the night? To summarize, most of these people probably have undiagnosed obstructive sleep apnea. With sleep apnea, every time you stop breathing, the vacuum pressures in your chest prevents blood from reaching your heart. Once you start breathing again, blood rushes back into your heart, causing your heart chambers to dilate. Your body thinks you’re fluid overloaded, and produces a hormone called atrial natriuretic peptide, which makes your kidneys make more urine.

Another past study showed that people who wake up to go to the bathroom do so not because they make too much urine, but because they stopped breathing, and think they have to go. Typically, people don’t usually have a full bladder. They also tend to wake up every 90 to 120 minutes, which is one sleep cycle. So every time you go into deeper levels of sleep when your muscles relax, you’ll stop breathing and wake up.

Having untreated obstructive sleep apnea has been shown to significantly increase your risk of developing heart disease, heart attack or stroke. Your risk of getting into a motor vehicle accident increases 4 to 7 times overall. Having all these risk factors can definitely increase your chances of dying.

If you look at the data from the study, you’ll also see that young men who have this problem are also at higher risk for dying, but not so for young women. But in the years after menopause, the risks for women spike significantly. One possible explanation for this finding is that estrogen and progesterone is protective for women against obstructive sleep apnea during their reproductive years, but once they go through menopause, women who develop sleep apnea do so at much more accelerated rates. With men, on the other hand, may develop sleep apnea gradually at a much earlier age, so the body has time to adjust and compensate to some degree.

This theory also is supported by studies showing that women are more likely to die after suffering from a heart attack or a stroke.

It’s disappointing that doctors aren’t taking nocturia more seriously. Instead, people are told to avoid drinking water before bedtime, or put on medications for overactive bladders or enlarged prostates. My feeling that anyone with significant nocturia should be screened for obstructive sleep apnea. Once treated for obstructive sleep apnea, not only will you go to the bathroom much less often, but you’ll sleep better and have a much lower chance of dying.

If you go to the bathroom more than 2 times per night, what are you doing about it? Please enter your answers in the text box below.


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3 thoughts on “Why Sleep Apnea is More Dangerous For Women

  1. I have been getting up to urinate for most of my adult life — and have a significant history of UTIs over the years. I was finally diagnosed with sleep apnea last December, and although I’ve had a few nights since started CPAP treatment without getting up to urinate, I’m still getting up once or twice most nights. My AHI has been as low as 1.5, but is usually closer to 3.5 on average. I use nasal pillows. What should I be doing next, in terms of managing my sleep apnea? I’m already planning to see a urologist.

  2. Steers,

    It sounds like you still can find tune your CPAP settings. Assuming there’s no leak, your pressure setting probably need to be tweaked. Try writing down a log of how many times you go to the bathroom and the corresponding AHI for each night. It’s likely that the lower your number, the less likely you’ll go to the bathroom. You’ll have to troubleshoot and work with your sleep physician and DME company to lower your numbers. Good luck.

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