The connection between sex hormones and obstructive sleep apnea (OSA) is complex and two-directional. Obstructive sleep apnea is affected in several ways by female sex hormones, such as estrogen and progesterone, and their male counterparts, such as testosterone. At the same time, lack of sleep, and sleep apnea specifically, affect the production and secretion of sex hormones.
Due to hormonal, anatomical and physiological reasons, there is a basic difference in sleep patterns between the sexes. For example, women tend to fall asleep earlier and quicker than men, and to have shorter sleep cycles. In addition, sleep architecture and depth vary with hormonal landmarks such as puberty, menstruation, pregnancy and menopause. They may also affect sleep disorders, and sleep apnea specifically.
Sex hormones influence sleep and breathing both directly and indirectly, their direct effect mediated by GABA and NMDA receptors in nerve and muscle systems. Elevation and decline in hormones’ levels and their changing ratios, contribute to changes in sleep, and sleep apnea.
During pregnancy, for example, progesterone becomes more dominant, which is likely related to the typical tiredness and sleepiness. That if we ignore all other things that make a pregnant woman get up at night… 🙂 Progesterone’s effect also accounts for the more rapid breathing during pregnancy. The changing levels of sex hormones and their effect on the tension or relexation of pharyngeal musclesrelaxation, are also likely to be related to the exacerbation of snoring and sleep apnea in later stages of pregnancy.
After menopause, the prevalence of obstructive sleep apnea in women begins to approach that of men. Hormonal changes play a direct role, but also the change in fat distribution that naturally occur with age. Hormone replacement therapy also has an effect on sleep patterns and sleep apnea, as it reduces the prevalence and severity of apnea compared to women not taking hormonal treatment.
Another link connects sleep apnea and polycystic ovary syndrome (PCOS). It is difficult to untangle the complex connection between sleep apnea, hormonal changes, and obesity that characterizes the syndrome, and we might get to it in another time.
Obstructive sleep apnea is not only a matter of quality of life. It is proven to contribute to the development of diabetes, hypertension, heart disease, sexual dysfunction and mood swings, and there for is a significant diagnosis to make, and a condition worth treating. When practicing gender-oriented medicine it is important to remember the role of sex hormones, and the two-directional relationship with sleep and obstructive sleep apnea.
In my experience, talking about sleep during the medical encounter might be difficult, sometimes even more than talking about bowel habits, or sex. It is an intimate subject that we sometimes don’t consider to be as important as our waking hours. For these reasons and others, sleep disorders are in general underdiagnosed, and are even more overlooked when it comes to women. Obstructive sleep apnea is a specific, common case of a sleep disorder. Its underdiagnoses in women, especially post-menopausal and the elderly, affects women’s long term health in many aspects of life. If you suffer from obstructive sleep apnea, or suspect that you do, I hope this article will encourage you to discuss it with your physician.
Wishing refreshing sleep and good health,