Alida Abdullah, 46, an educator and mother of four in Atlanta, spent decades taking for granted that she was tired much of the time. She would fall asleep at inopportune times, even nodding off while driving. Even so, Abdullah didn’t consider that she had a sleep condition. “I thought I was just sleepy and didn’t get enough rest,” she says.
In her early thirties, someone asked if she’d ever had a sleep study, an overnight test used to evaluate sleep disorders. She decided to get one. During the titration part of the study, she used a continuous positive airway pressure (CPAP) machine and was astonished by the result.
“When I woke up, I kid you not, I had never felt so refreshed in my entire adult life,” she says. She was diagnosed with severe obstructive sleep apnea (OSA), a common form of sleep-disordered breathing.
While sleep apnea may be more common in men, it still affects women. In fact, about 1 in 4 women are at high risk for the condition. However, by one estimate, over 90% of women with sleep apnea go undiagnosed.
The reasons for this are complicated. Contributing factors include a lack of understanding of the gender and sex differences in sleep medicine, gaps in sleep research, and limited public health efforts to raise awareness that sleep apnea is not just a “man’s disease”.
As a result, primary care doctors may not always ask women about sleep issues or sleep apnea symptoms. Further complicating matters is that women may not develop sleep apnea until certain stages in life due to hormonal changes.
Common misconceptions about sleep apnea often mislead women into thinking they couldn’t have the condition. The stereotype is that sleep apnea only affects older men, but young women can also be diagnosed with the disorder.
Snoring is known to be one of the hallmarks of sleep apnea. But women are less likely to snore than men and more likely to have other symptoms, like tiredness, often attributed to other health issues. And while obesity is a risk factor for sleep apnea, women who are not overweight can still be affected.
One reason why sleep apnea can go diagnosed in women is that doctors often respond differently to their female patients, says Dr. Valerie Cacho, an integrative sleep physician and founder of Sleephoria, an online resource for women’s sleep health. When women tell their doctors they’re tired, they’re often told to get their thyroid checked, or they’re sent to a therapist, she says. Both thyroid problems and depression can also cause tiredness. But “a man who’s tired and goes to his doctor will probably get a sleep study,” Dr. Cacho says.
This was the case for 46-year-old Florida resident Emma Cooksey, a patient advocate, writer, and podcast host. When she was 30, she consulted her doctor about sleep problems. “I said, ‘I’m really exhausted no matter how much I sleep,’” she recalls. “I was told, ‘You’re anxious and depressed. Let’s treat you for that.’”
Cooksey left the doctor’s office with the impression that sleep disorders are rare and sleep apnea only affects older men. She was told she didn’t have enough risk factors for sleep apnea to warrant testing.
The doctors also attributed Cooksey’s tiredness to her having a baby, even though her child was already sleeping through the night. When she fell asleep driving and narrowly avoided a collision, she knew she had to step up her self-advocacy. She said to herself, “I really need to be referred to somebody that knows about sleep.”“You’ll hear women complain that they wake up at 3:30am every night, and sleep doctors like me realized that that is the main manifestation of their sleep apnea.” – Dr. Joseph Krainin, neurologist and sleep medicine physician
Part of the knowledge gap among physicians comes from sleep apnea presenting differently in women, with less overall snoring and more fatigue, says Dr. Joseph Krainin, a neurologist and sleep medicine physician. Women also tend to have more of an issue with staying asleep than falling asleep.
“You’ll hear women complain that they wake up at 3:30 a.m. every night, and sleep doctors like me realize that that is the main manifestation of their sleep apnea,” Dr. Krainin says. However, not all physicians recognize these as signs of sleep apnea.