Too often sleep apnea in women goes undiagnosed

Although often associated with overweight middle-aged males, females, too may suffer from obstructive sleep apnea (OSA) but the symptoms may be overlooked or simply ignored.

Obstructive sleep apnea is a condition in which the flow of air pauses or decreases during breathing because the airway has become narrowed or floppy during sleep – thus, the condition is termed “obstructive.” A complete cessation of breathing is called an apnea while a significant decrease in airflow is termed a hypopnea. Heavy snoring may be a marker of obstructive sleep apnea, and it is created by the turbulence of the airflow through the floppy airway.

“Society almost expects women, especially those with young children, to be tired,” said Ryan Hays, MD, Parkland’s Director of Sleep Medicine and Assistant Professor of Neurology & Neurotherapeutics at The University of Texas Southwestern Medical Center. “But society may be too quick to attribute symptoms of sleepiness, irritability, and trouble concentrating to ‘baby brain’ or ‘working mom brain’.”

Women tend to have different types of complaints than their male sleep apnea counterparts including more insomnia, chronic fatigue and depression. In addition, women may be less knowledgeable of their own snoring; often women may be more vigilant about their bed-partner’s sleep, whereas men may be sound sleepers and less likely to note abnormal breathing in their bed-partner. But Dr. Hays cautions that undiagnosed sleep apnea may contribute to other health risks such as heart attacks and stroke, or even increase the probability of a serious car accident.

Like their male counterparts, women who snore and are overweight or have hypertension are at a greater risk for obstructive sleep apnea. Women who are post-menopausal are also at a greater risk.

The only true way to diagnose obstructive sleep apnea, Dr. Hays said, is through a careful history and, when indicated, a sleep study called a polysomnogram. During the study, pain-free sensors are placed on patients’ scalp, face, chest, limbs and finger. While the patient sleeps, the sensors record brain activity, eye movements, heart rate and rhythm, leg movements, air flow, and the concentration of oxygen in the blood. Elastic belts placed around the chest and stomach measure inhalation and exhalation. The recordings are analyzed by a qualified sleep specialist to determine whether a patient has sleep apnea or another sleep disorder.

“People who have sleep apnea experience a disruption of sleep numerous times per hour,” he said, noting those with a severe case may be aroused every two minutes. “Since sleep serves as a restorative process for the body, it’s important that it not be disrupted. Otherwise, daytime symptoms may begin to develop.”

For many women, a cure for sleep apnea may not be possible. But, there are several effective treatment options. Along with losing weight via exercising and developing a healthier lifestyle, the most common treatment is CPAP, or continuous positive airway pressure machine and mask. The mild pressure from the CPAP prevents the airway from collapsing during sleep. Other women may be candidates for an oral appliance specially fitted by a dentist, or even a surgical intervention.

Women are encouraged to discuss sleep problems or excessive fatigue with their primary care provider who can help determine if a sleep study or other therapy is needed. For a list of Community Oriented Primary Care health centers at Parkland, please visithttp://www.parklandhospital.com/medical_services/centers_locations.html