Rude awakenings: snoring, sleep apnea, and menopause
It’s a rare woman over 45 who gets a good night’s sleep every night (or any night, truth be told).
We exercise, eliminate caffeine, take melatonin, turn off screens, meditate, get acupunctured, do yoga, buy salt lamps and cooling clothing & pillows, and still we get up many mornings more tired than we were the night before.
Sleep – or lack thereof – affects everything from our weight to our heart health to our emotional well-being. Sleep is the time when bodies heal and brains re-energize to get us ready for the challenges of tomorrow. But many menopausal women are sleep-deprived for years, and this takes a serious toll on health, relationships, mood, and work.
Team Gennev wants to help you get a good night’s sleep, so we called “sleep 911” and found Dr. Katharine Christian at the Snoring & Sleep Apnea Center in Seattle, WA. Dr. Katharine is a dentist with extensive training in sleep apnea and its treatments and an expert on getting better rest.
What is sleep apnea?
Dr. Katharine: Sleep apnea happens when you stop breathing at night. There are two types. With central apnea your body forgets to breathe. In obstructive sleep apnea (OSA) you’re trying to breathe but something is in the way. When we’re asleep our bodies go into a state of near paralysis. This is especially true when we are in dream sleep (we don’t want to act out our dreams) and when we are on our backs.
Why is sleep apnea more common among women in menopause?
Dr. Katharine: There is a hormonal protection that women lose as we go through menopause. After menopause our rates of obstructive sleep apnea equal that of men’s.
How common is sleep apnea in menopausal women?
Dr. Katharine: Post-menopausal women are 2-4 times more likely to have sleep disordered breathing versus pre-menopause. Depending on the study, that’s anywhere from 15-30 percent.
Why is it necessary to treat sleep apnea?
Dr. Katharine: The health risks associated with sleep apnea are proportional to the amount of apnea you have. People with untreated, severe sleep apnea are much more likely to have heart attack or stroke. However, it’s often people with more mild sleep apnea who report large impacts on the their quality of life: Daily headaches, extreme daytime sleepiness, chronic pain.
What are the signs I might be dealing with sleep apnea and should talk to my doc?
Dr. Katharine: Feeling tired during the day despite getting a full night’s sleep. Waking up multiple times during the night. Moving a lot while you’re sleeping. Waking up with your heart racing. Witnessed apneas. Waking up with a headache.
If I snore, does that mean I have sleep apnea?
Dr. Katharine: Snoring is a sign of an airway restriction. A good number of snorers have sleep apnea, but not all. However, just because you don’t snore doesn’t mean you don’t have apnea. If you snore and have some of these other symptoms, definitely talk to your doctor about it. The only way to tell what’s really going on is with a sleep study.
I’m not conscious of waking up during the night; does that mean I don’t have it?
Dr. Katharine: Not everyone has all the same symptoms. OSA can manifest very differently in different people. I have a number of patients who were only diagnosed because they were having trouble controlling a seemingly unrelated health condition, like atrial fibrillation or blood sugar.
Are there degrees of severity? Is there such a thing as “mild” sleep apnea?
Dr. Katharine: Yes, it is normal to stop breathing up to 5 times per hour as your body transitions through stages of sleep. Five to 15 pauses per hour is mild, 15-30 is moderate and 30+ is severe. The scale we use to measure is called the apnea-hypopnea index. An apnea is where there is no air getting through. A hypopnea is where not enough air is getting through. Both are associated with a drop in the blood oxygen.
Is it possible to avoid developing sleep apnea?
Dr. Katharine: There are things that you can do to decrease your risk, but some people will have a collapsible airway no matter what.
It runs in my family; am I doomed to develop it?
Dr. Katharine: There are things you can do while kids are growing to give them a better chance of not getting this as an adult (these things also help treat pediatric sleep apnea). As an adult, you can maintain a healthy body weight. You can also pick up the didgeridoo or the oboe. Both have been shown to increase muscle tone in the back of the throat.
How is it diagnosed and treated? Does insurance cover both?
Dr. Katharine: Currently we can only diagnose sleep apnea with a sleep study. This can be a simple test done at home with a small monitor that you wear overnight, or it might be an in-lab study which is more sensitive. The gold standard for sleep apnea treatment is a CPAP machine. This creates a pneumatic splint that holds your airway open at night. The second best treatment is an oral appliance. This will hold your jaw a little bit open and a little bit forward to prevent collapse while you are sleeping. There are also a variety of surgical options available. It’s really a matter of finding whatever will work for you and your situation.
Sleep apnea itself won’t kill you, but it shouldn’t be taken lightly either. Interrupted sleep has all kinds of negative impacts on physical and psychological health, none of which you need to add to this often already challenging time.
But even more, managing sleep apnea could lead to a vastly improved quality of life. Remember when you got your first pair of glasses and how immediately the world was sharper, clearer, easier to navigate? Imagine doing that for your body and brain – feeding them the sleep they need so you can function at your best.
For a few lifestyle modifications that may help with getting better sleep, check out our previous article on snoring and sleep.
Do you have sleep apnea? How did you figure it out? What are you doing to manage the condition, and how has it impacted your life? Spill it, sister. Tell us your experience in the comments below, or on Gennev's Facebook page or Midlife & Menopause Solutions, our closed Facebook group.
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