Sleep Apnea Can Look Different in Women: 6 Signs That Shouldn’t Be Ignored

2. Fatigue and low energy

Daytime sleepiness is a symptom of sleep apnea for both men and women. But women may not necessarily feel sleepy. Instead, they may feel drained or report brain fog, says Dr. Alison Kole, a pulmonologist and sleep specialist at Oak Health Center in Southern California.

In a 2024 study looking at sex differences in sleep apnea symptoms, more women reported daytime symptoms, such as fatigue and low energy, than men.

3. Mood changes

People with sleep apnea can have symptoms similar to depression, such as fatigue and difficulty sleeping, according to a study in the journal Sleep Medicine and Disorders. The same study also noted that depression and sleep apnea can occur at the same time. Treating sleep apnea can sometimes help improve symptoms of depression. 

Women, especially, can have anxiety with sleep apnea, Kole says. With sleep apnea, your body doesn’t stay in the deeper, more restorative stages of sleep. Instead, repeated pauses in breathing cause tiny awakenings that can raise your heart rate and blood pressure, even if you don’t remember waking up. Over time, this broken-up sleep cycle will keep you from feeling refreshed.  

“Does that negatively impact your mood? Heck yes, for a lot of people,” Kole says. 

4. Aches and pains

To your brain, those repeated pauses in breathing can register as a threat, Gamaldo says. “It essentially feels like it’s in a fight or flight situation,” she explains. 

As a result, your heart rate increases and stress hormones, like cortisol, rise. These stress hormones not only keep you from getting quality z’s; they’re also associated with inflammation in the body. Over time, that can lead to aches and pains, Gamaldo says.

And, she adds, “a tired brain has a lower threshold to tolerate pain.”

5. Morning headaches

Pauses in breathing also prevent you from getting as much oxygen as your brain needs and prevent carbon dioxide (CO₂) from being fully expelled when you exhale, Gamaldo says.

A buildup of carbon dioxide increases pressure in the brain, which can lead to morning headaches.

“Once the day goes on, you breathe out that CO₂,” Gamaldo says, and the morning headache gradually goes away.

For women with a history of migraines, these headaches can be easy to dismiss as just another migraine, Kole says. 

6. Nighttime bathroom trips

Getting up often at night to use the bathroom? Don’t be so quick to blame a weak pelvic floor or a finicky bladder.

Instead, lower oxygen levels may be the cause. Kole says that low blood oxygen can strain the heart, triggering a stress response in the body. This stress response can cause you to have to urinate more often at night, instead of sleeping uninterrupted. 

Age affects sleep apnea in women

It was once believed that a woman’s risk for sleep apnea was 9 percent, compared with 24 percent for men. “We now know that’s actually incorrect,” Kole says. “What it depends on is your age group.”

Before menopause, women are less likely than men to have sleep apnea, Kole says. But that starts to change in perimenopause, when women’s risk begins to rise. After menopause, the risk of sleep apnea becomes more equal to that of men — about 24 percent. 

One thought as to why this risk increases with age may be the loss of estrogen and progesterone, which may have a protective effect on the upper airway muscles. As muscle mass starts declining, the muscles in the airway feel the effects too. Those muscles start losing their tone, which can lead to snoring and sleep apnea.   

Estrogen and progesterone also contribute to weight redistribution, Kole explains. Women may start gaining weight around the midsection or neck as they get older, which can put pressure on the airway. 

Don’t brush off your symptoms

If you suspect sleep apnea is to blame for how crummy you’re feeling, talk to your doctor. And know that you might need to advocate for yourself at the primary care level to get referred to a sleep specialist, Cooksey says.

Untreated sleep apnea may increase the risk for other health conditions like high blood pressure, stroke and diabetes, Gamaldo notes. 

A 2021 study followed people with sleep apnea and resistant hypertension (high blood pressure that can’t be controlled with three or more medications). Researchers found that when sleep apnea was treated, blood pressure improved significantly. 

A 2022 study found that people with sleep apnea have a higher risk of blood glucose intolerance and type 2 diabetes. 

 “If there’s something that feels off about your sleep, it’s not all in your head,” Cooksey says. “It’s not just sleep apnea — it might be insomnia or another sleep disorder, but there are treatments. It’s just that you need to get to the right specialist.”