September is Menopause Awareness Month. Menopause is a time of major hormonal, physical and psychological change for women, although menopausal symptoms vary from one woman to another. Women enter menopause around the age of 50, and during the transition they can encounter a multitude of different symptoms such as hot flashes, headaches, fatigue, and mood swings and surprisingly, even sleep apnea.
Menopause can cause sleepless nights
During the perimenopause, or transition phase, a woman’s ovaries gradually (over several years) decrease production of estrogen and progesterone. One year after menstrual periods have stopped, a woman is considered to have reached menopause – and from peri-menopause to post-menopause, women report an increased rate of symptoms that interfere with sleep. Most notably, these include hot flashes, which are unexpected feelings of heat all over the body accompanied by sweating. They usually begin near the face and spread to the chest, affecting 75-85% of women around menopause.
Hot flashes can interrupt sleep and last on average three minutes, leading to less sleep efficiency. Most women experience these for a year, but about 25% have hot flashes for five years. While total sleep time may not suffer, sleep quality does. Interrupted sleep and frequent awakenings cause next-day fatigue.
Other symptoms of menopause include mood disorders, insomnia, and sleep-disordered breathing; sleep problems are often accompanied by depression and anxiety. Generally, post-menopausal women are less satisfied with their sleep and as many as 61% report insomnia symptoms. Snoring has also been found to be more common and severe in post-menopausal women. Snoring, along with pauses or gasps in breathing are signs of a more serious sleep disorder, obstructive sleep apnea (OSA).
If you feel tired and/or sleepy all the time, or if you’ve been told you snore or stop breathing during your sleep, obstructive sleep apnea may be the cause. OSA can wreak havoc on your nights and your days and cause impairment in memory and decision-making, mood and alertness. Here’s what happens:
- In obstructive sleep apnea the airway becomes blocked (obstructed) during sleep, which causes a pause in breathing.
- When we stop breathing our oxygen levels drop, which triggers the brain to tell us to wake up and breathe.
- However, we don’t wake up completely (these sleep interruptions are called “micro-arousals”).
- It’s these micro-arousals that disrupt our sleep architecture and cause us to wake up in the morning feeling as if we haven’t slept a wink.
Sleep apnea and menopause: What’s the connection?
According to The National Sleep Foundation,
“During menopause, levels of the hormones estrogen and progesterone decrease in women’s bodies. These hormones act as stimulants and play a role in keeping airways open by maintaining muscle tone in the throat. As they decrease, the chances of obstructed breathing rise. What’s more, hormonal changes can lead to weight gain and a redistribution of body fat, sending more fat to the throat area, which can cause disrupted breathing.”
This weight gain can also cause snoring. According to statistics, snoring affects 3% of women before menopause and 11% after menopause1. An American study examined 2,852 post menopausal women to asses whether sleep apnea was more common in women who were not treated with Menopausal Hormonal Therapy (MHT) than those who did. In this study, MHT is associated with a significant decrease in the frequency of sleep apnea. Researchers found that patients receiving replacement therapy were able to reduce the severity of their apnea; however, it did not eliminate it.2
Sleep apnea is a risk factor in cardiovascular disease. In women, its frequency increases at the time of menopause. A study published in France in 2017 studied obstructive sleep apnea (OSA) in postmenopausal women with a high risk of cardiovascular disease. The 2 year study included 91 menopausal patients hospitalized at Lille University Hospital for cardiovascular disease. All these patients had a screening test for OSA and 73% of them had sleep apnea.3
So what should you do if you’re past menopause, you snore, and you suspect sleep apnea?
The first step is to get tested for sleep apnea. If you have OSA symptoms and feel that your sleep is not restful, it’s important to talk to your doctor about it. Apnée Santé offers simple, fast and effective home testing. You can also contact us for a free evaluation to see if sleep testing is right for you.
If the test shows you have sleep apnea, you’ll most likely be prescribed a continuous positive air pressure (CPAP) device. CPAP is the most effective treatment for OSA. Thousands of Canadians use it every time they sleep. CPAP consists of a gentle stream of air that is directed through the airway during sleep, allowing the airway to remain open, and therefore preventing apnea.
Additional tips for restful sleep
- Eat healthy. Avoid large meals, especially before bedtime. Maintain a regular, normal weight. Some foods that are spicy or acidic may trigger hot flashes. Try foods rich in soy as they might minimize hot flashes.
- Avoid nicotine, caffeine and alcohol, especially before bedtime.
- Dress in lightweight clothes to improve sleep efficiency. Avoid heavy, insulating blankets and consider using a fan or air conditioning to cool the air and increase circulation.
- Reduce stress and worry as much as possible. Try relaxation techniques, massage and exercise. Talk to a behavioral health professional if you are depressed, anxious or having problems.
- Create a schedule and avoid naps. Establishing a schedule will make it easier to fall asleep the same time every night, and napping could make it harder to get to sleep.
- Create a controlled sleeping environment. Your bedroom should be cool and dark to promote the bed sleep possible, invest in a fan or sleep mask if necessary.
- Don’t exercise before bed. It is important to maintain a healthy lifestyle through exercise, but try to fit your workout in earlier in the day.
Better sleep, better life
Women are underdiagnosed for sleep apnea across the country and around the world. To improve your sleep and your life, call Apnée Santé today! Proper diagnosis and treatment can make you more successful at home, at work or wherever your life’s focus is.
- ] Menopausal status and sleep-disordered breathing in the Wisconsin Sleep Cohort Study. American journal of respiratory and critical care medicine. Young. 2003. 1;167(9):1181-5 S,
- Hormone replacement therapy and sleep-disordered breathing. Shahar. American journal of respiratory and critical care medicine. Mai 2003. 1;167(9):1186-92
- Souad Sedir,Claire Mounier Vehier Christelle CharleyMonaca: Science direct, Médecine du sommeil, Volume 14, Issue, Mars 2017, page 21, https://www.sciencedirect.com/science/article/pii/S1769449317300109