From a survey conducted in 2019, around 38% of men and 30.4% of women reported that they snore at night (1). The gender gap narrows as we get older and the effects of menopause make women more likely to snore (2). The picture also gets more complicated when we throw pregnancy and even the routine hormonal fluctuations of the menstrual cycle into the mix (3,4).
When it comes to sleep apnea — a disorder where breathing repeatedly stops and starts during sleep — historic bias in science has created a narrative that this condition is a “male disease”. Consequently, screening and diagnosis is less sensitive to how it presents for women (5). In reality, it is a serious health concern in women that is overlooked and underdiagnosed.
All of this points to an increased need to address women’s snoring and sleep apnea. Indeed, when we look at SnoreLab’s users: 50% are men and 50% are women. Let’s take a deep dive …
Here we will discuss:
Snoring occurs in women the same way it does in men: disrupted airflow causes soft tissue in the airway to vibrate and make noise. The reason women are less likely to snore is due to differences in anatomy and physiology (6).
Men typically have more soft tissue in the upper airway, making it more prone to relaxation and vibration, leading to snoring (7).
MRI scans show men also have a larger soft palate area and more soft tissue around the pharynx (back of the throat), further increasing their snoring risk (8).
Body weight and its distribution also plays a role. Obesity is a well-known risk factor for sleep apnea, but where this weight is stored is what really matters (9,10).
Before menopause, women typically gain weight lower on their body where it does not impact on the upper airway. Men generally gain fat around the neck, chest and abdomen. This pattern of weight distribution increases airway collapsibility in men and makes snoring more likely (7,11).
Female sex hormones, estrogen and progesterone, help stabilise breathing during sleep, prevent the tongue relaxing too much, reduce airflow disturbances and ultimately provide protection against snoring and sleep apnea (12,13).
During menstruation, the levels of the protective hormones drops, meaning women who are predisposed to snoring have an increased risk of breathing disturbances (14).
Interestingly testosterone, the primary male sex hormone, may have the opposite effect. A study on transgender men (people undergoing female-to-male transition) found that self-reported snoring became more prevalent after starting testosterone therapy (15).
Snoring (and general sleep disturbances) tends to increase during menopause. As the ovaries produce less estrogen and progesterone, the protective effect of these hormones against snoring and sleep apnea also diminishes (12).
Studies have shown that hormone replacement therapy (HRT) after menopause can reduce the risk of obstructive sleep apnea (16). This further highlights the protective role of estrogen and progesterone in maintaining healthy sleep.
Hormonal changes during menopause can lead to shifts in body composition and a greater tendency for weight gain. Menopausal women who snore regularly tend to have higher fat mass, especially around the midsection, which contributes to increased airway resistance and collapsibility (17,18). Disrupted breathing during sleep has also been linked to further weight gain creating a cycle where weight gain and breathing difficulties worsen each other (19).
Early detection and intervention for snoring and weight gain during menopause could play a crucial role in overall health improvement.
It’s entirely normal to snore more during pregnancy, in a study of 1,719 pregnant women, 34% reported snoring, with 25% reporting pregnancy-onset snoring (20).
One contributing factor is weight gain, which isn’t just the growing baby, but is also the significant increase in volume of blood. This causes swelling throughout the body, including in the upper airway, narrowing it and making snoring more likely (21).
Additionally, pregnancy brings changes to breathing patterns. An increased breathing rate, combined with a lower residual lung volume as your uterus expands upwards, creates greater negative pressure in the airway and increases the chances of snoring.
Sleep apnea is a condition linked to snoring where your breathing stops and starts during sleep (22). While commonly perceived as a “male disease” sleep apnea affects women too.
Like a lot of medical science, historically, research has predominantly focused on men. The male-centric approach has led to sleep apnea in women to be underdiagnosed as it manifests differently in women (23).
The severity of sleep apnea is determined by the AHI number from a sleep study. AHI stands for “apnea hypopnea index” and is the average number of apnea (no breathing) or hypopnea (partial breathing) events per hour of sleep (24). It has been shown that women tend to have more hypopneas, while men experience more apneas (6).
Research has shown that women with sleep apnea experience a lower quality of life than men with the same condition (25). They are also more prone to mood disorders, such as anxiety or depression, which can even be observed in structural changes of the brain (26).
Further research is crucial to understand why women with sleep apnea experience these distinct challenges. This knowledge will pave the way for more effective and tailored treatments to improve their overall diagnosis, treatment and ultimately well-being.
With snoring often being perceived as a male problem, a stigma becomes attached to women who snore or have sleep apnea. We at SnoreLab see that men are more likely to talk about their snoring than women. This may reflect the shame or embarrassment some women feel about snoring, making them less likely to discuss their symptoms—potentially delaying diagnosis and treatment.
It’s crucial to break this taboo and open the conversation. It is important to emphasize that snoring, whilst often harmless, can be a sign of a serious medical condition and not something to be ashamed of. Openly discussing snoring, both with their partners and healthcare professionals, is the first step to diagnosis and appropriate care.
Ultimately, everyone deserves a good night’s sleep. By normalising conversation and raising awareness, we can empower women to seek help for their snoring and improve their sleep and overall health.
