Women Less Likely to Report Sleep Issues?

A women’s health researcher says that in general women are less likely than men to report symptoms with potential negative connotations.

By Peter Blais, RPSGT

A well-known researcher in women’s health says, while no specific research shows whether women are more or less likely than men to feel social pressure to bring up snoring and possible sleep-disordered breathing to a physician, other research suggests that women compared to men are generally less likely to report symptoms with potential negative connotations.

“It has been suggested that this could reflect negative social connotations of certain symptoms,” says Susan Redline, MD, MPH, senior physician at Brigham and Women’s Hospital and Farrell Professor of Sleep Medicine at Harvard Medical School, citing cough with sputum in COPD as one example. “Some people recognize snoring to be common in their male relatives and consider it a ‘norm’ for men to snore. This is a reason a woman may feel more stigma by reporting [her own] snoring.

“It is important to recognize that many people are unaware of their own snoring. It is a bed partner who often reports this. Men commonly snore and may be unaware of their bed partner’s snoring, which may contribute to under recognition of snoring among women.”

Susan Redline, MD, MPH

Another possible reason snoring in women is less likely to be reported, Redline notes, is that women tend to sleep more lightly than their male bed partners and therefore are usually the ones noticing snoring in a partner and not the other way around. Therefore the social pressure to “fix” the snoring is not as prominent.

“Research my group [Sleep Apnea Patient-Centered Outcomes Network patient panel] had conducted a number of years ago showed that for any level of sleep apnea, women were less likely to report snoring or daytime sleepiness than men. It is therefore important to consider a wider range of symptoms as possible indicators of sleep apnea in women, including unrefreshed sleep, problems falling asleep (which may overlap symptoms of insomnia), and daytime fatigue.”
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Dentists can play a role in steering female patients to seek a medical opinion whether they have obstructive sleep apnea, snore, or show other sleep-disordered breathing issues by being aware of other symptoms women may display, Redline says. “Women who have had recent increases in weight or during and after menopause are at especially increased risk for sleep apnea, and it is those times when there should be particular attention to considering sleep apnea,” Redline says. “Since insomnia is also common among women, considering both sleep apnea and insomnia as possible contributors for poor sleep quality and daytime fatigue are important.”

“There should be care in interpreting home sleep studies in women as women may have breathing interruptions (hypopneas) that result in arousal rather than drops in oxygen. Those events can be missed with home testing, which may underestimate sleep apnea severity. Women also may have more severe sleep apnea in REM sleep, which is most likely to occur in the early-morning hours. Thus, treatment should be especially used in the late night and early morning.”

Challenges in diagnosis and treatment of sleep apnea was identified by the Society for Women’s Health Research by the Sleep Apnea Patient-Centered Outcomes Network. The two networks are collaborating on a fact sheet intended to empower women with knowledge and tools to discuss their own sleep concerns with their healthcare providers. It also will have a summary of key facts on sleep apnea in women relevant to clinicians. Women may find further information and connect with other women with sleep apnea on MyApnea.org.