Lately, I’m seeing more online commentary about sleep apnea in women who suffered from chronic fatigue for years, but who just assumed it was from the pressures of motherhood, taking on too many things at once, or being perimenopausal. Take journalist Alice Dubin, for example, who said despite excessive rest, she never felt rested. Women are shocked to learn they have sleep apnea, because they assume it’s a male-only condition. In fact, recent estimates reveal that about 1 in 4 people with sleep apnea are women.
In the last several years, sleep apnea doctors have become more aware that there are differences between men and women in sleep patterns and sleep apnea. Unfortunately, widely-used screening tools may underestimate or miss cases of sleep apnea in many women. The good news is that new questionnaires are in development to better evaluate and identify sleep apnea in women.
In this article I share what sleep apnea looks like in women, as it often shows up differently than it does in men. You’ll understand the symptoms to watch for, why weight and BMI matter but aren’t the whole picture, what changes at menopause, and why current sleep studies don’t always catch everything that’s going on for a woman with sleep apnea . My goal is to help you recognize the signs, even if your case doesn’t fit the classic picture of loud snoring and daytime sleepiness.
Signs of Sleep Apnea in Women
The most common symptoms of sleep apnea are largely the same in men and women: daytime sleepiness, loud snoring, and witnessed apneas. A witnessed apnea is when another person, usually a bed partner, sees a pause in their loved one’s breathing, sometimes followed by a snort, gasp, or choking sound when the breathing begins again.
However, women with sleep apnea may report fatigue rather than sleepiness. They often have symptoms that are less common in men such as insomnia, depression, anxiety, morning headaches, and problems with concentration and memory.
Additionally, women and their bed partner may not notice snoring. Because of this, sleep apnea can hide behind headaches and daytime fatigue, only to be explained away as overwork.
If you experience these symptoms, even if you don’t snore, take it seriously.
The Weight Factor
For both men and women, weight is the single biggest cause of sleep apnea. Most people who come to see me are overweight or obese. In younger, pre-menopausal women, sleep apnea is usually tied to weight.
Extra weight changes the anatomy of the airway. Fat builds up around the throat and in the tongue, narrowing the space air needs to pass through. This makes the airway more likely to collapse during sleep, which is what causes the pauses in breathing that define sleep apnea.
In my patients who have struggled with their weight for years, weight loss drugs such as GLP-1 drugs play a critical role in treating their sleep apnea.
If you’re experiencing fatigue and memory problems and have a BMI over 30, you may have sleep apnea.
Risk Factors Beyond Weight: Hormones
Weight is the biggest single cause of sleep apnea in women, but it’s not the only one. Age and hormones matter as well.
Sleep Apnea in Women Looks Different Before and After Menopause
Sleep apnea is uncommon in younger women who are not overweight. One exception is polycystic ovarian syndrome, or PCOS. Women with PCOS face a much higher risk of sleep apnea, independent of weight. If you have PCOS and struggle with fatigue or poor sleep, it’s worth bringing up with your doctor.
Postmenopausal women often develop sleep apnea despite being thin, which is a distinct pattern from what I see in younger, often heavier, patients.
What Changes at Menopause
In women, estrogen helps maintain tone in the muscles that keeps the airway open. When estrogen drops, that support drops with it, and the airway is at greater risk of narrowing or collapsing during sleep.
Estrogen is also important for stabilizing sleep. When estrogen levels fall, sleep can become more fragmented, resulting in more awakenings during the night. This contributes to feeling tired after a night in bed.
A woman who never had breathing problems during sleep can develop them once she goes through menopause, even if her weight and lifestyle have not changed.
The Anatomy Factor
For both men and women, facial and jaw structure can play a major role in sleep apnea. A narrow jaw or midface, shaped by how those bones developed years earlier, can predispose someone to sleep apnea regardless of weight. Larger tonsils are another factor, especially in younger patients.
The length of the neck and soft palate matter too. A longer neck is more prone to collapse. A longer soft palate increases risk of collapse at the level of the palate. For women more than men, the airway and soft palate may become longer with age, which increases the risk of sleep apnea.
That’s why some women are especially surprised, “I’m thin, and I don’t snore, but I was just diagnosed with obstructive sleep apnea!”
Sleep Apnea and Insomnia
Many women have insomnia. Sixty percent of postmenopausal women report difficulty falling asleep or staying asleep during the night. Often, fatigue is attributed to insomnia. However, sleep apnea may also be present and should be considered.
Women with sleep apnea are also more likely than men to wake up to urinate multiple times a night. This happens because the extra effort to breathe during an apnea causes negative pressure in the chest, triggering the body to produce more urine. Most people blame this on getting older or drinking water too late, so it rarely gets connected to sleep apnea.
If you have insomnia and sleep apnea, getting your insomnia treated before starting sleep apnea treatment is important. Cognitive Behavioral Therapy for Insomnia (CBT-i) is the first step and may be combined with medications to restore normal sleep patterns.
The Sleep Study: What It May Miss in Women
Before a sleep study even happens, most patients fill out a screening questionnaire to determine whether a sleep study is needed in the first place. The problem is that these questionnaires were built and tested mostly on men. Loud snoring and neck size, two of the most heavily weighted questions, predict sleep apnea well in men but not as well in women. A woman can score low on one of these questionnaires and still have real, symptomatic sleep apnea. Better tools are being developed, but they aren’t widely used yet.
Home sleep tests have been designed to record periods of no airflow (apneas) or very low airflow (hypopneas) through the airway during sleep as well as oxygen levels. These tests are critical for establishing the severity of sleep apnea, as moderate and severe sleep apnea are linked to a greater risk of many health problems including heart disease, hypertension, stroke, and dementia in both men and women.
However, women may have sleep-related breathing disorders that affect their quality of life but do not cause apneas or hypopneas. They can experience restricted flow of air that is not enough to count as an apnea or hypopnea but make breathing a bit more difficult. Women in particular are more likely to be awoken if breathing requires more effort. This pattern can repeat all night long.
Even if the airway does not become completely blocked and the oxygen levels remain normal, restricted flow can cause fragmented, poor quality sleep. This can lead to symptoms of fatigue, brain fog, and memory problems. While this disturbance may not cause hypertension or heart disease, it can affect quality of life. Good quality sleep is also important for brain health and may reduce risk for dementia.
If You Think It Could Be Sleep Apnea
Sleep apnea in women is more common than most people realize, and it’s still underdiagnosed. If you’re dealing with fatigue, brain fog, morning headaches, or trouble sleeping and haven’t found an answer, it’s worth asking whether sleep apnea could be part of the picture, even without snoring. The earlier it’s identified, the sooner we can treat it and protect your long-term health.
If any of this sounds familiar, schedule a consultation and we’ll figure out what’s going on together.
References:
Antonaglia C, Citton GM, Siciliano M, Ruaro B, Salton F, Confalonieri M. Obstructive Sleep Apnea Syndrome in women: gender in sleep respiratory medicine is a first step towards personalized medicine. Sleep Breath. 2025 Jul 23;29(4):250. doi:10.1007/s11325-025-03420-1
Malhotra A, Huang Y, Fogel R, Lazic S, Pillar G, Jakab M, Kikinis R, White DP. Aging influences on pharyngeal anatomy and physiology: the predisposition to pharyngeal collapse. Am J Med. 2006 Jan;119(1):72.e9-14. doi: 10.1016/j.amjmed.2005.01.077. PMID: 16431197; PMCID: PMC2287192.
Peppard, Paul E et al. “Increased prevalence of sleep-disordered breathing in adults.” American journal of epidemiology vol. 177,9 (2013): 1006-14. doi:10.1093/aje/kws342
Trotta, Liliana et al. “Women and obstructive sleep apnea syndrome: Can we finally ask the right questions? The OSAF study.” Sleep medicine vol. 144 (2026): 108932. doi:10.1016/j.sleep.2026.108932
Wimms, Alison et al. “Obstructive Sleep Apnea in Women: Specific Issues and Interventions.” BioMed research international vol. 2016 (2016): 1764837. doi:10.1155/2016/1764837
Sleep Apnea in Women FAQ
What is a witnessed apnea?
A witnessed apnea is when another person, usually a bed partner, sees a pause in their loved one’s breathing during sleep, sometimes followed by a snort, gasp, or choking sound when breathing begins again. The person experiencing the apnea usually has no memory of it happening, which is why a partner’s account is often the first clue something is wrong.
How common is sleep apnea in women?
Sleep apnea is often underdiagnosed in women because their symptoms differ from the classic presentation seen in men. Rather than loud snoring and daytime sleepiness, women more often report fatigue, insomnia, and morning headaches, which can delay diagnosis for years.
What causes sleep apnea in women?
Weight is the single biggest cause of sleep apnea in both men and women. In younger, premenopausal women, sleep apnea is usually tied to weight, though age and hormones play a role as well.
How does menopause affect sleep apnea risk?
Estrogen helps maintain tone in the muscles that keep the airway open. When estrogen drops during menopause, that support drops with it, and the airway is at greater risk of narrowing or collapsing during sleep.
Why do sleep studies sometimes miss sleep apnea in women?
Women may have sleep-related breathing disorders that affect their quality of life but don’t register as full apneas or hypopneas on a standard sleep study. Restricted airflow that falls short of that threshold can still cause fragmented sleep, fatigue, brain fog, and memory problems.