Menopause & Sleep Apnoea: Why Sleep Gets Worse After 50

Sleep disruptions are a common challenge among women during and after menopause, and one of the most significant culprits is sleep apnoea. As hormone levels fluctuate, particularly with the decline in oestrogen, many women experience an increase in sleep problems, including snoring, interrupted sleep, and sleep apnoea. 

In fact, studies examining postmenopausal women have found that most women in this phase experience obstructive sleep apnoea. According to a meta-analysis on the global prevalence of sleep disorders during menopause, the prevalence of sleep disorders increases with age: approximately 42% of women in premenopause, 47% in perimenopause, and 60% in postmenopause experience obstructive sleep apnoea.

If you're noticing that your sleep is becoming more fragmented as you age, this blog will help you understand why and what you can do to regain restful, uninterrupted sleep.

We will explore how the decline in oestrogen levels contributes to worsening sleep, focusing on how hormonal changes lead to snoring, disrupted rest, and sleep apnoea. We’ll also cover the signs that you might have undiagnosed sleep apnoea, the impact it can have on your health, and practical strategies to improve sleep quality beyond melatonin, including lifestyle changes and treatment options.

How declining oestrogen levels contribute to snoring and sleep apnoea

One of the most notable changes as women go through menopause is the decline in oestrogen levels, which has a direct impact on the muscles of the airway and the regulation of breathing during sleep. This hormonal shift can lead to an increased risk of snoring and obstructive sleep apnoea (OSA), a condition where the airway becomes temporarily blocked during sleep, causing interruptions in breathing.

The role of oestrogen in muscle tone and airway health

Oestrogen plays a crucial role in maintaining muscle tone, including the muscles of the upper airway. These muscles help keep the airway open during sleep, preventing the collapse of tissues that can obstruct breathing. When oestrogen levels decline during menopause, the tone of these muscles weakens, making it more likely for the airway to collapse or become partially blocked during sleep.

Why oestrogen decline increases the risk of sleep apnoea

The drop in oestrogen during menopause can cause several physiological changes that make it harder for the body to maintain a clear and open airway during sleep:

• Weakened airway muscles: As mentioned, declining oestrogen leads to a reduction in muscle tone, including the muscles that support the airway. This results in a greater likelihood of airway obstruction during sleep.
  

• Changes in collagen production: Oestrogen is involved in the production of collagen, which helps maintain the elasticity of tissues, including those in the airway. As collagen production decreases during menopause, the tissues in the throat become less flexible and more prone to collapsing during sleep, contributing to breathing difficulties and apnoea episodes.
  

• Impaired breathing regulation: Oestrogen has been shown to play a role in regulating the respiratory system. As oestrogen levels decline, the brain may become less responsive to signals that regulate breathing, making it harder for the body to maintain normal breathing patterns during sleep. This can lead to periods of apnoea, where breathing stops for several seconds or even minutes at a time.

The connection between hormonal changes and sleep apnoea severity

The hormonal changes that occur during menopause don’t just increase the risk of developing sleep apnoea; they can also exacerbate existing conditions. For women who already experience mild sleep apnoea or snoring before menopause, the decline in oestrogen can make these symptoms worse. This is especially true for women in perimenopause and postmenopause, when hormonal fluctuations and lower oestrogen levels become more pronounced.

Other factors contributing to sleep apnoea during menopause

While the decline in oestrogen is a major factor, other menopause-related changes can also contribute to sleep apnoea and snoring:

• Weight gain: Many women gain weight during menopause, especially around the abdomen and neck. This extra weight can increase the pressure on the airway, making it more prone to blockage during sleep.
  

• Sleep disturbances: Hot flashes, night sweats, and mood changes during menopause can disrupt sleep, making it more difficult to maintain a restful night. Poor sleep quality can worsen symptoms of sleep apnoea, as fatigue and sleep deprivation can make the muscles in the throat more prone to collapse.

• Age-related changes: As women age, their sleep architecture changes, with more frequent awakenings and lighter sleep. These changes can make it more difficult for the body to maintain deep, restorative sleep, and the lighter sleep stages are associated with a higher risk of airway obstruction.

Signs you might have undiagnosed sleep apnoea

Sleep apnoea is a condition that often goes undiagnosed, especially in women experiencing menopause-related sleep disruptions. While many people are familiar with loud snoring as a sign of sleep apnoea, the condition can have a range of subtle and not-so-subtle symptoms that might be overlooked or mistaken for other issues. 

As the prevalence of sleep apnoea increases with age and menopause, it’s important to be aware of the signs that you might have undiagnosed sleep apnoea. If left untreated, sleep apnoea can significantly impact your quality of life and contribute to other health problems like high blood pressure, heart disease, and daytime fatigue.

1. Loud and persistent snoring

One of the most common and obvious signs of sleep apnoea is loud, persistent snoring. Snoring occurs when the airway becomes partially blocked, causing vibrations in the throat. While snoring alone isn’t always a definitive sign of sleep apnoea, it is one of the first symptoms to look out for. The snoring associated with sleep apnoea is often much louder and more frequent than regular snoring, and it’s usually accompanied by periods of silence, where breathing stops for a few seconds or even minutes.

💡What to look for: If your snoring is louder than it used to be, or if it is keeping your partner awake, this could indicate the presence of sleep apnoea. Pay attention to whether your snoring is followed by pauses in breathing or gasping for air.

2. Gasping, choking, or gulping for air during sleep

Another clear sign of sleep apnoea is waking up gasping or choking for air. When the airway becomes fully blocked during sleep, your body briefly stops breathing, which can trigger an automatic response to start breathing again. This often leads to a gasp or a sudden wake-up, which can disrupt sleep multiple times throughout the night.

💡What to look for: If you or your partner notice that you frequently wake up gasping for air or with a feeling of choking, it’s an indication that your airway might be obstructed during sleep. This is a key sign of sleep apnoea and should not be ignored.

3. Excessive daytime fatigue and sleepiness

Sleep apnoea often leads to poor-quality sleep, even though you may not realise it. Waking up multiple times throughout the night, due to interruptions in breathing, reduces the amount of restorative deep sleep you get. As a result, you might feel excessively tired or drowsy during the day, even after a full night’s sleep.

💡What to look for: If you find yourself feeling unusually tired, even after sleeping for 7-8 hours, or if you struggle to stay awake during the day, it could be a sign that you’re not getting quality sleep due to sleep apnoea. Increased fatigue can also lead to a lack of concentration and memory problems.

4. Morning headaches

Chronic morning headaches are another common symptom of sleep apnoea. When breathing stops during sleep, it can cause fluctuations in blood oxygen levels, which can lead to a buildup of carbon dioxide in the bloodstream. This may trigger a headache upon waking.

💡What to look for: If you regularly wake up with a headache, especially if it’s accompanied by other signs of sleep apnoea like snoring or gasping for air, it’s important to consider that sleep apnoea could be the cause. Headaches that are severe and persistent may be indicative of disrupted sleep caused by sleep apnoea.

5. Difficulty concentrating and memory issues

Poor sleep quality and frequent awakenings due to sleep apnoea can affect cognitive function. Many people with undiagnosed sleep apnoea report problems with memory, difficulty concentrating, and mental fog during the day. This can make everyday tasks more challenging and lead to frustration or feelings of incompetence.

💡What to look for: If you find that you are having trouble remembering things, staying focused on tasks, or if your mental clarity is significantly diminished, sleep apnoea could be the underlying cause. These cognitive symptoms are often mistaken for the normal aging process, but if they’re occurring alongside other signs like snoring and daytime fatigue, sleep apnoea should be considered.

6. Mood changes and irritability

Chronic sleep deprivation due to sleep apnoea can also affect your mood. Women experiencing menopause are already dealing with emotional shifts due to hormonal changes, so the added burden of sleep disruption can exacerbate feelings of irritability, anxiety, and depression.

💡What to look for: If you’re feeling more irritable than usual, or if mood swings, anxiety, or depression are becoming more pronounced, it’s important to assess whether poor sleep quality could be contributing to these emotional changes. Sleep apnoea can significantly impact your emotional well-being, making it harder to cope with daily stressors.

7. Dry mouth or sore throat upon waking

If you’re experiencing a dry mouth or sore throat upon waking up, this could be a result of snoring or breathing through your mouth during sleep. When the airway is obstructed, many people breathe through their mouths, which can dry out the mouth and throat, leading to discomfort.

💡What to look for: If you frequently wake up with a dry mouth, sore throat, or a feeling of throat tightness, especially if it’s coupled with other signs of sleep apnoea, such as snoring or gasping, it’s worth consulting a doctor for a sleep study.

Sleep strategies and treatment options beyond melatonin

While melatonin is often the go-to solution for improving sleep, it may not be sufficient for addressing the deeper causes of sleep disturbances, especially in cases like sleep apnoea. Sleep apnoea, which is often exacerbated during menopause due to hormonal changes, requires targeted strategies and treatments that address the root causes of disrupted sleep.

1. Lifestyle changes for better sleep

Making some simple yet effective lifestyle changes can go a long way in improving sleep quality, especially for those dealing with sleep apnoea.

• Maintain a consistent sleep schedule: Going to bed and waking up at the same time each day helps regulate your body's internal clock, making it easier to fall asleep and wake up naturally.
  

• Create a relaxing bedtime routine: Establishing a calming pre-sleep routine can help signal to your body that it’s time to wind down. This can include activities such as reading, taking a warm bath, practicing deep breathing, or listening to soothing music. Avoid stimulating activities such as using electronic devices or watching intense TV shows right before bed.
  

• Sleep hygiene practices: Improving your sleep environment is essential. Make sure your bedroom is dark, quiet, and cool. Use blackout curtains, earplugs, or a white noise machine if needed to minimise disruptions. A comfortable mattress and pillows that support proper alignment can also significantly improve sleep quality.

2. Positional therapy

For some individuals with sleep apnoea, their sleep position may contribute to airway obstruction. Sleeping on the back can exacerbate snoring and apnoea episodes, as gravity can cause the tongue and soft tissues in the throat to collapse and block the airway.

• Side sleeping: Sleeping on your side can reduce the likelihood of airway obstruction during sleep. You might consider using a body pillow to keep you in a side-sleeping position throughout the night.
  

• Positional devices: There are specialised devices available, such as positional pillows or wearable monitors, that help encourage side sleeping and prevent back sleeping, which may be beneficial for people with positional sleep apnoea.

3. Continuous Positive Airway Pressure (CPAP) Therapy

CPAP therapy is one of the most effective treatments for moderate to severe sleep apnoea. A CPAP machine uses a hose connected to a CPAP mask or nosepiece that delivers a continuous stream of air to keep the airway open while you sleep.

How CPAP works: 

The continuous airflow prevents the airway from collapsing, allowing you to breathe freely throughout the night and improving sleep quality. Many users find significant relief from snoring and daytime fatigue after using CPAP therapy.

It may take some time to get used to wearing a CPAP mask, but most people find the benefits of uninterrupted sleep outweigh the initial discomfort. Consulting with a sleep specialist or technician can help you find the right mask and settings for optimal results.

4. Oral appliances (Mandibular Advancement Devices)

Oral appliances, also known as mandibular advancement devices (MADs), are custom-made dental devices designed to help keep the airway open by repositioning the lower jaw or tongue during sleep.

These devices work by gently advancing the lower jaw forward, which prevents the airway from collapsing and reduces the occurrence of snoring and apnoea events. They are generally more comfortable than CPAP for those with mild to moderate sleep apnoea or snoring.

Benefits:

Oral appliances are a non-invasive treatment option and are often well tolerated, especially for those who have difficulty using a CPAP machine. They are portable, making them a good option for travel as well.

5. Weight management and physical activity

Weight gain is a common issue during menopause, and excess weight—especially around the neck and upper chest—can contribute to airway obstruction during sleep. Managing weight through a healthy diet and regular physical activity can help reduce the severity of sleep apnoea symptoms.

6. Breathing exercises and relaxation techniques

Breathing exercises and relaxation techniques can help reduce stress, promote relaxation, and improve airflow during sleep, particularly for those with sleep apnoea.

• Nasal breathing exercises: Techniques such as the Buteyko method or controlled nasal breathing exercises can help improve airflow and strengthen the muscles in the airway, potentially reducing the severity of sleep apnoea.
  

• Progressive muscle relaxation: This technique involves tensing and relaxing different muscle groups in the body, which helps to reduce stress and promote a deeper, more restful sleep. Progressive muscle relaxation can help ease the physical tension that might contribute to airway obstruction.

7. Cognitive Behavioral Therapy for Insomnia (CBT-I)

Cognitive Behavioral Therapy for Insomnia (CBT-I) is a structured programme designed to help individuals who have trouble falling or staying asleep. While CBT-I is typically used for insomnia, it can also benefit people with sleep apnoea by addressing negative sleep patterns and promoting healthier sleep behaviours.

How CBT-I works: 

This therapy focuses on changing thought patterns and behaviours that contribute to poor sleep. Techniques include stimulus control, cognitive restructuring, and sleep restriction. CBT-I can help you develop a consistent bedtime routine and address anxiety or stress related to sleep, which can improve overall sleep quality.

When to seek professional help

While lifestyle changes, sleep strategies, and home remedies can make a significant difference in improving sleep quality, there are times when professional help is necessary. Sleep apnoea, especially when left untreated, can lead to serious health issues such as high blood pressure, heart disease, stroke, and even cognitive decline. If you suspect you have sleep apnoea or if your sleep disruptions are impacting your daily life, it’s important to seek medical advice. Here are the key indicators that it might be time to consult a healthcare provider.

• Persistent snoring or gasping during sleep

• Daytime fatigue or excessive sleepiness

• Morning headaches and dry mouth

• Trouble concentrating or memory issues

• High blood pressure or heart problems

• Unexplained mood changes or depression

• Lack of or no improvement with home remedies or over-the-counter solutions

• Family history of sleep apnoea or other sleep disorders

Don’t ignore the signs—get the right treatment

Sleep disruptions during menopause can feel overwhelming, especially when they’re linked to something like sleep apnoea. But you’re not alone—many women face these challenges as their hormones shift. If you’re noticing signs and symptoms that we’ve highlighted above, it could be a sign that sleep apnoea is affecting your health.

The good news is that there are plenty of ways to tackle sleep apnoea, from lifestyle changes to professional treatments like CPAP therapy or oral appliances. By recognising the signs early and seeking the right treatment, you can improve your sleep and get back to feeling like yourself. Don’t hesitate to talk to your doctor if you think sleep apnoea might be the issue—it’s never too early to start improving your sleep and your overall well-being. 

Disclaimer: The information provided in this blog is based on thorough research conducted by our team, drawing from credible health websites, scientific studies, and expert sources. While we strive to provide accurate and helpful guidance, please note that the content here is for informational purposes only and should not be considered as medical advice. Always consult with a healthcare professional before making any changes to your health routine or if you have concerns about your health. A healthcare provider can offer personalised advice and recommend the best course of action based on your individual needs.