This is my PSA about obstructive sleep apnea in women

[tacom]

I had my sleep study follow up today, and it turns out I have obstructive sleep apnea. This was so far off my radar I audibly laughed when the doctor shared the news. I am a 25 year old non-smoking woman of normal weight and build who rarely drinks and has no family history of OSA. I do not snore. I do, however, have anxiety, chronic headaches, daytime drowsiness, difficulty falling and staying asleep,  and frequent wakings to urinate. I've incidentally noted that my body cannot regulate my heart rate during running, and I've had to rely more on memory strategies recently (which I credited to the stress of wedding planning whilst job hunting and planning a cross-country move).  I'm not happy to have another chronic disease so young, but I am glad that I have an informed diagnosis to better manage the issue. For now, I'll make positional sleep changes. We are going to trial an intraoral device that will displace my tongue/jaw during my sleep and thus prevent or reduce the pharyngeal collapse/airway obstruction. I'll need to be more careful about eating habits and exercise, because my doctor made it clear that even small weight gain could be dangerous. I'll also  schedule an appointment with a cardiologist to make sure everything checks out ok.

I've selected some relevant pieces below that highlight gender differences regarding the presentation, medical management, and morbidity associated with OSA.

• Women with OSA complain of symptoms such as insomnia, restless legs, depression, nightmares, palpitations and hallucinations whereas men are more likely to report snoring and apneic episodes
  
• It has been suggested that discrepancies between males and females in the prevalence of OSA could be a result of women frequently being misdiagnosed or under diagnosed. Less frequent reporting of ‘typical’ OSA symptoms by women, plus a higher prevalence of atypical symptoms such as headache, anxiety and depression, could contribute to the under-evaluation of OSA in women, lower referral rates to sleep clinics, and under-representation in clinical studies
• Women may be at increased risk of OSA during pregnancy due to a number of factors. The growing uterus elevates the diaphragm, changing pulmonary mechanics [43]. In addition, during pregnancy, neck circumference increases [44, 45], nasal patency is reduced [46] and pharyngeal edema occurs [47]. Substantial increases in snoring, snorting/gasping and witnessed apneas have been documented in pregnant women [45]. Snoring during pregnancy appears to be a risk factor for both pregnancy-induced hypertension and intrauterine growth retardation [48].

• "The long-term health consequences of OSA have been well- documented in patient populations with a predominance of males. More recently, however, studies are starting to specifically look at the consequences of OSA in female patients. Sympathetically-mediated responses to autonomic challenges in patients with OSA are blunted to a significantly greater extent in women versus men with OSA; this deficit is likely to reduce the effectiveness of BP regulation, and brain perfusion [49]. It is possible that women with moderate sleep apnea are more susceptible to the adverse cardiovascular consequences of OSA than men, having been shown to have more marked endothelial dysfunction [50]. Certainly, untreated severe OSA has been independently and significantly associated with cardiovascular death in women [51]. Conversely, the contribution of OSA to hypertension has been shown to be lower in women versus men [52].
  Women with OSA are more likely than their male counterparts to develop a number of comorbid conditions, including mood disturbances such as anxiety and depression, hypothyroidism, arthropathy, cognitive impairment and dementia [53, 54]. These comorbidities probably explain the increased mortality risk that has been documented in women compared with men [55]. Women with OSA experience worse health status, use more psychoactive drugs, and have higher healthcare costs (by 1.3-fold) compared with men [53, 54].
  Thus, the limited data available suggest that although the prevalence and severity of OSA may be lower in women than in men, the consequences of the disease are at least the same, if not worse [56].
  



www.resmed.com/content/dam/resmed/global/documents/articles/1017226-women-and-osa-forher-algorithm.pdf


I also thought this was a really good read: sleepfoundation.org/ask-the-expert/women-and-sleep-apnea

[AAM2012]

Wow how crazy but so glad you have a diagnosis so you can take care of yourself.

[orangeblossom]

Great PSA, though I'm sorry you're dealing with it.

I just read something the other day about feequent nights urination can be related to sleep apnea.

[tacom]

May 27, 2015 19:59:26 GMT -5 Stan said:

How crazy! I never would've thought this, but I do have some of those symptoms. H is getting a sleep study with the stereotypical symptoms, but now I wonder if I should try and get one. Glad you got a sleep study and can now get proper treatment! Thanks for posting.

Other than the inconvenience of removing electrode goo from your hair, it shouldn't hurt! I hope you can figure out what's going on.

[imojoebunny]

When you say your body can't regulate your heart rate while running,this sends up 1,000 red flags more serious than sleep apnea. My DH, who has run numerous marathons and other feats of athletics, has Bradycardia, which ended with him getting pace maker at an unusually young age. One suspected cause is sleep apnea(they don't really know, chicken or egg) though like you, he had few symptoms. Now that he has the pace maker, he no longer has the symptoms of sleep apnea. He would not have known to get a pace maker, had he not been very athletic. He knew something was wrong after he would exercise, and went to the doctor, who put him on a monitor that followed the heart beat, not just beats per minute, but when they are. Please follow up with the cardiologist, given your overall good health.

[awkwardpenguin]

I was diagnosed at 23 and had to push for the sleep study because I was normal weight and a woman. I hope treatment helps you to feel better - it was a game changer for me. It's actually not a huge deal to manage, you just have to tote around a machine when you travel.

[msmerymac]

Thanks for your post. I've been thinking I should investigate this for myself. I'm pretty sure my husband should, too.

[audette]

Now I'm curious about the results from my sleep study. My follow-up appointment isn't for another few weeks.


I presented with all the "typical" symptoms - overweight, daytime fatigue, difficulty staying asleep, and the biggy - a partner whining about my snoring. It did get me the sleep study referral super-fast.

[steph96]

I hope your treatment helps!

What exactly do you mean by you can't regulate your heart rate? I tried looking it up online, but I'm not having much luck.

[Deleted]

This sucks so hard that you have to deal with this. My sister and a close friend around 30 have both been diagnosed, but they are overweight. Getting a good nights sleep can change your world they have both said.

[Deleted]

Glad that you're getting treated.

My mom has OSA. She's obviously older, but she's not overweight either. It's definitely something that can affect people when they don't even realize it. Here CPAP has done wonders for her.

[redwino]

This psa is making me think I should start using my cpap again. I stopped because it seemed like too much work with getting up with the baby. MI guess I should just deal with it and go back to wearing my mask.

[Deleted]

My mom has OSA and the CPAP machine has made a HUGE difference in her sleep patterns. HUGE! It's been proven with her Fitbit too. So good luck! I hope this helps you going to share the article with her

[chickens987]

My mom was just diagnosed with sleep apnea. I have witnessed all the classic symptoms in her - snoring, she occasionally seems to stop breathing, excessive fatigue and cognitive issues. HOWEVER, she's decided they're wrong and the guy is just an CPAP pusher. Ugh. She's promised to follow up with her PCP, but I don't know.

[tacom]

May 28, 2015 6:22:50 GMT -5 chickens987 said:

My mom was just diagnosed with sleep apnea. I have witnessed all the classic symptoms in her - snoring, she occasionally seems to stop breathing, excessive fatigue and cognitive issues. HOWEVER, she's decided they're wrong and the guy is just an CPAP pusher. Ugh. She's promised to follow up with her PCP, but I don't know.

Maybe you can share the above articles with her? i'm sorry - that would be very upsetting to me, too.

[Deleted]

tacom, what made you seek treatment to begin with?

I'm trying to figure out my general lack of energy/motivation and have noticed via my fitbit that I don't sleep nearly as well or as much as I thought I did (average 4-5 hours when I'm in bed 8). I get up multiple times a night to use the bathroom too. I rarely snore and don't think I have breathing issues but now I'm curious. I do think some of my problems functioning are sleep related.

[ijack]

May 28, 2015 9:12:00 GMT -5 @buckybells said:

tacom, what made you seek treatment to begin with?

I'm trying to figure out my general lack of energy/motivation and have noticed via my fitbit that I don't sleep nearly as well or as much as I thought I did (average 4-5 hours when I'm in bed 8). I get up multiple times a night to use the bathroom too. I rarely snore and don't think I have breathing issues but now I'm curious. I do think some of my problems functioning are sleep related.

One of my docs pushed me to do it. At the time I was on 2 different stimulant meds and beyond exhausted all day long. I get a fairly normal amount of sleep, but could sleep all day if someone let me. I ended up having a study done about a month ago, but unfortunately it didn't tell them anything and they don't really know where to go from here. It's really frustrating
Averaging 4-5 hours of sleep when you're in bed 8 doesn't sound normal to me, I'd definitely ask your doc about it.

[tacom]

May 28, 2015 9:12:00 GMT -5 @buckybells said:

tacom, what made you seek treatment to begin with?

I'm trying to figure out my general lack of energy/motivation and have noticed via my fitbit that I don't sleep nearly as well or as much as I thought I did (average 4-5 hours when I'm in bed 8). I get up multiple times a night to use the bathroom too. I rarely snore and don't think I have breathing issues but now I'm curious. I do think some of my problems functioning are sleep related.

My fiancé told me he noticed me acting out my dreams. I contacted my PCP who referred me to a sleep clinic. He recommended a sleep study to rule out REM sleep behavior disorder.

[StJess80]

I have an at home sleep study scheduled for the middle of next month. When I went to my dr complaining of constant headaches, she wanted to rule out any sleep issues first.

[eponinepontmercy]

Thank you for posting. A lot of this fits my mom. I know my dad has a CPAP, and I'm going to bring this up with her today.