Depression. Insomnia. Waking to use the bathroom in the middle of the night. These are all symptoms of menopause — but they’re also signs of obstructive sleep apnea (OSA), at least in women.

OSA, which causes disruptions in breathing during sleep, has traditionally been considered a men’s condition, but an estimated 1 in 6 women experience it, and most don’t know it. This is, in part, because telltale signs of the condition, such as snoring and gasping for air, are common in men but not always present in women.

Emerging research shows that women exhibit different, more subtle signs of OSA and experience different health effects due to the disrupted sleep. For reasons that are not entirely clear, women tend to have a higher risk of serious long-term consequences like heart disease, cognitive decline, and death if OSA goes untreated.

Receiving treatment for OSA dramatically decreases these risks and may address health issues unrelated to sleep apnea as well. Treatment, though, depends on diagnosis — and diagnosis depends on understanding how the condition differs by gender.

7 Ways Apneas Are Different in Women

In OSA, the airway becomes blocked repeatedly during sleep, causing breathing to stop or be restricted temporarily. These breathing interruptions, called apneas, reduce the oxygen in your bloodstream and cause mini-awakenings. But apneas occur uniquely in women. Some differences include:

  • Lower frequency of apneas. The apnea hypopnea index (AHI) measures the number of times you stop breathing (apneas) and have shallow breathing (hypoapneas) during an hour of sleep. Women tend to have a lower AHI than do men — on average, 20 vs. 32 apneas per hour.
  • Shorter apneas. Women’s pauses in breathing tend to be shorter than those in men. One study found that shorter apneas are associated with greater risk of death because they suggest a more unstable autonomic system.
  • Less severe oxygen shortages. Because the apneas are shorter, women aren’t deprived of oxygen for as long as men.
  • More apneas during REM sleep. Women have more apneas during the dreaming phase of sleep.
  • Longer time to fall asleep. Women with OSA take longer to fall asleep than men with OSA.
  • Less likely to be related to sleeping position. In men, OSA can be more closely associated with certain positions, like when lying on their back, but this is less common in women.

Surprising Symptoms of OSA in Women

The telltale signs of sleep apnea, like snoring and waking up gasping for air, are less common in women, though they may occur.

For women, insomnia may be a stronger clue. “If you wake up at 3 in the morning and you don't know why, but you're wide awake and you have a really hard time getting back to sleep, that may be a sign of sleep apnea,” said Michael Grandner, PhD, director of the Sleep and Health Research Program at the University of Arizona, in a 2025 Embody webinar on sleep.

While men with OSA tend to complain of daytime sleepiness, women typically don’t, which may reflect a higher tolerance for fatigue than a genuine absence of that symptom.

Nighttime symptoms in women:

  • Nightmares
  • Insomnia or taking longer to fall asleep
  • Having to urinate at night

Daytime symptoms in women:

  • Waking up in the morning with a headache
  • Mood disturbances such as depression
  • Lack of energy

Why Diagnosis Lags for Women

At least 80% of all people with OSA are undiagnosed, but women are even more likely to go undiagnosed. That’s partly because nighttime symptoms are more subtle and might not be noticed by a partner. Snoring or gasping for air is loud, whereas waking suddenly to use the bathroom is not.

The gender disparity in diagnosis can also be blamed on screening tools to detect OSA, which are based on studies of men. One screening tool commonly used by primary care physicians, called the Epworth Sleepiness Scale, often does not detect mild to moderate OSA in women.

Home sleep studies have become more popular because they’re more convenient and less expensive than staying overnight in a sleep lab. But they are known to underestimate OSA presence and severity, and this may pose more of an issue for women than for men.

At the same time, the criteria for treating OSA is based on men’s experiences and may be too stringent for women. For example, the decision to treat OSA is based on the AHI score (the number of apneas and hypoapneas per hour) but women’s scores may fall below the cutoff, even if they have OSA. Another diagnostic marker is a drop in blood oxygen levels of 4%. Because women with OSA experience a slightly less severe drop in oxygen, some experts recommend changing this cutoff to 3%.

Risks for OSA

Certain factors can put women at increased risk of OSA:

  • Weight gain. The risk of OSA increases as your weight rises because excess fat deposits can narrow the airway.
  • Menopause. Estrogen and progesterone are thought to protect against OSA, so when hormone levels drop, risk of OSA increases. Hot flashes are also associated with an increased risk of OSA. Hormone therapy decreases the risk.
  • Certain hormonal conditions like polycystic ovary syndrome (PCOS), low thyroid hormones, and high levels of insulin are associated with OSA.
  • Drinking alcohol and smokingcigarettes may increase the risk for OSA.
  • Family history. OSA may run in families.

Though not risk factors, certain conditions are more common in women with OSA. These include depression, cardiovascular disease, diabetes, hypothyroidism, and asthma. These conditions may signal undiagnosed sleep apnea, so if you have these conditions and any of the signs of OSA sound familiar, consider asking your doctor to screen you.