| Sleepopolis

Episode 10: Sleep Apnea in Women Is More Common Than You Think

Show notes:
Sleep apnea is often thought of as a disorder for old white men, but women can have it too. In fact, women are more likely to be diagnosed at a later date and suffer from complications more than white men. In this episode, Dr. Harris talks with Emma Cooksey. Cooksey, who was diagnosed with sleep apnea in 2008 after falling asleep at the wheel with her baby in the backseat, launched her podcast, Sleep Apnea Stories, in 2020, to help other women navigate the same journey she had gone through.

Transcript

Dr. Shelby: Welcome to Sleep Talking with Dr. Shelby, where we really want to know, how are you sleeping? Are you sleeping? I’m Dr. Shelby Harris, licensed clinical psychologist, and I’m the director of sleep health at Sleepopolis, where we dive deep into all things sleep so you can get the rest you deserve.

Today we’re talking about sleep apnea in women. This is something super close to my heart. I’m really excited for today’s episode. If you have trouble sleeping at night and are concerned it could be caused by sleep apnea, then this episode is for you. But what is sleep apnea? So sleep apnea is a common disorder that causes you to stop breathing while you’re asleep at night.

Over time, it can cause additional complications, which can be managed for many. However, a majority of those with sleep apnea don’t know that they even have it. According to the Society for Women’s Health Research, nearly one in five women have sleep apnea. And of those women, 90, that’s nine-zero percent are completely and totally unaware.

Statistics like this make it crucial to raise awareness for the condition. To help with that, we’ve invited writer, content creator, and speaker, Emma Cooksey, to discuss warning signs, treatments, and her own journey with sleep apnea. Through her work with Project Sleep and as host of the podcast Sleep Apnea Stories, which I’ve been so lucky to be a guest on in the past, Emma advocates for those with sleep apnea, to help improve access to all available treatments and to teach as many people as possible about the condition.

Emma, thank you so much for joining us today and welcome to Sleep Talking with Dr. Shelby.

Emma Cooksey: Thank you so much for having me. I’m so delighted to be here with you.

DS: I’m so happy that you’re here today. Can you tell us a little bit more about yourself, your experiences with sleep apnea?

EC: Sure. So I always like to start off by explaining my accent, that I’m from Scotland originally. I live in Florida now with my Floridian husband and my two kids. But I started out in Scotland with these symptoms, right? So, in my, I would say, early twenties, I started having just not restful sleep. I would wake up and feel like I hadn’t even gone to bed the night before. I’d have eight hours sleep and I’d wake up just exhausted, still sleepy. I would have morning headaches every morning. Often I had disrupted sleep. I did snore. I had some gasping episodes. So all of those things showed up. I knew nothing about sleep apnea.

DS: How old were you at that time when you started noticing some of those symptoms?

EC: I would say it first became really noticeable the first job I had. So I studied law at university. And those four years, you know, I was a student. So I was sleeping. I probably napped more than other people. But I didn’t really notice. I could kind of plan my own schedule and I managed to keep up, right? But then I started a corporate job at a law firm, and within weeks, I was struggling to stay awake at my desk.

I noticed that towards the end of the day, everybody else was ready for an all nighter, and I was just looking at when I could go home. I was so exhausted, and I really didn’t do anything outside of working. I would just work and go home, and nap, and then sleep, and wake up, feel terrible, go and do it all again.

And so, when I really started thinking there might be something wrong with the situation was in my early 20s. I did go to a doctor around that time, explained all my different symptoms, and asked what it could be, and could there be something wrong with my sleep.

DS: Quick question, what kind of doctor did you go to?

EC: This was a primary care doctor, so in the UK we call them GPs for general practitioner. I, at that point, had no idea there was such a thing as a sleep doctor. So, I went and I explained my symptoms and I said, I feel just so exhausted, and he said, let’s test everything, they did blood work, he was like, let’s check your thyroid, let’s do all these different things.

And when I went back for the results, I was really hopeful we were going to get to the root of what was going on, and he essentially said, there’s nothing wrong with you. Like, he didn’t say the words, it’s all in your head. But he questioned, like, you know, maybe there’s some anxiety or some depression and just sent me home again.

DS: How did you feel upon that part?

EC: Pretty devastated because I think at that point, I’d been dealing with this for a number of years, but kind of just thinking… Well, I don’t know what I thought. I don’t think I thought that there could be a medical condition behind it because I’d never heard of anything to do with sleep apnea or sleep disorders or anything.

So I think by the time I got to the doctor, I was really desperate for help. And so to go through that and then have him say there’s really nothing medically wrong was pretty depressing in itself.

DS: And also, the fact that it kind of was hinted at that it might be in your head. I can’t imagine taking that necessarily well, thinking that you’re almost manifesting some of these symptoms. I mean, how did you deal with that in the moment? Did you end up going to psychiatry? Or did you just kind of say, I gotta keep powering through?

EC: So, I didn’t, but then I feel like, you know, this is- you talk about this all the time, the connection between mental health and sleep. So I feel as though as I went into my first few jobs in my twenties and was doing things where I was traveling and trying to keep up when I was really tired.

Eventually depression and anxiety did creep in. I felt overwhelmed all the time and I did eventually go to a doctor and get antidepressants. And so it’s not that I don’t think people should treat their anxiety and depression, I just with sleep apnea, if that’s the thing underlying it, like, you really need to address that, right? As well as whatever mental health thing you have going on.

DS: What do you wish you had known at that point when you first started having symptoms? And as a woman in general, like, what do you think you would have maybe done different at that time?

EC: So, the first thing is I wish I’d known all of these different symptoms because until you actually read the whole symptom list, I mean, there’s so many things where I was grinding my teeth and I was waking up to pee in the middle of the night.

When you go down the list of all the sleep apnea symptoms, if I had known those, I would have recognized all of them in myself. So, I think that that’s part of it. The other part I really wish I’d known is that GPs and primary care doctors really don’t get a lot of training in sleep, right? So I think that you’re going expecting them to know all about this. But actually knowing that they might not be the right person to help you would have been really helpful.

DS: It’s a challenge too, because they don’t have that much time nowadays, especially in the US with limited health care time and insurance regulations, they’ve got asked 8 million things. Sometimes the onus is on the patient to bring these things up when they don’t know that they should be bringing these things up.

EC: And sometimes, like, connecting it up, like, I feel, looking back I used to go to the doctor, you know, I went various different times over a 10 year period, and I would usually show up in tears. Because I didn’t know anything about sleep disorders, I didn’t know what to accentuate. So I basically was saying, I just feel terrible, right?

Rather than if I knew what all the symptoms were, I could have said I have daytime sleepiness, which I think a lot of doctors consider quite differently from fatigue or exhaustion or tiredness.

DS: What were you using, to no fault of your own or anybody’s, but were you using the word I’m sleepy or are you saying I’m tired too? I think that they get, they get kind of interpreted differently based on how you’re presenting.

EC: Yeah. I think all of that. I feel like I was showing up in tears. Saying, I feel overwhelmed at work. Really, really tired all the time. And I just didn’t know, like, to kind of parse out this is sleepiness and that is fatigue. You know, like I think sometimes it’s difficult for patients to understand the difference.

DS: And I think a lot of people just assume fatigue is a quote unquote normal part of living, especially in today’s world.

EC: Right, everybody is tired. So that’s part of it as well. Like I think when you’re dealing with an undiagnosed sleep disorder like sleep apnea, you’re surrounded by all of these different people who are saying, I’m so exhausted. I’m so tired, all the time because of our culture, right? And the way that everybody’s going all the time.

DS: Burnout.

EC: Yeah.

DS: For sure. But sleepiness is a different animal, right? That’s the irrepressible need for sleep. And that’s what you were, it sounds like, experiencing.

So how, I know that your diagnosis was delayed, but how did you eventually end up getting a proper diagnosis?

EC: So, from Scotland, moved to Florida with my husband, had my first child, and she was an amazing sleeper as a baby. So I was getting this opportunity, even though I had a newborn, I had seven or eight hours every night where I could have been getting great sleep, but I just wasn’t feeling any better at all.

I was just feeling the same as I’d felt for 10 years. So I went back to the doctor and I explained that and she pretty much just said you just had a baby and I think that’s one of the things with women, right? There’s so many periods of our life, whether it’s pregnancy, postpartum, menopause, all these different stages where doctors are super well meaning, but they’re basically saying, oh, it’s really normal to have sleep problems. Well, I think sometimes we need to ask more questions, right?

So, anyway, three weeks after that doctor’s appointment, I was driving home with my baby daughter strapped in the back of the car in her chi prank car seat.

DS: Oh, I remember those.

EC: I know. So we get onto this bridge called the Buckman Bridge, which is here in Jacksonville, Florida. And I’ve driven over a million times before, but once you’re on that bridge, it’s really long and there’s no hard shoulder. You can’t pull over, right?

DS: Yeah.

EC: So once I got on that bridge, I just had that real sleepy feeling, you know?. I couldn’t keep my eyes open. And essentially what happened was I fell asleep at the wheel and almost hit a truck.

So I slammed on my brakes and I managed to avoid that collision, but I think that that was kind of the turning point in my journey where I realized this problem, like I needed to get answers and nobody was listening to me. So I drove home and I gave the baby to my husband and I had that shaky, like adrenaline feeling.

And I called the doctor’s office that I’d just been in like three weeks before, because one of the things they’d said when I was at that doctor’s appointment was, you don’t seem to have a lot of risk factors for sleep apnea. They were kind of like, you know, you’re a younger woman and, you know, you’re not super overweight and all this.

And so I called them back and I said, I know what you said, but I really want a referral to somebody that knows about sleep because I fell asleep at the wheel.

DS: You’re literally fighting to get a better evaluation.

EC: Oh yeah. Yeah. And so I think the fact that, I mean, it shouldn’t ever take falling asleep at the wheel, right? Or anything like that for people to get this diagnosis. But for me, that’s what it came to.

I think, honestly, like, with a lot of the stuff that I do now, when people ask, you know, like, what motivates you to kind of keep going with all the stuff you’re doing, that’s it, right? There’s still not a lot, like, some things have changed, like, some things around testing, but honestly, not that much has changed since that day, 16 years ago. There are still women falling asleep at the wheel regularly.

DS: Yeah.

EC: I was one of the lucky ones.

DS: Testing has definitely changed. Treatment options are evolving, as we will talk about. I think I’m also seeing it more in like just In TV shows, people are mentioning apnea more, like, a random character will have their PAP with them. But the diagnostic side is still lagging a good amount.

EC: And just the awareness of what those symptoms are, right? Especially for women.

DS: So how do you think being a woman then played into your interaction with your doctors? Sounds like they were kind of taking you seriously but still putting you in this box of, well, you’re a woman so you probably are either having depression or you’re anxious or you just had a baby.

EC: Yeah.

DS: Do you think that was the main thing?

EC: Like we said before, primary care doctors, they’re looking for so many different things, right? So, I kind of get it on one level, right? There’s so many different things that can cause those symptoms and especially in a new mom and all of that, but I think that with sleep apnea, just the way that the research around it evolved.

They started out looking at this as a condition that older, overweight men with really loud snoring and really high, what we call AHIs, they’re having lots of events an hour where they’re stopping breathing. And so I think a lot of the tools that they came up with and ways to screen for this were kind of based around men because that’s who they’d seen it in a lot.

DS: Yeah.

EC: So, I think sometimes with women, it just shows up a little bit differently, and maybe it’s taking a while for doctors to kind of catch up to that. Not only myself, but some of the people that I’ve interviewed on my podcast, I hear a lot from women who start out with a diagnosis of depression or anxiety.

And that is their major thing that’s impacting their life, right, from it. And then there are some other things that when somebody says these are also symptoms of sleep apnea, they say, oh, I can check a bunch of those boxes. But the thing that’s standing out to them is that they feel really depressed. That’s a common thing I hear among women a lot.

DS: You finally got diagnosed. So you went to a sleep doctor. What happened? Did you have a overnight sleep study? I know this was what, 16 years ago, you said?

EC: Mm hmm.

DS: Okay. It might be a little different than now.

EC: So I just was at a conference with a bunch of sleep techs, and I don’t think I realized how unusual my polysomnogram was until I talked to people.

DS: I don’t know anything about this. Tell me.

EC: So yeah, I don’t know if we’ve talked about it. So I called the doctor. They said yes. You fell asleep at the wheel, let’s get you tested for this. So then, I didn’t then speak to a board certified sleep specialist. I was kind of like they went to my insurance to find out what the insurance would pay for.

Well, the insurance was doing a special trial of this way of doing a full polysomnogram in people’s homes where they sent the sleep tech to your house to wire the electrodes on your head.

DS: What?

EC: It gets so much funnier. So then they set up a laptop beside my bed with a webcam so that a sleep tech in Texas could watch me sleep through the Webcam.

DS: Oh my gosh.

EC: So I was completely wired up exactly the same as you would be in a sleep lab and certainly we got the diagnosis and that was fine, but I’d never heard of any of it. So I didn’t know that was unusual until after the fact.

DS: And that is not a model that they’re using at all now that I’ve seen, at least in the New York area.

EC: So then I went to see the board certified sleep specialist after that, and he essentially said your diagnosis is moderate obstructive sleep apnea, here is a CPAP.

DS: Yep. So what does Moderate Obstructive Sleep Apnea mean? Do you mind talking about that?

EC: I think that these terms mild, moderate, and severe are kind of misleading just because now that I’ve been interviewing so many people with sleep apnea, it doesn’t really correlate to how the patient necessarily feels.

They would say that anything under five events, so you explained it really well in the beginning, you can’t get oxygen to your brain because of an obstruction in your airway. And so, that airway’s closing multiple times every hour. And so, if it’s under five events per hour, they consider that normal.

Between five and fifteen events is mild, and then fifteen to thirty events an hour is moderate. Anything over thirty events an hour is considered severe. And so, yeah, they basically put you into one of those categories. But of course, at the time, I’d never even heard of sleep apnea. I certainly didn’t know what any of that meant.

DS: Yeah. And then you’re talking about the severity, not feeling necessarily the same for everyone either.

EC: Absolutely.

DS: So I think the interesting thing too, is that you can kind of get bumped into different categories or bumped up in severity if you’d let’s say only have mild or moderate number of events a night, but your oxygen is dropping, right? Because apnea hypopnea index, AHI is what they’re looking at. And A, apnea means full closing of breathing at night. Hypopnea is partial cessation of breathing. So it’s like narrowing.

EC: Right. And it’s for 10 seconds. So the more that I interview people, the more I’m like, what about the people with nine second pauses or, you know, it gets so that it’s a little bit, they just had to pick an arbitrary number.

DS: Yeah. And so moderate, was that like just, oh my gosh. What was it like when you actually got diagnosed? What went through your head?

EC: Honestly? I had no idea what he was talking about. I’d never heard of a CPAP. I’d never heard of sleep apnea. And he explained it to me. Like, well, your airway’s closing, so it’s cutting off the oxygen to your brain and sending stress hormones and waking you up a bunch of times.

So in some ways, I was really relieved to have an answer that I felt the way I did.

DS: Yeah, it gave you some perspective of what’s been going on, I know. So he gave you a CPAP.

EC: Mm hmm.

DS: And I’m assuming it wasn’t like an auto-

EC: So, no, no. Oh no, Shelby.

DS: 16 years ago.

EC: This was back in the day. So the doctor prescribes the CPAP and then sent me to what’s called a durable medical equipment company, a DME.

Now that’s changed a lot over the years. So this was a brick and mortar place I went to round the corner with some nice ladies who gave me a CPAP in a plastic bag and a mask that didn’t fit my face and sent me home. CPAP is a whole thing.

DS: As we mentioned before, 9 in 10 women with sleep apnea are totally unaware that they have it. So what are some other factors that you think make the condition difficult to identify besides depression or anxiety and that’s getting masked?

EC: Well, like, so here’s one of the things that comes up over and over again. And of course it’s not just straight couples sleeping in beds together all the time. But what doctors are telling me happens a lot is women are hearing their husbands snore loudly and making them go to the doctor to look into that. And I think that it’s not necessarily, like, I definitely did snore, but probably not loudly enough to disrupt my husband’s sleep.

So I think that that part of it is often missing for women. So somebody to sound the alarm and say there’s something not right with your sleep.

The other thing for women, there are lots of life stages. And I’ve definitely noticed this myself. So oftentimes in pregnancy, you know, I certainly gained a substantial amount of weight during my pregnancy. And that is a factor in sleep apnea. You know, new or worsening sleep apnea is something that we’re not really looking for in pregnant women, but that definitely can be a factor. But I think it’s this thing where they’re going to an OBGYN all the time who has a lot to look for, right? With what’s going on with the baby and the mother’s health in general.

And so they’re not necessarily screening for sleep apnea. So I think there’s oftentimes, even if people are saying, I’m really tired, the doctor perceives that as pretty normal during pregnancy.

DS: Even sleepiness, like I need to take a few naps during the day. Well, that’s completely normal. Look what’s happening, especially in your third trimester.

EC: Yeah, and then, you know, as you move into having a newborn, people are expecting you to be tired. And then especially around menopause, I’ve heard from a lot of women who have developed sleep apnea during that stage of life and are being told like, sleep interruption and disturbance during menopause is really normal.

DS: Yeah, for sure. And I think what we see in women typically are the rates of apnea. Yes, they’re still significant, 1 in 5 women, but they’re lower in comparison to men. Until you hit generally perimenopause. And that’s when the rates actually start to even out. So even if you are not necessarily overweight, obese, you don’t have any of those issues, you still are at a higher rate or higher risk because of hormone fluctuations, airway loosening, all that stuff that can happen the older that you get.

And I think the other thing with women too, is that. There’s this idea that it’s usually a man or that you have to be overweight.

EC: Yeah, we’re talking about women, but I’ve interviewed a number of athletes who have gone a really long time to getting a diagnosis because they’ve been told, whether they’re male or female, they’re like, look at you, you’re so healthy and fit. Like you couldn’t have sleep apnea when they absolutely can.

DS: Yeah, and I have so many women that come to my practice, thin, not even like broad shoulders, no history of polycystic ovarian syndrome or hypothyroidism, any of that sort of stuff. But it could also just be the way that your airway was designed.

And it might be hereditary. And it just might be that, that people just fly under the radar. And as a result, they say, well, my sleep is very disrupted, or I feel like I have awakenings at night. But they’re just assumed that they have insomnia. I think women often get put in that bucket of, oh, it’s insomnia, more so than anything.

And I know you’ve talked about this on your podcast, there’s Comisa, Comorbid Insomnia and sleep apnea. And yes, you want to treat both of them. And sometimes we treat the insomnia first, but I always say like, you still got to address the sleep apnea, even if it gets a little better from the insomnia treatment, the quality is not always still great. So you still got to address it.

EC: And I love it when you talk about that, because I think a lot of times. Whenever you get a diagnosis of something about your sleep, I feel like people say, well, I have insomnia, that’s what’s wrong with my sleep. And they don’t look beyond that, and it’s the same with sleep apnea.

People will say, well, I have sleep apnea, and I’m on treatment for that, so this is the best it’s going to get. But so many people are dealing, as you said, with both issues. I would have a lot of awakenings at night, but I just would fall straight back asleep. And, you know, whereas there’s other people who, they get woken up at night because of one of the apneas.

And, especially if they have a bunch of adrenaline running through them, they have a really tough time getting back to sleep and their mind kicks in and then you’re, you know, in insomnia territory.

DS: Right. And I would say too that women often, like we were saying, that it gets misdiagnosed or just kind of blamed to be, well, it’s anxiety that’s keeping you up.

So let’s put you on some sort of a benzodiazepine, Klonopin, Xanax, whatever that might be. And yes, that might make you sleep through the night. But if you have underlying sleep apnea, guess what? It’s actually going to likely worsen the apnea. So some people, women especially will say, well, I’m sleeping through the night, but I still feel like a truck hit me. And it’s because it’s worsening their apnea. So they don’t know they’re up.

EC: And again, I think that comes back to the fact that primary care doctors aren’t really trained in sleep, right? So oftentimes, their go to is, rather than cognitive behavior therapy for insomnia, they would reach for prescribing some sort of pharmaceutical drug for that.

And like you said, a lot of people with sleep apnea, like anything, whether it’s alcohol or prescription drugs, or whatever it happens to be, if it’s kind of relaxing everything, that’s the opposite of what you want to do.

DS: Right. And in women, too, like we were saying, the challenge to diagnosis, too, is it’s not necessarily overt, loud snoring.

Women will often report more just fatigue as opposed to extreme sleepiness. They’ll report more pauses in breathing, it won’t be that loud thing that we were talking about, so it can fly under the radar a lot more and the significant others that are in the bed don’t normally hear it.

EC: Certainly in my experience, when I talk about having anxiety, I would wake up with a gasp having just stopped breathing, right? And I would feel that feeling like you’re running from a bear. But first thing in the morning, nothing’s happened yet. You know? So I think sometimes when people have that sort of panicky anxiety feeling, sometimes that can be a flag.

DS: So for you, what are some of the differences that you might’ve noticed- I’m sure you’ve noticed, you’ve started your whole podcast and like dedicated a lot of your life to like helping people with sleep apnea. So what are the differences you’ve noticed pre versus post diagnosis and treatment for you?

EC: Well, it’s worth saying like everyone’s different and it’s not cut and dried, but I would tell you that when I started regularly using my CPAP, my morning headaches went away completely because I was getting oxygen to my brain.

DS: You’re breathing at night. Yeah.

EC: The other thing that I really struggled, and I did that thing which doctors love, where I would be on antidepressants and then feel better, and then I would come off them and then I would feel worse. And so I feel like after I got on regular CPAP treatment, like my sleep definitely has never been like perfect and amazing, right? But it’s better. It’s significantly better. I wasn’t falling asleep at the wheel at all. Sometimes I would have days where I’d have some daytime sleepiness, but it was a totally different level from how it had been before CBAP.

DS: So what are some challenges you might be still facing then, if you still have occasional sleepiness?

EC: That’s the million dollar question right there. So the thing that’s funny is just that when you have a podcast, I have the wonderful opportunity to interview all of these amazing sleep experts. So I feel like I’m always saying to people at the end, so, uh, how can that relate to me?

And I did have something really funny happen recently where I was interviewing Dr. Sahil Chopra from Empower Sleep. And he wanted me to try out their platform, and they’re using kind of sleep image rings to monitor people’s sleep over not just one night like a sleep study, but multiple nights.

And so I was kind of like, okay, I guess I’ll try this. I feel like at this point I’ve had so many sleep tests that I’m just like, do I really need to do another one? After looking at my data, he was like, Oh, your sleep apnea is actually extremely well controlled. So like when we’re talking about before with the insomnia, it’s not necessarily just one thing that’s going with your sleep.

So, he suggested having an in lab sleep study, actually in a lab, like not in my house. And that did show us some pretty significant periodic limb movements. Essentially where you’re having twitching or movement in usually your legs, could be your arms or whatever. The way that he described it was sometimes people will be moving in their sleep. sleep so much that it pulls them out of very deep sleep into a lighter stage of sleep.

I wasn’t waking up any more than I had been, but I just noticed over the last year that I felt a little bit more sleepy during the day. So that really hit home to me, like it’s not just one thing necessarily with your sleep.

DS: Yeah.

EC: Just because you have sleep apnea doesn’t mean that there’s not other things going on.

DS: And the interesting thing about periodic limb movement disorder is that- If anybody here has ever had a sleep study, an in lab, ideally, sleep study for something like this, because they’ll put sensors to figure that out on your legs. But you’ll see something called a Periodic Limb Movement Index, the PLMIs.

If you’re interested in looking at your sleep study, any listeners, I encourage you to go and look at that. But what’s interesting about PLMs is they get missed a lot. It’s more like a rhythmic kind of twitching, sometimes it’s more kicking at night, it varies. But a lot of people have restless leg disorder or restless leg syndrome at the beginning of the night, myself included, I’m one of those.

It’s that feeling of having to move your legs, it gets worse as the night goes on, but people who have restless legs frequently have periodic limb movement issues. So we’ll see it when we do a sleep study, but people who have periodic limb movement don’t always have restless leg. So, something like you, it doesn’t sound like you’re having restless leg, it just kind of showed up, you had no idea there was anything going on with your legs.

We often see it in people when they’re like, my significant other says I’m kicking a lot at night or my sheets are a mess, things like that a lot of times. But that could definitely be one other reason why you’re so tired, yeah.

EC: I feel like I was given all of these really interesting things that I would, so I’d still have loads of things to talk about.

DS: Do they have any idea of what they’re doing for the PLMs?

EC: I think we’re testing my ferritin levels and looking at if maybe iron supplementation would help and otherwise I was just planning to call you and be like, what are you doing?

DS: We’ll talk more. But, but that’s also very interesting, right? Like there is research out there showing that for a subgroup of people who have sleep apnea that is well managed, they still might have excessive sleepiness. So we have to think of other ways to treat it.

EC: One of my favorite podcast interviews was with Dr. Allan Pack, and he has been doing some research into this whole cohort of people in Iceland, where after two years, they’re all people who are using CPAP every night. And for the most part, it looks like it’s going really well. Like their data is great and their sleep apnea is under control.

But then they have them come back after two years, and they divide them up into groups. And one of the groups is people that are still sleepy. And so then they’re looking at like, why is that? The research is ongoing. So I don’t think we really have gotten to the bottom of that. One of the things he’s looking at is this delay to diagnosis and what that might do to your brain.

So if you’ve been hypoxic with no oxygen going to your brain for a significant period, that can’t do anything great to your brain. So they’re still looking at that.

DS: Yeah, I think a lot of times we just manage the symptoms right now, right? So some sleep specialists might put someone on a stimulant, something to help, even though we know the nighttime is well controlled when it comes to their apnea.

EC: Yeah.

DS: What do you wish women really knew about sleep apnea? If you were to give them, like, some Take home kind of message about it. What would you say?

EC: So it doesn’t look how you probably think it looks, right? Like I think that a lot of women are thinking that can’t be something that I’m dealing with because I don’t snore super loud.

And, you know, a lot of the risk factors they’ve heard about, like being really overweight and having a really thick neck, and all these different things, like just know that it absolutely can happen to women for sure. And just really pay attention to those symptoms. And all the different tired and sleepy and fatigued, really learn about the differences between those.

And if you’re sleepy. Really know that you need to advocate for yourself. If your doctor just dismisses you, you need to advocate for yourself. This is not something that’s super simple to get a diagnosis with as a woman at the moment, unfortunately.

DS: Yeah.

EC: One of the things I really wish people knew was how much easier it’s getting to test for this. Not everybody is going to do well with a home test, but that tends to be the first thing that, you know, a lot of sleep specialists are going to because it’s pretty easy and not everybody gets the diagnosis they need from a home test. I know a lot of women with milder sleep apnea that the home test didn’t show up as sleep apnea, but when they had an in lab sleep study, they were able to show, oh, like, you know, it just shows so much more data that they can make a more accurate diagnosis.

DS: Yeah. It’s a screener. They’re a really good screener for sleep apnea, but they can miss it. And some of those studies have shown upwards of 20 to 30 percent in some cases. So if you think something is off, you might want to push them for an in lab study if it didn’t show anything on your home study.

EC: And also be aware of like a lot of women are dealing with upper airway resistance syndrome or things that might not necessarily meet this criteria we talked about for sleep apnea. But if you’re sleepy during the day and you have some of these symptoms, you really need to just keep — whether it’s, you know, going to a dentist who can make you an oral ,appliance or there’s some different things — this is why I have a podcast because then all the different options for you know, milder sleep apnea are out there, but it’s just sometimes tricky to track them down.

DS: I think the other take home point is that there are many different treatment options, right? Some are better than others for certain types of sleep apnea. But it’s nothing to avoid treating because there are consequences from untreated sleep apnea. We know that there’s higher rates of cardiovascular issues, mood issues, quality of life in general. It really does impact so many different areas of your life. Blood pressure, we see uncontrolled blood pressure a lot of times, high blood pressure in these patients.

The thing that I hear all the time is it’s not sexy to have on a pap. Okay, well, let’s talk about all the other things that could happen that aren’t very sexy either and let’s reframe using it. And I work with couples all the time and in patients to get them using whatever treatment it is and it doesn’t always have to be a PAP. Sometimes it is an oral appliance or other things.

EC: And often I hear so much from people who say, I don’t want to get the sleep test for sleep apnea because I don’t want to use a CPAP. That’s really unfortunate. Consequences of untreated sleep apnea really can be dire. Like, I’ve interviewed a number of people who have lost loved ones.

You know, after I persevered with it and got through the initial issues, I certainly felt a lot better and was nicer to be around and was less depressed. So my husband certainly wouldn’t want me to get rid of my CPAP for the sake of how it looks, right? Because I feel so much better and I just have a better quality of life.

So, I think like sometimes, you know, people don’t realize maybe what terrible effects this is having on their long term health. I feel like every month they’re coming out with new options that are FDA approved for different levels.

If you don’t get the test, you don’t know if it’s mild, moderate, or severe. You don’t know, like, what the options could be, but there are multiple options out there.

DS: I’m a fan of just, if you feel like something is off, say something, get evaluated. And if you’re concerned about getting evaluated because you don’t want to worry about whatever the treatment might be, at least then you know what you’re dealing with.

So, if you ever have to have surgery, you have to be put under anesthesia, you can tell the doctors that you have apnea, and it is just safer for you in the long run.

EC: Yes.

DS: Emma, this has been quite the enlightening conversation. I always love talking with you. So thank you so much for being here.

EC: Thank you for having me.

DS: Anytime.

Thanks for listening to Sleep Talking with Dr. Shelby, a Sleepopolis original podcast. If you’re not routinely getting a great night’s sleep, remember to follow and subscribe for more Sleep Talking wherever you get your podcasts.

And for even more sleep tips. Visit Sleepopolis.com and you can also visit my Instagram page @SleepDocShelby.

Today’s episode was produced and edited by Freddie Beckley. Our Head of Content is Alanna Nuñez. And I’m Dr. Shelby Harris. Until next time, sleep well.

Episode 10: Sleep Apnea in Women Is More Common Than You Think

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