Why thousands of healthy women are secret SNORERS

Why thousands of healthy women are secret SNORERS,

Helen Robinson didn’t even know she snored until she shared a hotel room with one of her daughters after a family party. She was slim, fit and didn’t drink much – in short, very far from the stereotypical snorer.

‘I was really embarrassed when my daughter told me,’ says Helen, 66, a retired special needs teacher and divorced mother of three from Bromley, Kent.

‘I live alone so I just wasn’t aware. Apparently I disturbed her on and off all night.

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‘It was mortifying. To me it seemed really unladylike – the sort of thing you associate with overweight men.’

It didn’t cross Helen’s mind to see a doctor. But in the months following the party in 2023, she experimented with different sleeping positions and bought various ‘anti-snoring’ pillows said to encourage lying on the back.

Helen also noticed she was waking with a headache and a dry mouth.

‘I felt unrefreshed and groggy,’ she recalls. ‘I also had this dry cough that I couldn’t shift – but didn’t have a chest or throat infection.

‘As the year went on, I found myself increasingly awake at night too, unable to get back to sleep.’

Helen Robinson put her snoring down to ‘being older’ – but in fact it is a sign of obstructive sleep apnoea (OSA), a chronic sleep disorder in which breathing repeatedly stops and starts

She put her symptoms down to ‘being older’ – but in fact they are characteristic signs of obstructive sleep apnoea (OSA), a chronic sleep disorder in which breathing repeatedly stops and starts because throat muscles temporarily collapse and block the airway.

As well as causing snoring (the soft tissue in the nose and throat vibrate as air is forced past them), the repeated drop in oxygen causes surges in adrenaline to wake the person up and kick-start their breathing.

But this spikes blood pressure, and over the years these surges can damage the cardiovascular system, raising the risk of heart attack and stroke.

Fed up with waking at night and feeling out of sorts, Helen called her GP surgery for advice in January 2024.

Nearly a year later, following several tests including lung function checks and wearing a pulse oximeter on her finger to measure oxygen in her blood as she slept, Helen was told she had OSA.

OSA affects an estimated 12million people in the UK – but 85 per cent are undiagnosed.

Typically snorers, including those with OSA, are thought to be mainly overweight older men – figures show it is diagnosed around three times more commonly in men than women.

But now research suggests OSA is much more common in women than previously thought, increasing after the menopause.

A study of 1,300 women, published in the journal BMC Endocrine Disorders last year, found 36 per cent of pre-menopausal women had OSA symptoms, rising to 53.9 per cent of post-menopausal women.

And this is set to climb. Writing in The Lancet Respiratory Medicine in December, researchers at ResMed Science Center in San Diego, California, predicted OSA cases in women will increase 65.4 per cent by 2050, compared with a 19.3 per cent increase in men – partly due to an ageing population and greater recognition of the condition generally.

Kat Lederle, a sleep scientist at the London General Practice, says cases in women are under diagnosed partly because they are more embarrassed, thinking snoring is not ‘feminine’.

‘So when they come to clinic they are far more likely to say they’re fatigued than admit they’ve been snoring,’ she says.

There are a number of reasons that menopause is a key trigger. Not only is it a time when extra weight creeps on, but Kat Lederle points to a drop in the hormones progesterone and oestrogen.

‘These hormones strengthen muscles in the airway before menopause,’ she says. ‘When levels decline, muscles weaken and so the airway is more likely to collapse.’ This could help explain why slim and healthy women such as Helen develop OSA.

A complicating factor in getting the right diagnosis is that symptoms can differ in women.

A 2024 study found that while many women had the classic symptoms, such as headaches, snoring, disrupted sleep and waking unrefreshed, around a third had very few symptoms, or any they did have were less obvious.

Furthermore these patients, as in Helen’s case, did not have the usual cardiovascular risk factors such as high blood pressure and obesity linked with OSA, reported the journal Sleep Medicine.

And as Dr David Garley, a GP at the Better Sleep Clinic in Bristol, explains, while sleep apnoea ‘is common in women at this time, there’s a crossover with symptoms of menopause such as brain fog, irritability and muscle aches. So OSA can often be wrongly attributed to other health problems or go under the radar.’

Helen was offered the gold- standard NHS treatment for OSA: continuous positive airway pressure (CPAP), which blows air into your nose as you sleep to stop the airway collapsing.

Ama Johal, a professor of orthodontics at Queen Mary University, London, and the clinical lead at Aerox Health, a manufacturer of mandibular advancement devices

However, a study published in the journal Sleep Breath last year found that less than half of patients stuck with CPAP therapy, citing nasal congestion, discomfort and claustrophobia.

Alternatives to CPAP include a custom-made mandibular advancement device, essentially mouthguards worn during sleep which stop the tongue falling back and blocking the airway. These are recommended in NHS guidelines for mild OSA, but they are not routinely available. Privately, they cost around £1,000.

There is also a newer treatment called Inspire therapy, a device that is implanted under the collarbone with a breathing sensor and stimulation lead (similar to a pacemaker). It senses breathing and delivers mild stimulation to the tongue and muscles needed to keep the airway open. ‘This is available on the NHS but not widely,’ says Dr Garley.

Helen was not keen on the idea of the CPAP as she thought it would disrupt her sleep more and be awkward to take on holiday.

‘I was also worried it would frighten my grandchildren when they stayed the night, or that the noise of the machine would mean I couldn’t hear them if they woke.’

A few weeks after her diagnosis, she happened to have a dentist appointment and mentioned her snoring – they suggested she try the customised mandibular advancement device.

One study published in Dentistry Journal in 2023 showed success rates of 81 per cent in patients with moderate OSA and 73 per cent in severe OSA patients who used one of these devices.

Custom-made mandibular advancement devices work by moving the lower jaw forward from its resting position – this brings the tongue forward and increases the space in the airway behind it, explains Ama Johal, a professor of orthodontics at Queen Mary University, London.

Helen started wearing the device in March last year. As is standard, she had to incrementally adjust it to move her jaw forward by a tiny 0.5mm each week until finding the sweet spot, which can take a few months, says Professor Johal, who is clinical lead at Aerox Health, a manufacturer of mandibular advancement devices.

‘Usually patients will recognise this when they wake up feeling refreshed like they’ve had a good night’s sleep,’ he says.

Within weeks of using her device, Helen’s symptoms vastly improved – she no longer suffered headaches and would wake up feeling refreshed.

‘I wasn’t waking as much at night,’ she recalls. ‘A snoring app showed I wasn’t having as many sleep apnoea episodes.’

She pushed for another NHS oximeter test, which confirmed her OSA had improved from moderate-to-severe to mild in just eight months. She continues to use the device.

‘It’s a huge relief not to snore any more, and to know I’ve cut my risk of a heart attack or stroke. My message to women is: don’t ignore snoring or be embarrassed about getting help – you may be missing a serious health problem.’

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