Why Aren’t Women Being Diagnosed With This Deadly Disease?

November 15, 2020Swiatowicz StaffUncategorized6222

A specific type of patient comes to mind when we think of sleep apnea: an obese man. The problem with that image is that it causes us — and our doctors! — to pretend that women can’t suffer from sleep apnea. They can and they do. 

Here’s what you need to know about sleep apnea and women.

What is Sleep Apnea? 

Obstructive sleep apnea (OSA) is a chronic, terminal disease. It occurs when a person’s airway is physically blocked, which prevents them from breathing while they sleep. 

Who gets sleep apnea? 

OSA is usually thought to affect just men. In fact, some screening tools make “maleness” a risk factor prompting further testing. It’s true that men are often diagnosed with OSA at higher rates than women — but that could have more to do with gender bias. It is estimated that for every woman, three men are diagnosed with OSA. However, research suggests that OSA is more common in women than initially believed. 

Sleep apnea looks very different in women

One of the reasons for this under-diagnosis may be that the symptoms are different in women. Men complain of sleepiness and are told that they snore or stop breathing. Women are less likely to have the same complaints. Instead, they might mention fatigue, morning headaches, insomnia, restless legs, and mood disorders. When a man shares his symptoms with his doctor, they suspect OSA. When a woman discusses her symptoms, her doctor might suspect anemia, fibromyalgia, hypothyroidism, or depression.

Women are typically under-diagnosed

Up to 90 percent of women with OSA go undiagnosed. Some of that discrepancy might have to do with a medical practitioner’s bias, but some of it is likely owed to testing methods. Sleep test measures the number of hypopneas (decreased breathing) and apneas (no breathing) to get a diagnosis for OSA. Women tend to have more Respiratory Event Related Arousals (RERA). RERAs occurs when a patient wakes up because of increased difficulty in breathing. Because they are sometimes ignored on a sleep test, female patients are told they do not have a breathing problem while sleeping.

Researchers are now suggesting that the diagnosis of OSA in women be based on different criteria.

The health effects are usually worse in women.

The effects of RERAs are just as harmful as those of apneas and hypopneas, even if not picked up on testing. In fact, women have more severe health complications from their type of sleep breathing disorders. Some of the major health issues with OSA are hypertension, heart attack, and stroke. Females with OSA are more likely to have diabetes and hypothyroidism. Even more shocking, women are shown to have about 2.5 times the risk of death from OSA than men do.

Risk factors in women 

Pregnancy is a risk factor: 20 percent of women in their third trimesters have OSA. Besides the normal health risks, pregnant patients have higher risks of pre-eclampsia and eclampsia. Infants of apneic mothers have low birth weight, premature birth, and higher admittance rates to NICUs. Menopause also increases the risk for OSA in women, doubling the likelihood that they get the disease. 

It’s not all bad news, though!

Some things about being a woman actually help when it comes to OSA. Women’s shorter airways are less likely to collapse during sleep. The muscles of the tongue are more responsive at night, making it less likely to block the airway. And progesterone actually stimulates breathing while asleep, helping to keep the airway open. After menopause, hormone replacement therapy has been shown to bring OSA risks down to the level of pre-menopausal women. 

Sleep apnea is a serious medical condition regardless of your gender. Women patients have to be especially vigilant to make sure they get the diagnosis and treatment needed to manage OSA. Talking to a dentist who understands sleep can be your best bet for getting healthier and sleeping better.

A specific type of patient comes to mind when we think of sleep apnea: an obese man. The problem with that image is that it causes us — and our doctors! — to pretend that women can’t suffer from sleep apnea. They can and they do. 

Here’s what you need to know about sleep apnea and women.

What is Sleep Apnea? 

Obstructive sleep apnea (OSA) is a chronic, terminal disease. It occurs when a person’s airway is physically blocked, which prevents them from breathing while they sleep. 

Who gets sleep apnea? 

OSA is usually thought to affect just men. In fact, some screening tools make “maleness” a risk factor prompting further testing. It’s true that men are often diagnosed with OSA at higher rates than women — but that could have more to do with gender bias. It is estimated that for every woman, three men are diagnosed with OSA. However, research suggests that OSA is more common in women than initially believed. 

Sleep apnea looks very different in women

One of the reasons for this under-diagnosis may be that the symptoms are different in women. Men complain of sleepiness and are told that they snore or stop breathing. Women are less likely to have the same complaints. Instead, they might mention fatigue, morning headaches, insomnia, restless legs, and mood disorders. When a man shares his symptoms with his doctor, they suspect OSA. When a woman discusses her symptoms, her doctor might suspect anemia, fibromyalgia, hypothyroidism, or depression.

Women are typically under-diagnosed

Up to 90 percent of women with OSA go undiagnosed. Some of that discrepancy might have to do with a medical practitioner’s bias, but some of it is likely owed to testing methods. Sleep test measures the number of hypopneas (decreased breathing) and apneas (no breathing) to get a diagnosis for OSA. Women tend to have more Respiratory Event Related Arousals (RERA). RERAs occurs when a patient wakes up because of increased difficulty in breathing. Because they are sometimes ignored on a sleep test, female patients are told they do not have a breathing problem while sleeping.

Researchers are now suggesting that the diagnosis of OSA in women be based on different criteria.

The health effects are usually worse in women.

The effects of RERAs are just as harmful as those of apneas and hypopneas, even if not picked up on testing. In fact, women have more severe health complications from their type of sleep breathing disorders. Some of the major health issues with OSA are hypertension, heart attack, and stroke. Females with OSA are more likely to have diabetes and hypothyroidism. Even more shocking, women are shown to have about 2.5 times the risk of death from OSA than men do.

Risk factors in women 

Pregnancy is a risk factor: 20 percent of women in their third trimesters have OSA. Besides the normal health risks, pregnant patients have higher risks of pre-eclampsia and eclampsia. Infants of apneic mothers have low birth weight, premature birth, and higher admittance rates to NICUs. Menopause also increases the risk for OSA in women, doubling the likelihood that they get the disease. 

It’s not all bad news, though!

Some things about being a woman actually help when it comes to OSA. Women’s shorter airways are less likely to collapse during sleep. The muscles of the tongue are more responsive at night, making it less likely to block the airway. And progesterone actually stimulates breathing while asleep, helping to keep the airway open. After menopause, hormone replacement therapy has been shown to bring OSA risks down to the level of pre-menopausal women. 

Sleep apnea is a serious medical condition regardless of your gender. Women patients have to be especially vigilant to make sure they get the diagnosis and treatment needed to manage OSA. Talking to a dentist who understands sleep can be your best bet for getting healthier and sleeping better.

How A Dentist Can Treat Your Sleep Apnea

Obstructive sleep apnea (OSA) is a medical problem that occurs when a person’s airway is physically blocked while they sleep. This prevents them from breathing, usually causing them to snore and wake up. OSA is linked to a lot of serious complications, including high blood pressure, heart attack, stroke, diabetes, ADHD, and dementia. And most frightening of all, studies show that untreated OSA decreases life expectancy by up to 7 years.

The gold standard for treating OSA has been positive airway pressure, commonly known as CPAP. A patient wears a mask connected to a machine that pumps air into her lungs all night. Although effective, some studies show that more than 80% of patients choose to stop wearing CPAP after the first year.

Many patients are surprised to hear that their dentist may be able to help them improve their sleep hygiene. There are a variety of dental options available that can be as effective as, or supplement, CPAP for most patients. Here are a few of them. 

Oral Appliance Therapy [OAT]

Oral appliances are a set of retainers that go over the top and bottom teeth and hold the jaw forward while you sleep. This non-invasive treatment pulls the tongue off the back of the throat and widens the airway so you can breathe naturally, without a machine. Comfortable and effective, oral appliances are more likely to be worn by patients long term than CPAP. OAT is typically a dentist’s preferred method for treating OSA.

Orthodontics

A narrow and crowded jaw can make it difficult to breathe properly. Expanding the jaws gives a patient’s mouth and increases the amount of room in our nose. Expansion is an option for both children and adults. Be warned though, widening the jaws will leave a significant gap in your front teeth, so you will need traditional braces to straighten them after.

Jaw Surgery

Oral surgeons can help you treat your OSA through jaw surgeries. By breaking and repositioning the jaws, surgeons can increase the space of the airway and help reposition the soft tissues that normally block the airway. Just like with orthodontic expansion, braces are typically required (before and after the surgery) to keep your teeth straight.

Frenectomy

In some people, there is a tight band of tissue, called a frenum, underneath their tongue that prevents it from moving — hence the term “tongue-tied.” The problem is when the tongue is held low and towards the back of the mouth, it can easily block our airway. A frenectomy cuts this tissue, allowing the tongue to be more responsive. However, in some patients releasing a tongue-tie can actually make OSA worse. 

Myofunctional Therapy

Think of myofunctional therapy as physical therapy for the tongue and muscles that support the jaws. Strengthening these muscles through guided exercises can help correct bad “oral habits,” promote nasal breathing, and even help with facial pain. While not a quick fix, myofunctional therapy is a proven, non-invasive way to help patients suffering from OSA.

Next time you make a trip to the medical provider, talk to them about your snoring or sleep apnea. They should be able to refer you to a dentist who is trained in treating these problems. 

Airway Imaging Many dentists have ways to take an image of your airway right in the office. Cone-beam computed tomography (CBCT) can let the dentist see a 3-D image of your head. While it is helpful in showing if there is a skeletal problem with your airway (narrow nose, jaw, etc.), all research shows that it is not good at determining the size of your airway in the back of the throat. Pharyngometry is a way to evaluate the volume of your airway without radiation. However, research shows that it does not have a lot of value in treating OSA in patients compared to standard methods we have. The biggest problem with any imaging used for OSA is that most of the time you are awake and upright, which is very different than being asleep.