Snoring And Menopause Hormones: Is It Sleep Apnea?

If you’re wondering about snoring and menopause, you’re not alone. Many people are curious if there is a connection between snoring and menopause. Let’s take a look at how these two are related.

Snoring And Menopause: Is Snoring Increased?

Yes, snoring may increase for certain patients during the menopause transition.

What Happens During Menopause?

Menopause is a natural biological process where a woman’s estrogen and progesterone levels decline. The official definition of menopause is cessation of menses for one consecutive year.

Why Does Snoring Increase?

Estrogen and progesterone are the hormones that maintain muscle tone in the upper airway. This includes the tongue and throat muscles.

During menopause, a decline in these hormones leads to weakened muscle tone, allowing the tissues in the airway to collapse more easily and vibrate during sleep, causing snoring.

Progesterone may also have a more specific role in snoring. There is some research that says progesterone may be important specifically when it comes to preventing excessive relaxation of the upper airway tissues.

Snoring And Menopause: Physical Changes

The hyoid bone is a small, U-shaped bone located in the anterior (front) part of the neck, just above the larynx (voice box). Unlike most bones, the hyoid is not directly attached to other bones but is anchored by a network of muscles and ligaments. It serves as a support structure for the tongue and is involved in several functions related to swallowing and speech.

How the Hyoid Relates To Snoring:

Airway Stability: The hyoid bone plays a role in maintaining the openness and stability of the upper airway. Its position and the tone of the muscles and ligaments attached to it can influence the airway’s patency (openness), especially during sleep when muscle tone generally decreases.
Snoring and Sleep Apnea: Snoring occurs when the flow of air through the mouth and nose is partially obstructed during sleep. This obstruction is often due to the relaxation of the muscles in the throat, including those connected to the hyoid bone, leading to the vibration of soft tissues such as the soft palate and uvula. In more severe cases, this obstruction can lead to obstructive sleep apnea (OSA), a condition characterized by repeated pauses in breathing during sleep. The position and function of the hyoid bone can contribute to the severity of OSA by affecting the degree of airway obstruction.
Treatment Implications: Understanding the relationship between the hyoid bone and airway stability has implications for treating snoring and obstructive sleep apnea. Some surgical treatments for OSA involve repositioning the hyoid bone to enlarge the airway and reduce obstruction. Additionally, exercises that strengthen the muscles attached to the hyoid may improve airway stability and reduce snoring in some individuals.

Study On Hyoid, Airway And Menopause

Research has shown that during menopause, the space in women’s upper airways gets smaller. This study looked into how the shape of the upper airway changes in women going through menopause and after it’s finished.

Study Methods:

The study looked back at medical records from 367 Chinese women over 25 who had special 3D X-rays at Peking University’s dental school and hospital between October 2016 and September 2020. They also looked at 283 men of the same age to compare.

The study measured the shape of the upper airway, where the hyoid bone (a bone in the neck) is located, and the structure of the face.

Study Results:

Women in their late 40s to early 50s had a noticeable decrease in the size and opening of their upper airways and an increase in airway length compared to women in their mid-30s to early 40s.

This change was not seen in women of other ages or in men of the same age. Also, women 55 and older had the hyoid bone positioned lower than women of other ages, a change that was not seen in men.

Study Conclusion:

During the years around menopause, women’s airways get smaller and longer, and after menopause, the position of the hyoid bone lowers. Because these changes were not seen in men or in women who had not started menopause, these changes seem to be directly related to menopause and not just to getting older.

Study Name: A Cone Beam CT Study of Upper Airway Morphology in Perimenopausal and Postmenopausal Women

Study Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8627894/

Snoring And Menopause: Hormonal Changes

Decrease in estrogen and progresterone can cause changes in sleep patterns. Hormones maintain the muscle tone of your airways. Decrease levels of estrogen and progesterone can lead to laxity in the ariways. This laxity in the airways can then lead to snoring and other sleep disturbances.

Snoring And Menopause: Sleep Apnea

As women age, the prevalence of sleep apnea increases, particularly in postmenopausal women. Sleep apnea is characterized by symptoms such as loud snoring, excessive daytime sleepiness, and choking during sleep.

One study found that 11.2% of women reported habitual snoring, with 21.7% having intermittent snoring during menopause. Changes in hormone levels during this time can result in increased self-reported snoring and contribute to increased risk of developing sleep-disordered breathing, such as obstructive sleep apnea (OSA).

OSA is characterized by symptoms such as dry mouth, choking sensations, and blocked nasal passages during sleep. The prevalence of OSA varies with age and hormonal status during a woman’s life, with the menopausal transition potentially increasing the risk. Sleep studies confirm that postmenopausal women have a higher prevalence of severe OSA compared to premenopausal women.

Symptoms To Watch Out For

There are many women that experience daytime sleepiness during perimenopause and after menopause. Several of these patients may falsely believe that this is just a result of being tired as a menopausal woman.

While for some patients that could be true, for many patients it could be a sign of undiagnosed sleep apnea. A sign of sleep apnea is snoring and any snoring should be brought to the attention of your medical doctor.

What Can Happen If Sleep Apnea Goes Undiagnosed

It is crucial for older women experiencing symptoms related to sleep apnea to consult a sleep specialist 4. In most cases, sleep medicine professionals will recommend treatment options depending upon the severity of the condition.Untreated sleep apnea in older women can lead to health complications such as high blood pressure, heart attack, or stroke.

Treating Sleep Apnea

Treating obstructive sleep apnea is very important. This is not just for optimizing respiratory function but also for ensuring good sleep and that oxygen is reaching vital organs.

Common treatment options for sleep apnea in older women include continuous positive airway pressure (CPAP) therapy, oral appliances like a mandibular advancement device (MAD), or lifestyle modifications, such as weight loss or positional therapy. CPAP therapy is considered the gold standard for treating moderate to severe sleep apnea cases but can be challenging to adhere to, especially for older adults.

Snoring And Menopause: Poor Quality Sleep

During menopause, changes in sleep patterns may occur. This can mean a woman’s ability to good quality of sleep is often decreased.

Aside From Sleep Apnea, What Can Cause Poor Sleep In Menopause?

Low Progesterone

Not getting a good night’s sleep can be related to low Progresterone levels in general. Progesterone is a natural anxiolytic and can help people calm down during bed time.

Low Estrogen

Also, patients who have hot flashes and night sweats from low estrogen levels can have reduced sleep quality. These patients may be waking up more often because of the symptoms they are experiencing.

Sleep disturbances caused by menopause-related sleep disorders can have a profound effect on a woman’s health and well-being. It is important to let your healthcare provider know if you are having poor sleep and whether or not you are snoring when you sleep.

Snoring And Menopause: Weight Gain

Weight gain, particularly around the neck and mid section (belly and abdomen) is another factor that may contribute to snoring in post-menopausal women.

Obesity has been shown to be associated with sleep apnea and snoring. This is because of excess weight or a large neck circumference can lead to the narrowing of airways during sleep.

Maintaining a healthy weight through regular exercise and a balanced diet can help improve sleep quality, reduce snoring, and lower the risk of developing sleep disorders in middle-aged and post-menopausal women.

Snoring And Menopause: Summary

Exploring the connection between snoring and menopause for middle-aged women is a crucial aspect of women’s health. Menopause symptoms, including disruptions in sleep patterns, can be exacerbated by hormonal shifts, notably in female sex hormones like estrogen and progesterone. These changes can lead to a decrease in the airway’s muscle tone, increasing the risk of snoring and obstructive sleep apnea (OSA), a condition marked by symptoms such as loud snoring, choking sensations, and frequent awakenings.

Treating OSA and symptoms of menopause is important. Lifestyle changes, such as reducing alcohol consumption and maintaining a healthy weight, can complement hormone therapy in managing menopause symptoms and reducing the risk factors for heart disease and severe obstructive sleep apnea. Healthcare providers may recommend a sleep study to diagnose symptoms of sleep apnea accurately. A holistic treatment strategy aims not just to improve sleep quality but also to enhance overall quality of life for postmenopausal women, acknowledging the complex interplay between hormonal status, sleep problems, and lifestyle factors.

Sources:

Perger E, Mattaliano P, Lombardi C. Menopause and Sleep Apnea. Maturitas. 2019;124:35-38.

https://www.sciencedirect.com/science/article/abs/pii/S0378512219300313

Tianyi Huang, Brian M Lin, Susan Redline, Gary C Curhan, Frank B Hu, Shelley S Tworoger, Type of Menopause, Age at Menopause, and Risk of Developing Obstructive Sleep Apnea in Postmenopausal Women, American Journal of Epidemiology, Volume 187, Issue 7, July 2018, Pages 1370–1379

https://doi.org/10.1093/aje/kwy011

Zhang W, Gao X. A Cone Beam CT Study of Upper Airway Morphology in Perimenopausal and Postmenopausal Women. Int J Womens Health. 2021 Nov 23;13:1129-1137. doi: 10.2147/IJWH.S335728. PMID: 34853538; PMCID: PMC8627894.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8627894/

Zhou, Y., Liu, F., Li, C. et al. Association of snoring and body composition in (peri-post) menopausal women. BMC Women’s Health 20, 175 (2020)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7427281/