Recent clinical evidence suggests that women with sleep disordered breathing may experience different symptoms to men. A recent study from UCLA which reviewed the brain scans and medical notes of women with sleep apnoea found thinning of the brain structure (frontal cerebral cortex), the part of the brain responsible for higher cognitive functioning like mental processing and memory. The study was by Professor Paul Macy from UCLA and he states “Because women report different symptoms, they tend to be misdiagnosed…. Early detection and treatment is the best way to protect against damage to the brain and other organs”.
Women are more likely to experience upper airway resistance syndrome UARS and this can cause them to experience daytime fatigue, feeling groggy, lack of motivation to do anything, poor focus, concentration problems, bruxism or grinding of teeth, cold feet and hands, low mood and depression.
This study builds on other research that sleep disordered breathing is a spectrum – ranging from sleep apnoea to upper airway resistance syndrome (UARS). Obstructive sleep apnoea is a well-known sleep related breathing condition where there is repetitive stopping in breathing during sleep, due to collapse of the tissues of the throat. Unlike sleep apnoea where you have an obstruction causing an apnoea or cessation of breathing for 10 seconds and then an arousal or waking up, UARS patients typically have mostly partial obstructions and increased effort of breathing and then arousals or waking up. Patients with UARS do not actually have the 10 seconds of cessation of breathing but are still doing the same harm to their bodies as those with sleep apnoea.
Patients will UARS have some form of fatigue, most will say they are “light sleepers,” and almost invariably, they don’t like to sleep on their backs. Some people attribute their poor quality sleep to insomnia, stress or working too much. Due to repetitive arousals at night, especially during the deeper levels of sleep, one is unable to get the required deep, restorative sleep that one needs to wake feeling refreshed in the morning.
In most cases, the cause is due to collapse of the tongue and the muscles of the airway. There are many reasons for the tongue and soft tissues to cause obstruction including being too large/floppy or if you are overweight. But once the obstruction occurs, the only thing you can do is to wake up and stop yourself from suffocating.
Due to repetitive arousals, your body is under a chronic state of low-grade stress – or what is referred to as the “flight response”. This is akin to when you’re frightened or running away from something. Your heart rate and blood pressure go up, your vision and hearing become very sensitive, and all your blood flow and energy is ready for a fight. As a result, blood gets shunted away from your gastrointestinal system to the heart muscles, this can lead to chronic diarrhoea, constipation, indigestion, acid reflux or bloating. In addition we know that stress can worsen acid production in the stomach. Many people with UARS also have laryngopharyngeal reflux which is different to gastro-esophageal reflux disease.
People with laryngopharyngeal reflux do not feel heartburn but can complain of chronic throat clearing, hoarseness, cough, postnasal drip, ear or throat pain, a lump in the throat, difficulty swallowing, tightness or pain with swallowing. Once the stomach acid gets into the throat it can enter the lungs causing or aggravating asthma or bronchitis. Acid can even get into the nose and ears causing or aggravating nasal congestion, sinus or ear infection.
Another study showed that about 23% of people with UARS have low-blood pressure. In addition, these people feel dizzy or lightheaded which is worse when they stand up too soon. Even if their blood pressure is normal, some may still be prone to bouts of dizziness or light-headedness.
Tension headaches and classic migraine can occur frequently in people in UARS along with TMJ (temporo-mandibular joint) problems, which is due to grinding and/or clenching of their teeth. TMJ pain can be felt in the ear and many people think they have ear pain, as well as headaches along the side of your head, and teeth grinding can wear down your teeth or lead to having cracked teeth.
Some people can also have chronic or recurrent sinus pain, pressure or infections. Frequently, patients present to their doctor with frequent and recurrent sinus infections and are given antibiotics (which only help temporarily). In many cases, migraines can also masquerade as a sinus headache without the classic symptoms.
Depression, anxiety or attention deficit problems can be also seen in people with UARS. Multiple arousals and the fact you don’t sleep deeply, has been shown to cause your body to produce increased levels of cortisol. Cortisol (is a hormone that) makes you eat more and put on weight. It also lowers your body’s immune system to fight infections and can lead to insulin resistance, and eventually diabetes.
It seems that UARS symptoms can be aggravated by small changes in the person’s life. Gaining a small amount of weight, even 2-5kg, can aggravate the symptoms which go away once the body adjusts and accommodates to the increased weight it has to carry. A bad cold or respiratory tract infection that causes swelling and narrowing of the upper airway can also aggravate these symptoms. Pregnancy is another situation where this can occur.
In most cases the treatment of UARS is like sleep apnoea. The options are trying to improve you nasal breathing, dental appliances, myofunctional therapy, CPAP, or surgery, as a last resort. A mandibular advance splint (dental device) that pulls the lower jaw forward, similar to one used for snorers and in sleep apnoea patients can help. By pulling the jaw forward, it also pulls the tongue forward, creates tone in the muscles of the airway which can lead to an improvement in the size of the airway.