World Menopause Day: Is It Menopause, or Is It Sleep Apnoea?

Every year on 18 October, World Menopause Day draws attention to women's health during the menopausal transition. Sleep is one of the most common concerns, with around 40-60% of women experiencing disturbed sleep during peri- and post-menopause¹. Hot flushes, mood changes and life stress all play a part¹, but one cause is often missed. Obstructive sleep apnoea, where breathing repeatedly pauses or becomes shallow during sleep, becomes more common after menopause¹˒². For some women, what feels like menopausal insomnia is partly a treatable breathing problem.

What the research shows

In the Wisconsin Sleep Cohort Study, which measured breathing during sleep in a community sample, women who had been through menopause were about 2.6 times as likely as premenopausal women to have sleep apnoea, and about 3.5 times as likely to have moderate to severe sleep apnoea, after allowing for age, weight and cigarette smoking². The increase was clear after menopause, while women still in perimenopause did not show a significant increase². A follow-up study found that sleep apnoea became more severe as women progressed through menopause, by about 4% for each additional year, regardless of age or body shape³. A 2025 review describes a sharp rise in sleep apnoea in women after menopause, and notes that changes in weight and body fat do not fully explain it⁴.

Why would menopause affect breathing?

The Australasian Menopause Society says that hormonal changes at menopause appear to affect the upper airway, restricting airflow and in some cases causing sleep apnoea⁵. It also notes that sleep usually starts to deteriorate a few years before menopause⁵. Laboratory research suggests that female hormones, possibly progesterone, have a substantial effect on the muscles that help hold the throat open⁶.

A European study of 774 middle-aged women found that those with lower oestrogen and progesterone levels were more likely to snore and to report sleep apnoea symptoms⁷. Each doubling of progesterone was linked with 9% lower odds of snoring, and each doubling of the oestrogen estrone with 19% lower odds⁷. As symptoms were self-reported, the study can't prove cause and effect. However, it fits the idea that oestrogen and progesterone help protect the airway, and that this protection fades as their levels fall⁷.

The International Menopause Society adds that hot flushes and night sweats may be linked to a higher risk of sleep apnoea, and that it appears more common after surgical menopause than natural menopause⁸.

Why it is so often missed

In the 2016 Sleep Health Foundation national survey, 3.7% of the women surveyed reported a sleep apnoea diagnosis, while a further 9.6% reported loud snoring or witnessed breathing pauses suggesting undiagnosed sleep apnoea⁹. For men the figures were 12.9% and 12.1%⁹. Put another way, roughly seven in ten women with diagnosed or possible sleep apnoea had no diagnosis, compared with about half of men (our calculation from these figures)⁹.

Symptoms can also differ. The Sleep Health Foundation notes that women with sleep apnoea more often report trouble falling and staying asleep, low mood and fatigue, while men more often have loud snoring and heavy daytime sleepiness¹⁰. An Australian study notes that research shows women may under-report snoring and are more likely to report atypical symptoms such as fatigue, insomnia and mood disturbance¹¹. In that online survey, women made up 55.5% of people at high risk of sleep apnoea who had not been diagnosed, but only 43% of those who had been diagnosed¹¹. The International Menopause Society notes that sleep apnoea is not just about loud snoring and gasping, and that low mood, anxiety and sleep disturbance can be features of it⁸. These symptoms are easily put down to menopause, and researchers have warned that doing so may lead to underdiagnosis of treatable sleep disorders in midlife women³.

Hot flushes & sleep apnoea

Between 36% and 87% of women experience hot flushes and night sweats during the transition, and women tend to wake just before a hot flush¹. Sleep apnoea adds its own interruptions. Each time the airway closes, a brief arousal, sometimes as short as 3 seconds, restarts breathing¹⁰. These are usually too short to remember, so many people have no idea it is happening¹⁰. A woman with both can wake repeatedly, never recall the apnoea, and put it all down to menopause.

Signs that deserve attention

The Sleep Health Foundation lists these common signs of sleep apnoea¹⁰:

• Waking unrefreshed despite enough time in bed

• Struggling to stay awake, especially in the afternoon

• Waking often during the night, sometimes gasping or choking

• Low mood, irritability or less clear thinking

• A partner noticing snoring or pauses in breathing

If several apply, ask your GP about a sleep study. It is the best way to confirm sleep apnoea, and your GP can refer you¹⁰.

Treatment that works

The two most commonly used treatments for moderate to severe sleep apnoea are CPAP and an oral appliance¹⁰. The Australasian Sleep Association regards CPAP as first-line therapy¹². However, a custom mandibular advancement splint, fitted by a dentist with sleep medicine training, is less obtrusive and more portable than CPAP, makes no noise and needs no power source¹². The Association supports these sleep apnoea mouthguards for mild to moderate sleep apnoea, and for moderate to severe sleep apnoea when CPAP has not worked or cannot be tolerated¹². The Sleep Health Foundation notes that they are particularly useful for snoring and milder forms of sleep apnoea¹⁰.

CPAP is better at stopping breathing pauses, but only when it is used. Even with support, only about half of people use it for four hours or more a night after six months¹³. In the 2016 Australian survey, 31% of people with diagnosed sleep apnoea used CPAP for at least four hours a night, and 55% used no treatment at all⁹. In randomised trials, oral appliances and CPAP produced similar improvements in sleepiness, quality of life, driving performance and blood pressure, even though CPAP did more to reduce breathing events¹³. The likely reason is that people use oral appliances for more of the night¹³. A treatment that works slightly less well but is used every night can protect your health as well as one that works better but stays in the bedside drawer¹³. Most of these trials were short-term, and response to an oral appliance varies from person to person, so it is important to check that your splint is working¹³.

Among people who completed a year of treatment in one clinical trial, 78% of women and 77% of men responded to oral appliance therapy, although side effects were more common in women¹⁴. A dental examination is needed first, and side effects such as tooth soreness and changes to the bite are relatively common¹². Early side effects are usually mild and temporary, and a dentist trained in dental sleep medicine will monitor for them with regular follow-up and manage any problems that develop¹²˒¹⁵.

What about hormone therapy?

For women with hot flushes, the Australasian Menopause Society says menopausal hormone therapy can markedly improve sleep quality¹. But it is not a substitute for treating sleep apnoea. In a randomised trial of 62 healthy postmenopausal women, oestrogen had only a minor effect on sleep apnoea and none on partial airway obstruction¹⁶. If you are on hormone therapy and still sleeping badly, snoring or waking unrefreshed, ask about a sleep study.

This World Menopause Day, if your sleep has deteriorated or your snoring has worsened, please do not assume it is simply menopause. At SleepWise Clinic, we have treated women at every stage of this journey, and we understand the full picture.

Call 1300 101 505 to speak with our friendly Treatment Coordinators to find out more about treatment with a mandibular advancement splint, treatment costs and treatment inclusions, or take our free online sleep apnoea test. What feels like menopause might be something very treatable.

References

1. Sleep Health Foundation. Menopause and sleep [fact sheet]. Updated 9 February 2026. https://www.sleephealthfoundation.org.au/sleep-topics/menopause-and-sleep

2. Young, T., Finn, L., Austin, D., & Peterson, A. (2003). Menopausal status and sleep-disordered breathing in the Wisconsin Sleep Cohort Study. American journal of respiratory and critical care medicine, 167(9), 1181–1185.

3. Mirer, A. G., Young, T., Palta, M., Benca, R. M., Rasmuson, A., & Peppard, P. E. (2017). Sleep-disordered breathing and the menopausal transition among participants in the Sleep in Midlife Women Study. Menopause (New York, N.Y.), 24(2), 157–162.

4. Sleep disordered breathing after menopause. Lancet Obstet Gynaecol Womens Health. 2025. https://www.thelancet.com/journals/lanogw/article/PIIS3050-5038(25)00112-8/abstract

5. Australasian Menopause Society. Sleep disturbance and the menopause [information sheet]. https://www.menopause.org.au/hp/information-sheets/sleep-disturbance-and-the-menopause2

6. Popovic, R. M., & White, D. P. (1998). Upper airway muscle activity in normal women: influence of hormonal status. Journal of applied physiology (Bethesda, Md. : 1985), 84(3), 1055–1062.

7. Sigurðardóttir, E. S., Gislason, T., Benediktsdottir, B., Hustad, S., Dadvand, P., Demoly, P., Franklin, K. A., Heinrich, J., Holm, M., van der Plaat, D. A., Jõgi, R., Leynaert, B., Lindberg, E., Martinez-Moratalla, J., Sainz De Aja, L., Pesce, G., Pin, I., Raherison, C., Pereira-Vega, A., Real, F. G., … Triebner, K. (2022). Female sex hormones and symptoms of obstructive sleep apnea in European women of a population-based cohort. PloS one, 17(6), e0269569.

8. International Menopause Society. Menopause and Insomnia. https://www.menopauseinfo.org/wp-content/uploads/2023/09/IMS-Factsheet-11-sleep.pdf

9. Appleton, S. L., Gill, T. K., Lang, C. J., Taylor, A. W., McEvoy, R. D., Stocks, N. P., González-Chica, D. A., & Adams, R. J. (2018). Prevalence and comorbidity of sleep conditions in Australian adults: 2016 Sleep Health Foundation national survey. Sleep health, 4(1), 13–19.

10. Sleep Health Foundation. Obstructive sleep apnoea (OSA) [fact sheet]. https://www.sleephealthfoundation.org.au/sleep-disorders/obstructive-sleep-apnoea

11. Krishnan, S., Chai-Coetzer, C. L., Grivell, N., Lovato, N., Mukherjee, S., Vakulin, A., Adams, R. J., & Appleton, S. L. (2022). Comorbidities and quality of life in Australian men and women with diagnosed and undiagnosed high-risk obstructive sleep apnea. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 18(7), 1757–1767.

12. Australasian Sleep Association. The use of oral appliances in the treatment of snoring and obstructive sleep apnoea: a position paper. https://www.sleep.org.au/common/Uploaded%20files/Public%20Files/ASA%20Membership/Guidelines/OA%20Position%20paper.pdf

13. Sutherland K, Phillips CL, Cistulli PA. Efficacy versus effectiveness in the treatment of obstructive sleep apnea: CPAP and oral appliances. J Dent Sleep Med. 2015;2(4):175-81.

14. Fransson, A., Nohlert, E., Tegelberg, Å., & Isacsson, G. (2024). Gender differences in oral appliance treatment of obstructive sleep apnea. Sleep & breathing = Schlaf & Atmung, 28(4), 1723–1730.

15. Balasubramaniam, R., McCloy, K., Almeida, F. R., & Cistulli, P. A. (2024). Oral appliance therapy for snoring and obstructive sleep apnoea: a Practical Guide for Clinical Care. Australian dental journal, 69 Suppl 1, S84–S100.

16. Polo-Kantola, P., Rauhala, E., Helenius, H., Erkkola, R., Irjala, K., & Polo, O. (2003). Breathing during sleep in menopause: a randomized, controlled, crossover trial with estrogen therapy. Obstetrics and gynecology, 102(1), 68–75.