Why Am I Snoring More In Perimenopause?

The Hormone-Airway Connection Explained

For many women, perimenopause arrives with a familiar constellation of symptoms: irregular periods, hot flushes, night sweats, mood changes, and disrupted sleep. What is far less discussed - and far less well recognised, even within the medical community - is that perimenopause also significantly increases the risk of snoring and obstructive sleep apnoea. This is not coincidental. The hormonal changes of the menopausal transition have a direct and scientifically well-established effect on the upper airway and understanding why can be genuinely life-changing for the women affected.

What Is Perimenopause - and When Does It Happen?

Perimenopause is the transitional phase preceding menopause, during which the ovaries gradually reduce their production of oestrogen and progesterone. It typically begins in a woman's mid-to-late forties, though it can start earlier, and lasts anywhere from a few years to over a decade before periods cease entirely. It is characterised by fluctuating and ultimately declining hormone levels. It is these hormonal fluctuations, and their effects on multiple body systems, that drive many of the symptoms women experience during this period.

Sleep disturbance is one of the most common and most impactful symptoms of perimenopause. A 2025 narrative review published in PMC found that sleep disturbances affect up to 47% of perimenopausal women - a figure that rises to as high as 60% in postmenopausal women - and encompass a spectrum that includes insomnia, sleep-related breathing disorders, and movement disorders.¹ Among these, snoring and obstructive sleep apnoea are increasingly recognised as a significant and undertreated component of perimenopausal sleep disruption.²

The Hormonal Mechanism: Why Oestrogen and Progesterone Matter for Your Airway

To understand why perimenopause causes snoring, it helps to understand what oestrogen and progesterone are doing in the airway during a woman's reproductive years, and what stops happening as these hormones decline.

Progesterone is a powerful respiratory stimulant. It acts on both central and peripheral mechanisms to promote stable, regular breathing during sleep, and plays a direct role in maintaining the tone of the upper airway muscles - the muscles responsible for keeping the throat open during sleep.³ Higher progesterone levels, such as those present during the luteal phase of the menstrual cycle or during pregnancy, enhance upper airway muscle activity and reduce airway resistance,⁴ making women considerably less prone to snoring and airway collapse during these periods. Indeed, research has found that a doubling of progesterone levels is associated with a 9% decreased odds of snoring in women - direct quantitative evidence of the hormone's airway-protective effects.⁵

As progesterone levels decline during perimenopause, this protective mechanism weakens. The muscles of the upper airway - the soft palate, uvula, tongue base, and pharyngeal walls - relax more readily during sleep, increasing the likelihood of partial or complete airway collapse. The result is tissue vibration that produces snoring, or the intermittent complete obstruction that characterises obstructive sleep apnoea.³

Oestrogen - specifically oestradiol - contributes to airway health through a different but complementary pathway. Oestrogen supports muscle and connective tissue integrity throughout the body, including the soft tissues of the upper airway. It also plays an anti-inflammatory role in the nasal and airway mucosa - meaning that as oestrogen declines, airway tissue can become more susceptible to inflammation, swelling, and congestion. Oestrogen receptors have been identified in the pharyngeal muscles, and experimental studies have demonstrated that oestradiol stimulation accentuates the contractility of the genioglossal muscle, one of the key muscles responsible for keeping the tongue forward and the airway patent during sleep.⁶ Research has found that lower oestradiol levels are independently associated with increased sleep apnoea risk in perimenopausal and postmenopausal women, separate from the effects of age and body mass index,⁵ and that a doubling of serum oestrone concentrations is associated with a 19% decreased odds of snoring.⁵

Together, the decline of both oestrogen and progesterone during perimenopause removes the hormonal protection that has kept many women's airways stable during sleep for decades - and the effects can manifest remarkably quickly, sometimes within the first year of perimenopausal transition.⁶

Weight Redistribution: The Compounding Factor

Hormonal changes alone do not fully explain the increased airway vulnerability of perimenopause - weight redistribution compounds the effect significantly. Declining oestrogen alters the way the body stores fat, shifting distribution from the hips and thighs toward the abdomen and, critically, the neck and throat. Excess weight around the neck and throat can further increase the risk of obstructive sleep apnoea by narrowing the space available for airflow during sleep. Notably, research has confirmed that body mass and visceral fat changes do not fully account for the menopause-related increase in sleep apnoea prevalence, meaning hormonal mechanisms operate independently of weight change.⁷ For women who are already experiencing hormonally driven reductions in upper airway muscle tone, even modest increases in soft tissue volume around the throat can tip the balance from occasional snoring into habitual, clinically significant sleep-disordered breathing.

The Scale of the Problem and Why It Goes Undetected

The prevalence of obstructive sleep apnoea in women increases dramatically across the menopausal transition. Research has found that between 47% and 67% of postmenopausal women have obstructive sleep apnoea,⁸'⁹ a figure that is startling when set against the widespread perception of sleep apnoea as a predominantly male condition. Sleep apnoea affects 47% of postmenopausal women compared to just 21% of premenopausal women, with postmenopausal women showing a significantly higher mean apnoea-hypopnoea index even after adjusting for BMI and neck circumference.⁸ A 2024 study published in Chronobiology in Medicine further found that progression through menopausal stages is associated with sleep-disordered breathing severity, with a 4% higher apnoea-hypopnoea index for every additional year since entering the menopausal transition - meaning the condition actively worsens as women move further through perimenopause and into postmenopause.²

Despite this, women with sleep apnoea are consistently underdiagnosed. Among the general population with symptoms of sleep-disordered breathing, women are significantly less likely to be diagnosed compared to men, and also less likely to receive any treatment.¹⁰ Up to 75% of women with obstructive sleep apnoea are estimated to remain undiagnosed.¹⁰ The reasons are multiple and systemic. Sleep apnoea research has historically used predominantly male study populations, establishing diagnostic criteria and typical symptom profiles based on male presentations.¹¹ Women frequently present differently - reporting fatigue, depression, insomnia, and morning headaches rather than the classic loud snoring and witnessed apnoeas associated with male OSA¹¹'¹² - and these atypical presentations are more likely to be attributed to menopause itself than to prompt a sleep study referral. Research has also found that social stigma leads women to under-report snoring, further reducing the likelihood of clinical investigation.¹³

The result is that many perimenopausal and postmenopausal women spend years attributing their exhaustion, low mood, and poor sleep quality to the menopause transition - when in fact obstructive sleep apnoea is a significant or primary contributing factor that could be effectively treated.

Hot Flushes, Night Sweats, and the Fragmentation Spiral

The relationship between perimenopause and disrupted sleep is further complicated by vasomotor symptoms - the hot flushes and night sweats that affect the majority of perimenopausal women. Perimenopause impacts 80-90% of women and encompasses a range of vasomotor, urogenital, cognitive, and psychiatric symptoms associated with the fluctuation and gradual reduction of gonadal hormones.¹ Hot flushes and night sweats cause frequent nocturnal arousals that fragment sleep architecture, preventing women from spending adequate time in the deep NREM and REM stages where physical restoration and memory consolidation occur.

When obstructive sleep apnoea is also present, causing its own separate cycle of arousals, the fragmentation becomes compounded. Women with both vasomotor symptoms and untreated sleep apnoea face a dual assault on sleep continuity that produces profound sleep deprivation even when total time in bed appears adequate. And because the sleep apnoea arousals are typically too brief to be remembered, women are often unaware of their contribution, attributing all of their disrupted sleep to the menopause symptoms they can actually feel.

Signs That Perimenopausal Snoring Deserves Clinical Attention

Not every woman who begins snoring in perimenopause has obstructive sleep apnoea, but every woman who does should be properly assessed, because the consequences of leaving it untreated are serious regardless of age or sex. The following signs warrant clinical investigation beyond the snoring itself: waking unrefreshed despite what feels like adequate sleep, excessive daytime fatigue that doesn't resolve with rest, morning headaches, difficulty concentrating or memory changes, mood disturbance or increased anxiety or depression, a partner reporting pauses in breathing or gasping during sleep, and frequent waking during the night for no clear reason.

If you are a perimenopausal woman experiencing any combination of these symptoms alongside new or worsening snoring, a sleep study is the appropriate next step, not a reassurance that it's simply the menopause.

Effective Treatment Is Available

The treatment of snoring and sleep apnoea in perimenopausal women follows the same evidence-based pathways as in the broader population, with some additional considerations. Custom mandibular advancement splints - fitted by a sleep medicine dentist - are a highly effective, comfortable, and practical treatment for snoring and mild to moderate obstructive sleep apnoea. They are particularly well suited to women who are managing multiple perimenopausal symptoms and need a treatment that is simple, unobtrusive, and does not add to the equipment burden of an already disrupted night.

Research also suggests that hormone replacement therapy (HRT) may reduce the severity of sleep-disordered breathing in some women by partially restoring the hormonal protection of the upper airway, though this is a conversation to have with a GP or specialist who can assess the appropriateness of HRT in your individual clinical context.

At SleepWise Clinic, we understand that snoring and sleep apnoea in women - particularly during the perimenopausal transition - is a clinical issue that deserves to be taken as seriously as any other health change of this life stage. If your sleep has deteriorated, your snoring has worsened, or you simply don't feel right despite what seems like enough time in bed, please come and speak with us.

Call SleepWise Clinic on 1300 101 505 or take our free online sleep apnoea test, because what feels like menopause might be something very treatable.

References:

1. Guida M, Castaldi MA, Rosamilio R, Giudice V, Orio F, Selleri C, et al. Sleep disturbance and perimenopause: a narrative review. PMC. 2025. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11901009/
2. Sleep Disturbance in Perimenopausal Women. Chronobiology in Medicine. 2024. Available from: https://www.chronobiologyinmedicine.org/journal/view.php?doi=10.33069%2Fcim.2024.0027
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8. Shahar E, Redline S, Young T, Boland LL, Baldwin CM, Nieto FJ, et al. Impact of menopause on the prevalence and severity of sleep apnoea. PubMed. Available from: https://pubmed.ncbi.nlm.nih.gov/11451831/
9. Jehan S, Masters-Isarilov A, Salifu I, Zizi F, Jean-Louis G, Pandi-Perumal SR, et al. Obstructive sleep apnoea: women's perspective. PMC. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC5323064/
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11. Raphelson JR, Fuentes AL, Holloway B, et al. OSA in women: associations with reproductive ageing and screening challenges. ScienceDirect. 2025. Available from: https://www.sciencedirect.com/science/article/abs/pii/S0012369225051256
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13. Maimon N, et al. Social stigma and under-reporting of snoring in women. Journal of Clinical Sleep Medicine. Available from: https://gulfnews.com/world/americas/why-your-wife-wont-admit-she-snores-as-loud-as-you-1.63547551