Perimenopause vs Sleep Apnea: Understanding Overlapping Sleep Symptoms
Perimenopause and sleep apnea both disrupt sleep and cause fatigue. Learn how to tell the symptoms apart and when to seek a proper diagnosis.
Two Conditions, One Very Tired Body
When sleep starts falling apart in your forties, it is tempting to attribute everything to perimenopause. Hormonal changes do profoundly affect sleep, but sleep apnea is also far more common in this decade of life than most women realise. Sleep apnea causes breathing to stop and restart repeatedly during the night, often without the person being aware. The result is fragmented, unrestorative sleep and significant daytime fatigue. Because both perimenopause and sleep apnea produce similar surface-level symptoms, distinguishing between them requires looking more carefully at what is actually happening during sleep.
Symptoms More Specific to Perimenopause
Perimenopause has hormonal markers that sleep apnea does not produce. Hot flushes and night sweats are characteristic of estrogen fluctuation and are strongly associated with perimenopause. Irregular periods, including changes in cycle length, flow, or spotting between periods, point directly to hormonal change. Vaginal dryness, breast tenderness, and changes in sexual desire are also tied to shifting hormone levels. When sleep disruption is accompanied by these physical changes, perimenopause is a strong candidate. Tracking symptoms in an app like PeriPlan alongside cycle data can help reveal the hormonal pattern underlying sleep difficulties.
Symptoms More Specific to Sleep Apnea
Sleep apnea has its own signature that is distinct from perimenopausal sleep disruption. Loud snoring, gasping or choking sounds during sleep noted by a bed partner, waking with a dry mouth or sore throat, and choking awake during the night are all features of obstructive sleep apnea. Morning headaches caused by overnight drops in blood oxygen are another indicator. Excessive daytime sleepiness that is so pronounced it interferes with driving or working is more severe than typical perimenopause fatigue. Women with sleep apnea may also experience elevated blood pressure, which does not arise from perimenopause alone.
Why Sleep Apnea Goes Underdiagnosed in Women
For decades, sleep apnea was considered predominantly a condition affecting overweight middle-aged men. Research now shows that the prevalence in women rises significantly after the menopause transition begins, partly because progesterone, which has a protective effect on upper airway tone, declines during perimenopause. Women also tend to present differently, often reporting fatigue and mood symptoms rather than the classic loud snoring that prompts investigation in men. Doctors may attribute all sleep complaints to perimenopause without considering sleep apnea. If daytime sleepiness is severe or a bed partner has noticed abnormal breathing, raising this possibility directly with a GP is worthwhile.
Getting the Right Diagnosis
Perimenopause assessment typically involves discussing symptom history and menstrual changes, and sometimes blood tests for hormone levels, though these fluctuate considerably during this phase. Sleep apnea is diagnosed through a sleep study, which can be done at home using a wearable device or in a sleep clinic. The two investigations are entirely different and one does not rule out the other. It is also possible to have both conditions simultaneously, which is more likely than many assume. If treating perimenopause symptoms with lifestyle changes or HRT does not fully resolve fatigue and sleep disruption, asking specifically about a sleep study is a reasonable next step.
Managing Sleep When Causes Are Unclear
While you are working toward a diagnosis, there are practical steps that help regardless of the underlying cause. Keeping the bedroom cool reduces the impact of hot flushes and also benefits anyone with sleep apnea, since elevated temperature worsens airway relaxation. A consistent sleep and wake time supports circadian rhythm. Avoiding alcohol in the evening is particularly important if sleep apnea is suspected, as alcohol relaxes throat muscles and worsens airway obstruction. Logging sleep quality alongside daytime symptoms in PeriPlan gives you a record that is genuinely useful in a clinical consultation. Patterns that emerge over several weeks can help direct the investigation.
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