For three years, Vicki Maylan received treatment for bladder problems that were not actually the cause of her symptoms.
The former NHS worker, then 66, noticed something unusual shortly after the menopause. Once a sound sleeper, she began waking repeatedly during the night to use the toilet—sometimes as many as seven times.
‘It was incredibly disruptive,’ says Vicki, who lives in Devon. ‘I woke every morning feeling exhausted and with a headache. My GP diagnosed nocturia—the need to urinate frequently at night—but couldn’t explain what had triggered it.’
The medication prescribed to control the problem made no difference. Instead, it left her dealing with severe daytime side-effects, including nausea and splitting headaches.
After three years, Vicki was referred to a urologist, who carried out a battery of tests. The results were normal. Then, while her case was being reviewed by a multidisciplinary team, one doctor suggested that the nightly toilet trips might be linked to her sleep rather than her bladder.
The doctor explained that nocturia can be a symptom of obstructive sleep apnoea (OSA). The condition develops when the muscles in the throat relax excessively during sleep, repeatedly blocking the airway and depriving the brain of oxygen for short periods.
Many people do not realise these interruptions are happening. Each pause in breathing can jolt the body into a more alert state, severely fragmenting sleep. OSA can also affect the kidneys, which normally reduce urine production overnight but may continue working when breathing is repeatedly disrupted.
Vicky Maylan, once a sound sleeper, began waking to use the toilet as many as seven times a night
Breathing interruptions can keep the body alert and interfere with the kidneys, prompting them to produce urine throughout the night
Doctors monitored Vicki’s breathing and blood oxygen levels overnight. The findings were striking: she was experiencing almost 70 episodes of apnoea every hour.
A respiratory consultant confirmed the diagnosis and prescribed continuous positive airway pressure, or CPAP, therapy. The device uses a mask over the nose and mouth to deliver a steady flow of air, keeping the airway open while the patient sleeps.
Within just a week, Vicki’s nighttime bathroom visits had fallen to one. She now regularly sleeps through the night without needing to get up.
‘The machine has been amazing,’ she says. ‘I finally wake up feeling refreshed, while the headaches and fatigue have improved considerably. I had also been struggling with high blood pressure, and that has fallen significantly. I only wish I had been diagnosed earlier.’
Experts believe tens of thousands of women could be living with undiagnosed OSA. Without treatment, the condition may contribute to long-term health problems, including weight gain, high blood pressure and a higher risk of heart disease and stroke.
Women are often less likely to have OSA recognised because of the lingering belief that it mainly affects men. Symptoms such as tiredness, poor-quality sleep and mood changes can also be attributed to the menopause, making the underlying sleep disorder easier to miss.
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Dr Zoe Schaedel, a Brighton-based GP specialising in sleep and menopause, said: ‘Research shows that women’s symptoms are less likely to be identified through the routine assessments GPs use when deciding whether to refer patients for further testing.
Vicky was prescribed continuous positive airway pressure (CPAP) therapy, which uses a mask over the nose and mouth to keep the airway open during sleep
‘Women can have symptoms that differ from men’s and are less easily recognised, meaning they may not fit the standard criteria. Some recent studies suggest that up to 85 per cent of women with sleep apnoea remain undiagnosed. It is a major problem.’
An estimated eight million people in Britain have OSA, with the number thought to have increased almost sixfold since 2000.
Research indicates that a woman’s risk of developing OSA roughly doubles after menopause. The sharp decline in oestrogen and progesterone—hormones that help support the upper airway and maintain muscle tone—is believed to play a key role.
Yet because women can present with different symptoms than men, many cases are still missed, says Dr Christopher Turnbull, respiratory consultant and medical adviser for the Sleep Apnoea Trust Association.
‘The typical symptoms of OSA are loud snoring, that can be heard through a closed door, disturbed sleep and excessive sleepiness in the day – falling asleep accidentally despite getting a good amount of hours in bed,’ he adds.
‘Yet these are more likely to be reported by men than women. Women, meanwhile, are more likely to have general tiredness or fatigue in the day without the overwhelming need to sleep, as well as to experience headaches and mood changes.’
Dr Schaedel says: ‘The fact that women refer to tiredness, but don’t necessarily report falling asleep in the day, is enough to make them less likely to be referred by GPs.’
Studies have shown women’s risk of obstructive sleep apnoea roughly doubles after menopause because of sharp drops in levels of oestrogen and progesterone
Dr Turnbull adds: ‘Many of the commonest symptoms of OSA, such as sleepiness, disrupted sleep and waking up in the night have overlap with menopause symptoms.’
Luckily, there are some signs of OSA that should be brought up with one’s GP.
‘Morning headaches are always worth investigating – and are much more common in women,’ says Dr Schaedel.
‘New nightmares when you haven’t them in ages and fragmented sleep more generally are also concerning.’