In short
- The NHLBI says women's risk of sleep apnea increases during and after menopause, and that menopause symptoms such as insomnia, headaches and fatigue can make sleep apnea harder to recognize.
- In a Sleep Heart Health Study analysis of 2,852 women aged 50 or older, women using hormone therapy had about half the rate of moderate or worse sleep-disordered breathing as non-users, an association the authors said may or may not be causal.
- In a 1994 trial of 15 postmenopausal women with moderate sleep apnea, about 50 days of hormone therapy did not reduce the clinical severity of their sleep apnea.
- A 2003 randomized crossover trial in 62 healthy postmenopausal women found estrogen therapy had only a minor effect on sleep apnea and no effect on partial airway obstruction.
- In the Icelandic Sleep Apnea Cohort, 33.3% of women with untreated sleep apnea reported night sweats at least three times a week, compared with 12.4% of women in the general population.
- The American Academy of Sleep Medicine recommends against diagnosing sleep apnea with questionnaires alone, and recommends an in-lab study rather than a home test for people with severe insomnia.
Sleep apnea becomes more likely during and after menopause. Falling estrogen and progesterone seem to make breathing during sleep less stable, and weight gain around the neck can add to it. The tricky part is that sleep apnea in women often shows up as insomnia, tiredness, night sweats or low mood, which are easy to put down to menopause. If your sleep changed in midlife and hasn't settled, a sleep test is the only way to know whether sleep apnea is part of it.
Why does sleep apnea risk go up after menopause?
Sleep apnea risk goes up after menopause because of hormone changes and, for many women, weight changes. The NHLBI says women may have a lower risk than men earlier in life, but that the risk increases during and after menopause. It says changes in hormones raise the risk, and that women may also gain weight during menopause, including around the neck.
A review in Chest, published online in 2025 by sleep researchers in the US and Israel, describes reproductive aging as an overlooked risk factor, separate from getting older. The authors write that estrogen and progesterone are involved in stabilizing breathing, and that their decline contributes to breathing difficulties during sleep. They also note that women who reach menopause earlier, either naturally or because both ovaries were removed in surgery, appear particularly susceptible.
The long-running cohort studies that first showed this link, including the Wisconsin Sleep Cohort, are covered in our article on menopause and snoring. Here we focus on the hormone research, the symptoms that get confused with menopause, and how to get tested.
What does the hormone research show?
Research: moderate (what this means)The hormone research shows a clear association between menopause and sleep apnea, but the trials testing hormone therapy as a fix have been small and mostly disappointing. That gap between "linked" and "treatable with hormones" is the main thing to understand.
| Study | Who was studied | Main finding |
|---|---|---|
| Cistulli and colleagues, Thorax, 1994 | 15 postmenopausal women with moderate sleep apnea | About 50 days of hormone therapy didn't reduce clinical severity |
| Shahar and colleagues, American Journal of Respiratory and Critical Care Medicine, 2003 | 2,852 women aged 50 or older | Hormone users had about half the rate of AHI 15 or more |
| Polo-Kantola and colleagues, Obstetrics and Gynecology, 2003 | 62 healthy postmenopausal women, randomized crossover | Estrogen had only a minor effect on sleep apnea |
| Gao and colleagues, Menopause, 2018 | 1,691 women at a women's health clinic | Severe hot flashes linked with higher sleep apnea risk scores |
Women on hormone therapy had less sleep apnea
The largest study comes from the Sleep Heart Health Study. Researchers gave home sleep studies to 2,852 women aged 50 or older and compared those who used hormone therapy with those who didn't. Moderate or worse sleep-disordered breathing, defined as an apnea-hypopnea index (AHI) of 15 or more, showed up in 61 of 907 hormone users and 286 of 1,945 non-users. That's roughly half the rate.
After adjusting for age, body mass index and neck size, hormone users still had lower odds (an adjusted odds ratio of 0.55). The link was strongest in women aged 50 to 59. The authors were careful: they wrote that if the association is causal, hormone therapy could have a role. An observational study can't show that, because women who choose hormone therapy may differ in other ways.
Trials of hormone therapy were less encouraging
When researchers actually gave hormones to women and measured their breathing, the effect was small. In a 1994 Australian trial in Thorax, 15 postmenopausal women with moderate sleep apnea took estrogen alone or estrogen with progesterone for about 50 days on average. Their estrogen levels nearly doubled, but the clinical severity of their sleep apnea didn't fall. There was a small drop in AHI during REM sleep, from 58 to 47, which the authors called clinically insignificant. They concluded that short-term hormone therapy is unlikely to have an effective role in managing sleep apnea in postmenopausal women, while leaving the door open to longer or higher-dose treatment.
A 2003 Finnish trial in Obstetrics and Gynecology was better designed. Sixty-two healthy postmenopausal women completed the trial, taking estrogen for three months and a placebo for three months, in random order, with sleep studies after each. Only 1.6% had obstructive sleep apnea, while 17.7% had partial narrowing of the upper airway. Estrogen reduced how often sleep apnea occurred but had no effect on the partial narrowing or on blood oxygen. The authors' conclusion was that estrogen alone has only a minor effect on sleep apnea.
So hormone therapy may treat hot flashes and other menopause symptoms, but the evidence doesn't support it as a sleep apnea treatment. If you're considering it, that's a conversation with your doctor about menopause, not a substitute for a sleep test.
Why is sleep apnea easy to miss during menopause?
Sleep apnea is easy to miss during menopause because the two share so many symptoms. The NHLBI says women with sleep apnea more often have:
- anxiety or depression
- daytime sleepiness or tiredness
- headaches, especially in the morning
- insomnia
- waking up often during sleep
It adds that menopause itself can cause insomnia, headaches and fatigue, which may make it harder for you or your provider to recognize sleep apnea. And because some women don't snore, they may not suspect it at all. Our guide to sleep apnea without snoring explains how that happens.
The Chest review makes a related point about screening. It says women are more likely to report insomnia and mood problems and less likely to have loud snoring or witnessed pauses in breathing. Most screening questionnaires were built around the symptoms men tend to report, so they can miss women.
Insomnia and sleep apnea can go together
The NHS lists trouble getting to sleep or staying asleep as a common menopause symptom, and says it may be worse with night sweats. Insomnia can also sit alongside sleep apnea rather than replacing it. If you've been told you have menopausal insomnia but you still wake exhausted however long you stay in bed, our article on sleep apnea and insomnia explains how the two overlap.
Are night sweats a sign of sleep apnea or menopause?
Night sweats can come from menopause, sleep apnea or both. The NHS describes hot flushes as the face, neck and chest suddenly feeling very hot or cold, which can make you sweat a lot, and says they can happen at night as night sweats.
Sleep apnea can cause night sweats too. In the Icelandic Sleep Apnea Cohort, published in BMJ Open in 2013, 33.3% of women with untreated sleep apnea reported sweating at night at least three times a week, compared with 12.4% of women from the general population. Among people who used their PAP machine fully, the rate fell to general population levels. The researchers suggested doctors consider sleep apnea when patients complain of night sweats.
Hot flashes and sleep apnea risk may also be linked. A 2018 study in Menopause gave a sleep apnea screening questionnaire, STOP-BANG, to women attending a women's health clinic at Mayo Clinic in Minnesota. Of the 1,691 women analyzed, those reporting severe or very severe hot flashes had 1.87 times the odds of scoring at intermediate or high risk for sleep apnea, and the link held in women of normal weight. This was a questionnaire, not a sleep test, and the authors noted the tool may have overestimated risk. Still, it's a reason not to assume sweating at night is always hormonal.
How do you get tested for sleep apnea during menopause?
You get tested for sleep apnea with a sleep study, arranged through your doctor. The NHS says your GP may refer you to a sleep clinic, and that you can usually do the test at home, though sometimes you'll stay overnight in the clinic. The NHLBI says your provider will ask about your symptoms, risk factors and family history, and may suggest a sleep diary. It says they may also order blood tests, for example to check thyroid hormone levels.
A few points from the American Academy of Sleep Medicine's 2017 diagnostic guideline matter for women in midlife:
- Questionnaires and prediction tools shouldn't be used to diagnose sleep apnea without a sleep test.
- A home test is fine for uncomplicated adults with signs of moderate to severe sleep apnea.
- An in-lab study is recommended over a home test for people with severe insomnia, as well as for several other conditions.
- If a home test comes back negative, inconclusive or technically inadequate, an in-lab study is recommended.
That last point is worth knowing. If your home test is negative but you still have strong symptoms, it's reasonable to ask whether a lab study makes sense. Our guide to the home sleep apnea test explains what to expect.
What to tell your doctor
Bring the whole picture, not just the menopause symptoms. Tell your doctor when your sleep changed, how often you wake, whether you wake with a headache or a dry mouth, how tired you are in the day, and whether anyone has noticed snoring or pauses in your breathing. The NHS suggests asking someone to watch you sleep and bringing them along if they've seen symptoms. If you've gained weight around your neck, mention that too; our article on snoring and neck size explains why it matters.
How is sleep apnea treated in menopausal women?
Sleep apnea is treated the same way in menopausal women as in anyone else. The NHS says lifestyle changes such as losing weight, stopping smoking and drinking less alcohol can sometimes help, but many people need CPAP, a machine that gently pumps air into a mask while you sleep. Other options it lists include a mouthpiece that holds the airway open, surgery, mouth and facial muscle exercises and hypoglossal nerve stimulation. Our overview of sleep apnea treatment options compares them.
Hormone therapy isn't on that list. Treating sleep apnea may also help with symptoms you've been blaming on menopause. In the Icelandic study above, frequent night sweats fell to general population levels in people who used PAP fully.
When should you see a doctor?
See your doctor if your breathing stops and starts in your sleep, you make gasping, snorting or choking noises, or you always feel very tired during the day. Those are the NHS's main reasons to see a GP about sleep apnea. In midlife, add new insomnia, frequent night waking, morning headaches or night sweats that don't fit your other menopause symptoms. Our list of sleep apnea warning signs has more detail.
A blocked nose that never clears is worth raising too. The NHS notes it's still possible to get pregnant during perimenopause; if you are pregnant, raise snoring or breathing pauses with your midwife or doctor. And if your menopause symptoms are affecting your work or relationships, the NHS says early advice can help, so there's no need to wait.
This article is general information, not medical advice. Talk to your doctor about your own symptoms and treatment.
Read next
- Sleep apnea in women: symptoms that get missed
- Menopause, snoring and sleep apnea: what changes
- Waking up tired: common causes
Common questions
Does menopause cause sleep apnea?
Menopause doesn't cause sleep apnea on its own, but it raises the risk. The NHLBI says women's risk increases during and after menopause, partly because of hormone changes and partly because many women gain weight, including around the neck. Researchers think falling estrogen and progesterone, which help keep breathing stable, play a part.
Can hormone therapy treat sleep apnea?
Hormone therapy isn't a treatment for sleep apnea. One large observational study found lower rates in women taking hormones, but small trials were disappointing. In a 1994 trial, about 50 days of hormone therapy didn't reduce the severity of moderate sleep apnea. Decisions about hormone therapy for menopause symptoms belong with your doctor.
Are night sweats a sign of sleep apnea or menopause?
They can be either, or both. The NHS lists night sweats as a common menopause symptom. In an Icelandic study, a third of women with untreated sleep apnea reported frequent night sweats, about three times the rate in the general population, and the rate fell to normal levels with successful CPAP. A sleep test can help tell them apart.
What are the symptoms of sleep apnea in menopausal women?
Women often notice insomnia, waking up a lot, daytime tiredness, morning headaches, low mood or anxiety, according to the NHLBI. A review in Chest says women are less likely to have loud snoring or witnessed pauses in breathing. Because these overlap with menopause, it helps to mention all of them to your doctor rather than only the snoring.
How do I get tested for sleep apnea during menopause?
Start with your GP or primary care doctor, who can refer you for a sleep study. Many people can do this at home, according to the NHS. The AASM guideline recommends an in-lab study instead for people with severe insomnia, and an in-lab study if a home test is negative, inconclusive or technically inadequate.
At what age does sleep apnea risk go up for women?
There's no single age, because it tracks menopause more than birthdays. A review in Chest, published online in 2025, says risk rises significantly after menopause alongside normal aging, and that women who reach menopause earlier, naturally or after surgery to remove both ovaries, appear particularly susceptible.
Sources
- Sleep apnea and women
- Sleep Apnea - Diagnosis
- Sleep apnoea
- Symptoms of menopause and perimenopause
- OSA in Women: Associations With Reproductive Aging and Screening Challenges
- Hormone replacement therapy and sleep-disordered breathing
- Effect of short-term hormone replacement in the treatment of obstructive sleep apnoea in postmenopausal women
- Breathing during sleep in menopause: a randomized, controlled, crossover trial with estrogen therapy
- Association of vasomotor symptoms and sleep apnea risk in midlife women
- Nocturnal sweating--a common symptom of obstructive sleep apnoea: the Icelandic sleep apnoea cohort
- Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline
About this article
- Research
- 11 published sources, listed above.
- Evidence
- Moderate. How we rate it
- Last checked
- November 2, 2026
- Funding
- Paid partner of Titan Recovery. Their ads are labeled.
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* This content is for informational and educational purposes only and is not medical advice. It is not intended to diagnose, treat, cure or prevent any disease or health condition. Talk to a qualified healthcare provider about your health.