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Menopause and Sleep Apnea
By Michael F. Hnat, D.M.D.

Michael F. Hnat, D.M.D.

Menopause in women is a time of hormonal, physical and emotional changes and sleep disturbance is one of the primary symptoms. The majority of women complain of difficulty in falling asleep and staying asleep .i.e. insomnia as well as reporting less refreshing sleep, all contributing to significant daytime sleepiness during this stage of life. These sleep problems are often accompanied by anxiety and depression with atypical mood changes.

Although sleep disruption occurs from the most common manifestations of menopause – the "hot flashes" and night sweats – it is also attributed to the significant increase in sleep apnea (OSA) during this time. This fact is often overlooked in trying to improve sleep patterns of menopausal women. The well-known Wisconsin Cohort study published in 2003 identified menopause as an independent risk factor for OSA. Additional research published in the American Journal of Respiratory Critical Care Medicine found that post menopausal women are 2.5 times more likely to have OSA than those pre-menopause.

While hormone replacement therapy using synthetic estrogens and progesterone are helpful in limiting the "hot flashes" and improving the insomnia, the common development of obstructive sleep apnea must also be addressed to improve sleep quality.

OSA in menopausal women results from physical changes to the airway restricting normal nighttime breathing. The deposition of additional fatty tissue in the neck area and in the tongue, narrow the airway, increasing the tendency to collapse and obstruct air passage during sleep. This physical change can appear even in the thinnest of women. Each breathing obstruction disrupts the maintenance of deep, restorative sleep resulting in poor sleep patterns and a very unrefreshed feeling upon awakening. Menopause can linger for years and chronic disrupted sleep patterns during this time can have a debilitating effect on a woman's physical and emotional well-being. Dentist's qualified to screen for sleep-related breathing problems can identify menopausal women at risk for OSA. The diagnosis of OSA is confirmed when the woman at risk is referred to the sleep lab and completes an overnight sleep study. Menopausal women being very sensitive and irritable and prone to insomnia, may have difficulty adjusting to the more common medical treatment for OSA – the nighttime breathing mask (CPAP). Use of an oral appliance that is custom made by a qualified dentist to fit over the teeth and prevent the nighttime collapse of the airway, can be a more tolerable and user-friendly option.

Menopause for women does not have to be so sleep disruptive if a progressive approach is taken to recognize and correct the issues contributing to poor sleep.

Michael F. Hnat, D.M.D., is a 1979 graduate of the University of Pittsburgh School of Dental Medicine and Director of Progressive Dental Solutions, dental sleep medicine facility in McMurray PA. The primary focus of the facility, which is accredited by the American Academy of Dental Sleep Medicine, is the custom fabrication of oral appliances for the treatment of snoring and obstructive sleep apnea. For more information, call (724) 942-5630 or visit www.progressivedentalsolutions.com.

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