PCOS and sleep apnea: Causes, diagnosis and treatment

PCOS and sleep apnea often co-exist, with women with PCOS having an increased risk of obstructive sleep apnea. Sleep apnea can worsen PCOS symptoms, such as insulin resistance, fatigue, and difficulty losing weight. Untreated sleep apnea can increase the risk of type 2 diabetes and heart disease, so diagnosis and treatment is essential.

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Women with polycystic ovaries syndrome (PCOS) are more likely to be diagnosed with sleep apnea than women without PCOS. Scientists are still exploring the link between these conditions. Sleep apnea can worsen symptoms of PCOS, including tiredness, insulin resistance, and difficulty losing weight.

If left untreated, sleep apnea can increase your risk of conditions, including high blood pressure and stroke. It’s crucial to seek treatment for sleep apnea to manage your risk of developing associated conditions.

Your doctor may prescribe a CPAP machine to help regulate your breathing at night or hormonal therapy to reduce sleep apnea symptoms. Losing weight, quitting smoking, reducing alcohol intake, and practicing good sleep hygiene can also help boost your sleep.

What is PCOS?

PCOS is a common endocrine and metabolic disorder that affects around 13% of women of reproductive age. Though it is a relatively common condition, our understanding of PCOS is still lacking.

You will receive a PCOS diagnosis if you meet two of the following criteria:

• Irregular periods
• Excess androgen (so-called ‘male’ hormones)
• Polycystic ovaries (a large number of follicles in your ovaries)

Common symptoms of PCOS include:

• Irregular periods
• Excess facial and body hair
• Acne
• Thinning hair on the scalp
• Weight gain
• Difficulty getting pregnant

Many women do not know they have PCOS until they access fertility support after experiencing difficulty conceiving.

Women with PCOS have a higher risk of developing conditions, including type 2 diabetes, cardiovascular disease, and depression. Women with PCOS are also more likely to be diagnosed with obstructive sleep apnea.

PCOS and sleep apnea

Women with PCOS have an increased risk of suffering from obstructive sleep apnea. The reasons behind this are not fully understood. However, we know that women with PCOS and sleep apnea have worse metabolic dysfunction than those without sleep apnea. A 2021 study published in Current Opinion in Endocrine and Metabolic Research concluded that more research was needed to determine whether sleep apnea exacerbates the metabolic risk in patients with PCOS.

What is obstructive sleep apnea?

Sleep apnea is when your breathing stops and starts while you are sleeping. Obstructive sleep apnea occurs because the throat relaxes and narrows during sleep. Symptoms include:

• Stop-start breathing when sleeping
• Making snorting, gasping, or choking noises when sleeping
• Loud snoring
• Noisy and labored breathing
• Waking in the night
• Feeling tired during the day

Untreated sleep apnea can increase your risk of a range of conditions, including type 2 diabetes, high blood pressure, heart disease, and stroke. If you think you may have sleep apnea, it’s vital to seek treatment for this condition.

Why is there a link between PCOS and sleep apnea?

Scientists are still exploring the link between PCOS and sleep apnea, but it’s thought that insulin resistance plays a significant role. A 2013 study published in Fertility and Sterility found that insulin resistance was present in most women with PCOS. An old study from 2001 published in the Journal of Clinical Endocrinology and Metabolism found that women with PCOS were 30 times more likely to suffer from sleep apnea than their peers.

Insulin resistance

Many women with PCOS suffer from insulin resistance. Scientists aren’t exactly sure what the relationship is between these two conditions, but we know insulin resistance can worsen symptoms of PCOS. Insulin resistance may also play a part in sleep apnea, though scientists don’t yet know exactly why these conditions are linked. However, treating your insulin resistance could improve your sleep apnea.

Obesity

A 2018 study published in the Nature and Science of Sleep concluded that the sleep disturbances associated with PCOS were not simply down to obesity. Women with PCOS are more likely to suffer sleep disturbances regardless of their weight. However, fat deposits can narrow your area, putting you at risk of sleep apnea.

A 2017 study published in Sleep Medicine and Disorders found that diet improvement in people with sleep apnea improved sleep problems and associated disorders such as depression and insomnia.  

High androgens

Androgens are ‘male’ hormones, such as testosterone. These hormones are found at higher levels in women with PCOS. Sleep apnea affects more men than women, though women with PCOS also face high levels of sleep apnea. It was previously believed that this was due to high androgens, though scientists now think it’s more complex than simply hormones.

Does PCOS cause sleepiness?

One of the symptoms of sleep apnea is tiredness during the day. If you’re not getting enough sleep at night, it makes sense that you’ll feel groggy during the day. If your sleep apnea keeps you up night after night, you can end up feeling pretty rubbish.

Women with PCOS frequently complain of fatigue, and it’s thought that sleep disturbances are to blame. This fatigue can then make exercising more challenging, which is one reason why women with PCOS may struggle to lose weight.

PCOS and sleep apnea treatment

If you think you have sleep apnea, make an appointment to see your doctor. Untreated sleep apnea can increase your risk of type 2 diabetes, heart disease, and stroke. PCOS increases your risk of type 2 diabetes and cardiovascular disease, so it’s essential you seek treatment for your sleep apnea.

Your doctor may want to perform a sleep test to diagnose your sleep apnea. These can usually be done at home using specialist equipment, though in some instances, you may be invited to spend the night at a sleep clinic for a full assessment.

CPAP machine

A continuous positive airway pressure (CPAP) machine is the leading treatment for sleep apnea. Not all people with sleep apnea need a CPAP machine; many can manage the condition with lifestyle changes. Speak to your doctor about whether a CPAP machine is the right option for you.

Hormonal therapy

Hormones play a role in sleep apnea in women with PCOS, so your doctor might want to try hormonal therapy to reduce your symptoms. Progesterone and estrogen may protect the body from sleep disturbances, so hormonal birth control may improve your sleep.

Lifestyle changes for PCOS and sleep apnea

You can make lifestyle changes to manage this condition at home. These include:

Losing weight

If you are overweight, losing weight could help with your sleep apnea. While losing weight with PCOS isn’t easy, it is possible. Changing your diet can have a considerable impact on your weight. A PCOS-friendly diet is rich in fresh fruits and vegetables, lean proteins, healthy fats, and whole grains. Ditch the junk food, soda, and processed foods; instead, load up on fresh food.

Exercise can also help you to reach a healthy weight. Focus on cardio and strength training to improve your fitness and burn energy.

Stopping smoking and cutting down on alcohol

Both alcohol and smoking could be worsening your sleep apnea. A 2021 article published in Medicina found that smoking increases inflammation in the upper airway, which can increase symptoms of sleep apnea. A 2024 article published in the Journal of Sleep Research found that stopping drinking could improve sleep and decrease sleep apnea symptoms.

Sleeping on your side

Side sleeping is best for people with sleep apnea. Sleeping on your back can worsen symptoms as your tongue can block your airway in this position. Elevating your head with a pillow may also reduce instances of sleep apnea during the night.

Getting enough sleep

People with sleep apnea may wake frequently during the night, decreasing the amount of sleep they get. For this reason, it’s essential to set aside extra time for sleeping. Try to spend nine hours a night in bed to increase the amount of sleep you manage.

Practicing good sleep hygiene

Good sleep hygiene can help you sleep better at night, even if you have sleep apnea. Try to use your bed only for rest so that you associate it with sleep. Avoid screens for an hour before bed. Sleep in comfortable clothing in a dark room. Avoid distractions at night. Practice meditation and mindfulness to prepare your mind for restful sleep.

Summary

Women with PCOS have an increased risk of sleep apnea. If left untreated, sleep apnea can increase your risk of type 2 diabetes and heart disease. PCOS can also increase your risk of these conditions, so treating your sleep apnea is essential.

The main treatment option for sleep apnea is a CPAP machine, though usually only people with severe sleep apnea will require these. For most people, lifestyle changes can help to reduce symptoms. For example, losing weight can help relieve symptoms, as can quitting smoking and reducing or stopping drinking alcohol.

If you think you may have sleep apnea, make an appointment to see your doctor for a diagnosis. They may recommend a CPAP machine, hormonal therapy, or lifestyle changes to treat the condition.