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When we think of someone snoring, we usually picture a portly man with his mouth agape. It’s supposed to be humorous (despite it being a little sizeist). Society says it’s okay to hold up the male figure to be powerless as he makes a funny sound in his dormant state. As medical professionals, we see someone who potentially has a debilitating disorder. But women aren’t normally associated with snoring like men are, both in the culture and in the exam room. The reasons why are simple yet profound.

Imbalance between Men and Women

Women do actually suffer from sleep apnea less than men. So, there is some truth to the common trope used in photo and film. There’s no definitive reason as to why there’s a calculable difference between the incidences of male and female sleep apnea, but there are a few reasonable guesses. We’ve previously described how these hormones have affected how the anatomy and the physiology differ. In general, these studies point mostly to hormonal differences between men and women that influence how the throat is constructed and how its supporting muscle system operates.

According to the National Sleep Foundation, men are “3 to 5 times as likely” to have sleep apnea as women. But doctors don’t diagnose sleep apnea in the same proportions. Actually, it’s been shown that doctors diagnose sleep apnea in men “8 to 10 times” more than they do with women.  This trend concentrates mostly around primary care physicians or general clinicians working on that front line of diagnosing women’s health issues.

What’s up with that? Is this healthy?

Excluding an entire sex from treating their affliction is dangerous. Accounting for almost 47% of U.S. workers, the loss of female productivity due to a protracted illness affects the economy nationwide. If 47% of our workforce isn’t treating an affliction that produces fatigue, heart problems, and diabetes, then we’re keeping our economy down.

Studies have shown that women shoulder 1.5-2 times of the domestic duties as men do. So, if the people performing these tasks are suffering from drowsiness due to their sleep apnea, they’re unable to help raise the next generation as effectively as they could be otherwise.

According to a cross-sectional NIH study investigating studies on sleep apnea noted that “patients with diagnosed but, untreated [sleep apnea], have higher medical costs compared to patients not receiving treatment.” This potentially adds an extra $34-69 billion in healthcare costs as a result of increased likelihood of vehicle collisions, work-related accidents, cancer, depression, stroke, hypertension, metabolic syndrome, coronary artery disease, arrhythmias, and heart failures.

Given how much sleep apnea can affect our lives and our economy, it’s important to correctly diagnose the 50.8% of our U.S. population. It’s smart. It’s healthy. It makes sense. But why does this underdiagnosis occur?

Clinicians’ Underdiagnosis Bias

Unequal diagnosis of sleep apnea between the sexes can be attributed to various different causes. We can blame the doctors, we can blame the patients, or we can blame the science. In this case, it seems to be all three.

From the outset, there seems to be a bias against women in sleep apnea diagnosis. This is both a cognitive bias as well as a gender one. Women complaining of irritability, headaches, difficulty concentrating, or daytime sleepiness are steered a different direction initially. So, a doctor could diagnose depression, hypertension, or even hypochondria before thinking of sleep apnea as the root cause of a female patient’s symptoms. There’s no intentional malice, but the normal decision tree a doctor follows is interrupted by this cognitive bias.

Patients’ Biases

There are also gender biases that are probably contributing to the problem. As an example, a woman might not want to mention her snoring to her doctor. This could be for reasons that are based in societal norms, like “it’s unladylike to snore.” The comfort level a woman has with her doctor is important as well for overcoming this mental block.

Additionally, if a woman’s partner observes her snoring but doesn’t tell her, then she’s missing an important tidbit of information. This keeps her from self-reporting her symptoms to the attending clinician. A romantic partner may do this because of the snorer’s self-concept of femininity. Again, there’s no real desire to conceal information, but simply socially constrained blind spots and politeness that maintain the current trend of underdiagnosis.

The Bias in Science

Women also present their sleep apnea symptoms differently than men do. On a fundamental basis, the symptoms are less specific than the male-centric ones. So, a female patient describing restless legs, depression, lack of energy, and sleepiness are not checking all the boxes a doctor needs to correctly diagnose for sleep apnea.

A further complication is that most studies have focused on male patients and the way they present their sleep apnea symptoms. This means clinicians first diagnosing a health issue don’t have the full picture of how an incoming patient presents her sleep-related disorder.

Fixing the Problem

There are a few things that need to be done to ensure female patients get the correct diagnosis. The first thing is to educate primary care doctors on the differences between the sexes. Increased awareness to their cognitive and gender biases is important. By the time patients come to an ENT specialist, they’re probably focused on the issue being related to breathing. So be informed is important. Women themselves need to get better educated about how dangerous snoring might be.

Quite simply, women should know that snoring is a primary indicator of a potential instance of sleep apnea. Not all snoring is sleep apnea, but all sleep apnea is snoring. Ask both for openness and honesty from women and their doctors. It’s simple. It may not necessarily be easy, but it’s important for the long-term well-being of everyone in our community.

Struggling with sleep apnea, snoring, or another sleep condition? We’ve got plenty of options for you. Take back your sleep (so you can live your life fully and healthily) by scheduling an appointment with Dr. Pasha and his team. Follow us on Facebook and Pinterest for more updates!

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