Snoring is a common problem among Australians. It translates into long-term and devastating consequences. Many factors dictate the prevalence of snoring in a population.  These include:

• Age
• Gender
• Race
• Genetics
• BMI
• Medical conditions

Since discrepancies are also based on gender, it is obvious that trend varies among males and females. This article will discuss, what causes snoring in females, in detail.

Are Females Less Susceptible to Snoring?

Fortunately, Yes.

Women are less susceptible to snoring than men.

The research shows that only 18% of females suffer from snoring as compared to 81% of male patients. This is due to various reasons:

• Women have lesser fat distribution in the neck region
• Smoking is a risk factor and is more common in men as compared to women
• Men have abdominal obesity which aggravates the risk of mouth breathing and snoring

This difference, however huge, does not mean females always sleep peacefully. Saying this would be turning blind eye to many Australian women who face sleep disturbances. For effective management of snoring, it is imperative to know the causes involved in this condition. The common causes are enlisted below:

#1 Women Are Prone to Sleep Disorders

Women often suffer from sleep-related disturbances.

• Obstructive sleep apnea

Obstructive sleep apnea is a deficiency of oxygen due to the hindrance of airway. This also causes the production of vibration when the air hits this resistance, leading to snoring.

Structurally, the airway in women is smaller in diameter as compared to men.

Anatomical Features of Women

• Spacious and lower nasal floors
• High large airway to small airway ratio
• Small neck circumference
• Small size of pharynx

 Considering this, logically, the incidence of obstructive sleep apnea should be more in women. But the reality is different; many other factors also play a role. It also shows that women may have some protective mechanism against this obstruction.

Historically, obstructive sleep apnea is a disease of men. Some experts think it is a careless over-generalization. In recent decades, sufficient evidence has emerged that ensures women are also prone to obstructive sleep apnea. The exaggeration is due to differences in menifestation of disease. Clinically, many women who suffer from obstructive sleep apnea have different symptoms than men.

However, even if you minus the exaggeration claim, the susceptibility of sleep apnea is lower in women. The severity levels also differ and women often have a lesser AHI score. A comparison of the prevalence of obstructive sleep apnea in population according to severity is given below:

	Mild Sleep Apnea	Moderate to Severe Sleep apnea
Males	24%	9%
Females	9%	4%

These gender discrepancies, although statistically significant, do not change the fact that the quality of life is affected in women by this sleep problem. In Australia, thousands of women often end up fatigued sue to poor sleep. This puts a huge strain on the efficiency of the workforce.

To improve snoring, the health resources and efforts need to be allocated to correctly diagnosing and effectively treating obstructive sleep apnea.

• Upper airway resistance syndrome

Upper airway resistance syndrome is also a common cause of snoring. Unlike obstructive sleep apnea, this disease is found mostly in women. According to an estimate, 56% of women suffer from the upper respiratory syndrome. The anatomical structure of the airway in women supports the incidence of this problem.

If you consider the anatomical characteristics mentioned above, women have high hard palates. They also have thick mucosa of the soft palate. These features cause upper airway resistance syndrome in women and lead to snoring.

Upper airway resistance syndrome, apart from snoring, causes other serious problems. It reduces oxygen saturation levels, oxygen exchange, and consequently, airway space in women. So, the snoring becomes the least of your worries. However, it is the first symptom to appear.

Snoring is the first symptom of Upper Airway Resistance Syndrome (UARS)

The sneaky onset of upper respiratory resistance attributes to a relative lack of wakefulness in this disease. In obstructive sleep apnea, women experience wakeful events frequently (although significantly lesser than men). However, in upper respiratory syndrome, such events are even less prevalent. The apnea-hypopnea indicator (AHI), used to measure the severity of obstructive sleep apnea and other sleep problems, stays less than 5.

In contrast, the clinical condition of women deteriorates quickly and they end up becoming chronic insomniacs. So, a better indicator to measure the severity of upper respiratory resistance syndrome includes other sleep changes as well.

The parameter that records wakeful sessions in upper respiratory resistance syndrome is respiratory event-related arousal (RARS). Respiratory event-related arousal means waking up as a result of difficult breathing or respiratory effort.

The official criteria used to diagnose upper respiratory resistance syndrome is as follows:

Major Criteria	– Excessive day time sleepiness – AHI less than 5 – RERA greater than 2   *RERA is respiratory-event related arousal
Minor Criteria	– Snoring – Increase in intensity of snoring -Snoring before EEG arousal – Clinical response to CPAP therapy

Some of these parameters can only be measured clinically. However, snoring and increase in its occurrence is largely dependent on your perception.

So, you also need to keep an eye on your sudden onset of snoring. It mostly starts with benign and mild snoring once in a while (primary snoring). Gradually, it becomes a habit and, before you know, your respiratory effort becomes so compromised.

• Hypoventilation syndrome

This disease is common in obese individuals, particularly women.

The hypoventilation syndrome is a consequence of persistent sleep apnea due to either of the two above mentioned sleep problems. The long-term deficiency of oxygen in your body resets your body’s thermostat to abnormal levels of respiratory gases. The carbon dioxide is more (hypercapnia) and oxygen is low (hypoxia). This increases the respiratory effort and aggravates mouth breathing, which is a major risk factor for snoring.

#2 Pregnancy Brings Physiological Changes in Women Bodies

The risk of snoring triples during pregnancy. It is associated with adverse obstetrical outcomes and maternal health.

 The research shows that the risk of snoring increases from 4% in the first trimester to 14% in the third trimester.

Snoring increases from 4% to 14% until the end of pregnancy

Some studies describe that it goes up to 37% during the last months for pregnancy. This significant rise in the incidence of snoring is attributed to physiological changes that women go through during the course of pregnancy.

• Pregnancy causes edema in the body

Have you noticed swelling of legs and feet during pregnancy? This becomes worse with advancing gestation. It is due to leakage of fluid from your blood into the tissues of your body. So, edema is just a fancy term for swelling due to estrogen. However, the tricky part is that this edema is not limited to your legs only. It also affects your airway. Soft palate and mucosa in your air tract narrow due to edema. The airway becomes congested and offers greater resistance to air while passing through the air tract. This leads to snoring, which worsens with an increase in gestation. Those women who experience frequent edema during pregnancy are more prone to snoring.

• Pregnancy affects respiratory effort

The respiratory effort is impacted due to two reasons.

The uterus increases in size in pregnancy to allow the growth of the baby.

The uterus nudges away many organs in its vicinity, including the diaphragm. The diaphragm is a major muscle responsible for respiration. Pressure by the uterus declines the expansion of the lungs and reduces the ventilation capacity. This creates a false impression of oxygen deficiency and you start breathing from mouth. Mouth breathing leads to snoring and aggravates with the onset of each trimester.

Secondly, body mass index changes in pregnancy due to weight gain. When women gain weight, the fat distribution around the neck increases. Neck circumference increases and causes narrowing of the airway.

Coupled with edema of pharyngeal tissues and elevation of the diaphragm, pregnancy takes a serious toll on respiration. This leads to immense aggravation in sleep-related troubles.

Comparison of Habitual Snorers Vs. Snorers During Pregnancy

• Those who snore before pregnancy have their bodies adapted to mouth breathing. Therefore, the impact of advancing gestation on snoring is less marked. Contrary to this, those women who experience the onset of snoring during pregnancy face severe snoring.
• Those who are habitual snorers face fewer symptoms of fatigue and tiredness due to sleep disturbances. In contrast, women with onset of snoring in pregnancy report lethargy, fatigue, and tiredness more frequently.
• The Epworth Sleepiness score is higher for pregnant snorers without snoring habits before the pregnancy. This means that excessive daytime sleepiness is more marked in women who develop snoring after conceiving.

#3 Menopause Increases the Risk of Obstructive Sleep Apnea

The sex differences between the occurrences of obstructive sleep apnea diminish with menopause. Once the ovarian aging happens, the estrogen and progesterone levels in your body decline.

Some experts speculate that this sharp decrease might reduce the protective effect offered by sec hormones in women, against obstructive sleep apnea. This could explain the occurrence of obstructive sleep apnea and snoring in 47% to 67% of postmenopausal women. However, the role and underlying mechanism is still unclear and needs more research.

Apart from this, age is also a relevant factor regarding what causes snoring in women. The average menopausal age in Australian women is 45 to 50 years. Many experts speculate that a sharp rise in sleep disturbances and snoring after menopause may be related to the increase in age. This claim is also corroborated by the fact that even in the perimenopausal state (when women are transitioning into menopause), women often experience snoring and insomnia. At that time, their hormonal levels are sufficient but advancing age impacts sleep troubles.

Moreover, the research also confirms age being a strong risk factor for snoring in females.

#4 Sleep Disorders Are Often Underdiagnosed

One major issue in females is the lack of accurate diagnosis among females.

• Due to Different clinical picture

Obstructive sleep apnea has varying symptoms. In men, they are closer to clinical picture documented in textbooks. In women, however, they are slightly unusual. Some of the symptoms common among women with obstructive sleep apnea are:

• Anxiety
• Daytime sleepiness
• Depression
• Morning headache
• Insomnia
• Night terrors

Due to these obscure symptoms, it is often difficult for physicians to pinpoint the disease. Hence, snoring becomes impossible to treat.

• Due to Socio-cultural reasons

The socio-cultural factors also play an important role in the lack of correct diagnosis in women. Many women hesitate in seeking help because of denial. Snoring is considered “not ladylike” and has a stigma attached to it. So, you may experience the feeling of guilt and shame but you need to understand such emotions can be harmful in the long-run. Overpowering them is the first step in the correct diagnosis and treatment of snoring.

Many women often do not visit sleep clinics with their partners while seeking treatment. This also affects the treatment course because the presence and severity of snoring are often reported accurately by your partner.

These two factors immensely hinder the process of establishing a true picture of the prevalence of snoring among women. 

The Final Verdict

Although snoring is less frequent in women as compared to men, it still has a major impact on their lives. Due to underreporting, correct data collection remains a huge problem in dealing with snoring on the individual as well as collective level. Australia has been affected by is immensely. However, extensive research is available on what causes snoring in females and some of them are discussed above.

The anatomical variations and hormones offer significant protection from snoring in women but their effects become futile with advancing age. Menopause adds fuel to the fire and aggravates the risk even further. In the case of pregnancy, snoring becomes prominent in later trimesters and presents with edema. This alteration is also attributed to hormonal and bodily changes in pregnancy.

However, it is worrying because, if not treated, snoring can lead to pregnancy-induced hypertension and preterm birth. The healthier approach is to be vigilant about snoring and relieving it before it leads to serious respiratory and other health problems.