For three years, Vicki Maylan received treatment for bladder problems that were not actually the cause of her symptoms.
The former NHS worker, then aged 66, began experiencing an unusual problem shortly after menopause. Once a sound sleeper, she suddenly started waking to urinate—sometimes as many as seven times each night.
‘It completely disrupted my life,’ says Vicki, from Devon. ‘I woke up exhausted and had a headache every morning. My GP diagnosed nocturia—the need to pass urine repeatedly during the night—but couldn’t explain why it had started.’
The medicines prescribed to ease the problem made no difference. Instead, they left her dealing with severe daytime side-effects, including nausea and splitting headaches.
After three years, Vicki was referred to a urologist and underwent several tests. The results were normal. While her case was later reviewed by a multidisciplinary medical team, one doctor suggested that the problem might not be her bladder at all—it could be linked to her sleep.
The doctor explained that nocturia can be associated with obstructive sleep apnoea (OSA). This condition develops when the throat muscles relax excessively during sleep, briefly blocking the airway and depriving the brain of oxygen for several seconds at a time.
People may be unaware that these repeated breathing pauses are happening, but they force the body into a state of alertness and severely fragment sleep. OSA can also affect the kidneys, which normally reduce urine production during sleep, causing them to continue making urine throughout the night.
Vicki Maylan, once a relatively sound sleeper, began waking to use the loo as many as seven times a night
Repeated breathing pauses keep the body alert and may affect the kidneys, prompting them to produce urine throughout the night
Vicki’s breathing and blood oxygen levels were monitored overnight. The findings were striking: she was experiencing almost 70 apnoea episodes every hour.
A respiratory consultant confirmed the diagnosis and prescribed continuous positive airway pressure, or CPAP. The treatment uses a machine to deliver air through a mask over the nose and mouth, keeping the airway open while the patient sleeps.
Within just a week, Vicki was getting up only once a night to use the loo. She now regularly sleeps through until morning without needing to get up.
‘The machine has been incredible,’ she says. ‘I finally wake up feeling refreshed, and my headaches and fatigue have improved significantly. I had also been struggling with high blood pressure, but that has fallen considerably. I only wish the condition had been diagnosed earlier.’
Experts believe tens of thousands of women could be living with undiagnosed obstructive sleep apnoea. Without treatment, OSA can contribute to long-term health problems, including weight gain, high blood pressure and a greater risk of heart disease and stroke.
Women are less likely to have the condition identified, partly because of the widespread belief that OSA mainly affects men. Symptoms such as tiredness, broken sleep and changes in mood can also be mistaken for typical effects of menopause.
Dr Zoe Schaedel, a Brighton GP specialising in sleep and menopause, said: ‘Research indicates that women are less likely to have their symptoms recognised during the routine assessments GPs use when deciding whether to refer patients for further testing.
Vicki began continuous positive airway pressure (CPAP) treatment, which uses a mask to deliver air and keep the airway open during sleep
‘Women often experience symptoms that are less familiar than those seen in men, meaning they may not meet the usual referral criteria. Some recent studies suggest that up to 85 per cent of women with sleep apnoea remain undiagnosed. It is a significant problem.’
An estimated eight million people in Britain have OSA, with the number thought to have increased almost sixfold since 2000.
Research suggests that a woman’s risk of developing OSA approximately doubles after menopause. This is linked to the sharp decline in oestrogen and progesterone, hormones that help support the upper airway and maintain muscle tone.
However, many cases continue to go unnoticed because women’s symptoms can differ from those typically associated with men, says Dr Christopher Turnbull, a respiratory consultant and medical adviser to the Sleep Apnoea Trust Association.
‘The classic symptoms include extremely loud snoring, sometimes audible through a closed door, broken sleep and marked daytime sleepiness—falling asleep unintentionally despite spending enough hours in bed,’ he says.
‘Men are more likely to report these symptoms. Women, by contrast, often describe ordinary daytime tiredness or fatigue rather than an uncontrollable urge to sleep. Headaches and mood changes are also more common.’
Dr Schaedel says: ‘When a woman describes feeling tired but does not say she is falling asleep during the day, that alone can make a GP less likely to consider a referral.’
Research indicates that women’s risk of obstructive sleep apnoea roughly doubles after menopause as oestrogen and progesterone levels fall
Dr Turnbull adds: ‘Many of the most common signs of OSA—including daytime sleepiness, disrupted sleep and waking during the night—overlap with symptoms of menopause.’
There are, however, warning signs of obstructive sleep apnoea that should be discussed with a GP.
‘Morning headaches should always be investigated, particularly because they are reported more often by women,’ says Dr Schaedel.
‘New nightmares after years without them, along with generally fragmented sleep, should also raise concerns.’
