The Hidden Link Between Sleep Apnea and Mental Health: Why Older Women Are at Risk

A critical yet frequently overlooked factor contributing to anxiety, depression, and burnout surfaced in an interview with The American Journal of Managed Care^®: undiagnosed sleep disorders. Martin Hopp, MD, PhD, an otolaryngologist and sleep specialist at Cedars-Sinai Medical Center and medical director of Daybreak, explained that patients often fall into a vicious cycle where anxiety disrupts sleep and sleep deprivation, in turn, amplifies anxiety.

A primary obstacle to diagnosis is that individuals who sleep alone often have no idea they are suffering from obstructive sleep apnea (OSA). Without a partner to report heavy snoring, gasping, or paused breathing during the night, patients remain unaware of the root cause of their daytime fatigue and mood shifts.

Kate Willis, vice president of government and provider strategy at Daybreak, emphasized that these symptoms are especially prone to being missed in women. "Stereotypically, you think of OSA symptoms associated with middle-aged men," Willis noted, adding that women often do not exhibit typical loud snoring. Furthermore, Willis pointed out that prolonged health care wait times—often stretching from 3 to 6 months for a specialist evaluation—leave many patients struggling with untreated mental health symptoms that could be alleviated by a timely OSA diagnosis.

Hopp elaborated on the biological differences, explaining that estrogen provides younger women with a natural defense against sleep apnea. However, during perimenopause and menopause, estrogen levels drop, leading to the late-onset development of OSA. Compounding the issue, women are statistically more likely to sleep alone as they age. Consequently, they experience a sudden decline in brain oxygenation and sleep quality without realizing it, mistakenly attributing their depression and altered moods entirely to the aging process. Hopp and Willis urged health care providers to screen for sleep disorders when treating mental health, particularly in menopausal women.