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Three women wrote to me this week, and I did not spot what their letters shared until the third one.
FROM THE INBOX
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His snoring has sent me to the spare room twice this month. I am the one lying awake, so why do I feel like the difficult one?
Denise, 54
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I wake at 2am drenched. My doctor said menopause, and that was the end of the conversation. Two years of sweating through sheets.
Karen, 51
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Up three times a night for the bathroom. I stopped drinking anything after six and it changed nothing.
Yvonne, 58
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The timing is not a coincidence. Sleep apnea in women has been all over the health press this month, and every piece says the same thing: hardly anyone looks.
The pharmacy has an answer ready for each of them. Chin straps, nose strips, anti-snore pillows, cooling pyjamas, bladder tablets. Not one of those products asks the question a sleep physician would ask first.
All three of these women may be describing the same condition. Nine out of ten women who have it are never told.
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None of this is a willpower problem. Every one of these letters has a mechanism behind it.
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WHAT THE THREE LETTERS HAVE IN COMMON
Obstructive sleep apnea is the throat narrowing during sleep until air stops moving, and the brain jolting the body awake to restart it. In men it announces itself with loud snoring. Women tend to get something quieter: insomnia, morning headaches, flat mood, restless legs, exhaustion that sleep does not touch.
Every one of those has a tidier explanation nearby, and after fifty the tidy explanation is hormones.
Yvonne's bathroom trips have a mechanism too, and it is the one that surprised me most. Each time breathing stops, the pressure inside your chest swings hard, the heart chamber stretches, and that stretch releases a hormone instructing your kidneys to make more urine. The bladder is not the problem. Her airway is.
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THE EVIDENCE
Close to one in five American women meet the threshold for obstructive sleep apnea, and roughly nine in ten of them are never diagnosed. Andrea Matsumura, a sleep physician specialising in menopause, said in 2026 that women present with subtler symptoms that get attributed to hormonal change rather than investigated properly.
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Risk climbs after menopause, exactly when every symptom has somewhere else to be filed.
WHAT TO DO WITH THIS
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Record the room while you sleep.
Any free voice recorder, phone face down on the nightstand, one full night. Listen for the gaps rather than the noise: snoring that stops, silence, then a gasp. A recording is harder to wave away than a description.
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Ask for a home sleep apnea test by name.
Say that you wake unrefreshed, that you want obstructive sleep apnea ruled out, and that a home study would suit you. Those tests are routine now. Put the word apnea in the room yourself, because it may not arrive any other way.
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Stay off your back until you know more.
For many people the airway gives way when lying face up, so turning onto a side cuts the events. A tennis ball sewn into the back of a sleep shirt still works. This buys you nights. It does not replace a test.
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And one more thing...
One symptom on that list gets waved off more than the rest. Restless legs, the crawling itch that has you kicking the sheets loose, shows up again and again in women reporting broken nights. There is a mineral story behind it: your brain needs iron to make dopamine, and the legs get loud when stores run low. Ferritin is the number that matters, not the standard iron panel. Plenty of women sit inside the normal range on paper while their ferritin is on the floor.
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QUICK QUESTION
Has anyone ever tested your breathing while you sleep?
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