A woman wakes with a persistent headache. Another reports exhaustion despite eight hours in bed. A third describes anxiety and depression that seem disconnected from her waking life. For decades, these symptoms would land in the offices of neurologists, psychiatrists, and gynaecologists. Few doctors would suspect the real culprit: sleep apnoea.
Sleep apnoea is often underdiagnosed in women because symptoms like fatigue, insomnia, morning headaches, and mood changes may be mistaken for stress, hormonal shifts, or other conditions. The gap between prevalence and diagnosis has created a silent crisis in healthcare, one rooted not in biology but in medical bias.
The symptom mismatch
Women with obstructive sleep apnea are more likely to report the symptoms of insomnia, depression, and morning headache. Women may also experience other symptoms like restless legs, nightmares, and heart palpitations. This presentation differs markedly from the male profile that dominates medical textbooks.Women with obstructive sleep apnea are less likely to report daytime sleepiness and snoring when compared to men.
The problem is structural.Historically thought of as a "male disease," women have been underrepresented in clinical trials addressing OSA. This means the screening tools themselves, built on male data, fail women.Only BMI, neck circumference, and a high Epworth Sleepiness Score were independently predictive of moderate to severe OSA in men, whereas age, neck circumference, and morning headache were independently predictive in women. Yet many clinicians continue using male-centric metrics.
The cost of missed diagnosis
The consequences extend far beyond a poor night's sleep.Women with OSA experience higher rates of functional impairment at work, disability, adverse cardiovascular events, and sick leave compared to those without OSA. Recent research quantifies this toll:women showing markedly lower employment rates (54.7% vs. 70.4% in controls) compared to men with OSA (74.5% vs. 78.7% in controls), higher rates of disability pension (20.6% vs. 11.1%), and greater case-control net cost differences increasing from €8259 to €13,730 per year for women versus €4217 to €8749 per year for men.
Part of this burden stems from diagnostic delay.Women with OSA face longer diagnostic delays than men. When diagnosis finally arrives, it often follows years of fragmented care, with women treated for depression, insomnia, or thyroid disease while the root cause goes unaddressed.
Why awareness matters more than technology
Some readers may expect this story to pivot toward new technology. Artificial intelligence and wearable devices are indeed emerging as diagnostic aids. But the immediate fix is simpler and more human:scoring and reporting RERAs may provide additional information, particularly in women and non-obese and is therefore recommended in the Australasian commentary.
Australian sleep medicine is responding. Guidelines from the Australasian Sleep Association now explicitly acknowledge gender-specific presentation. TheSTOPBANG and OSA50 are industry-standard questionnaires for screening for obstructive sleep apnea with the latter developed specifically in an Australian primary care population.
Still, awareness among frontline GPs remains patchy. A patient presenting with insomnia and low mood may never be asked about witnessed apnoeas, neck circumference, or morning headaches. The screening happens; the questions simply miss.
A pragmatic path forward
This is a case where knowledge already exists but practice lags. No regulatory reform is needed. No expensive new infrastructure. What is required is a straightforward shift in clinical habits: when a woman presents with fatigue, depression, or sleep disturbance, ask the questions that work for women. Check for morning headaches. Ask whether she experiences witnessed apnoeas. Measure neck circumference.
The condition itself remains unchanged. The biology is fixed. What is changing is our ability to see it clearly, which demands that clinicians look where the disease actually hides rather than where they have always looked. For Australian women living with undiagnosed sleep apnoea, this shift from assumption to evidence-based, sex-specific inquiry could mean the difference between decades of treatable illness misnamed as something else, and early intervention that restores both sleep and livelihood.