For three years, Vicki Maylan, a former National Health Service worker from Devon, was treated for bladder problems that she did not have, highlighting a lesser-known symptom of obstructive sleep apnoea (OSA). Shortly after menopause, the 66-year-old began waking up multiple times each night—sometimes as many as seven times—with an urgent need to use the bathroom, a condition her general practitioner diagnosed as nocturia. Despite medications aimed at treating bladder issues, her symptoms persisted, accompanied by exhaustion and morning headaches.

After referral to a urologist, tests revealed no bladder abnormalities. It was during a multidisciplinary review of her case that a doctor suggested her frequent nighttime urination might be linked to sleep, rather than a urinary condition. Specifically, nocturia can be a consequence of OSA, a disorder in which throat muscles excessively relax during sleep, causing repeated breathing interruptions and reducing oxygen supply to the brain. These apnoea events can disrupt sleep significantly and affect kidney function, leading to continued urine production throughout the night.

An overnight assessment of Maylan’s breathing and oxygen levels confirmed the diagnosis: she experienced nearly 70 apnoea episodes per hour. Following diagnosis by a respiratory consultant, she began treatment with a continuous positive airway pressure (CPAP) machine, which maintains airway openness by delivering air through a mask worn during sleep. Within a week, her nighttime awakenings decreased to just once, and she now reports regular uninterrupted sleep, reduced fatigue, and resolution of her morning headaches. Additionally, Maylan noted an improvement in previously high blood pressure, which normalized after treatment.

Experts believe many women remain undiagnosed with OSA, as symptoms in females often differ from those commonly seen in men. These include fatigue, mood changes, and disrupted sleep—symptoms frequently attributed to menopause rather than sleep disorders. According to Dr. Zoe Schaedel, a general practitioner specializing in sleep and menopause, up to 85 percent of women with sleep apnoea may be undiagnosed. Women’s risk for the condition approximately doubles following menopause, likely due to declining levels of hormones such as oestrogen and progesterone that help maintain airway muscle tone.

OSA prevalence has increased significantly in the UK, now affecting more than eight million people. Dr. Christopher Turnbull, a respiratory consultant and medical adviser for the Sleep Apnoea Trust Association, noted that typical OSA symptoms—loud snoring, disrupted sleep, and daytime sleepiness—are more commonly reported by men. Women, in contrast, often report generalized fatigue or headaches without the intense daytime sleepiness characteristic in men, making diagnosis more challenging.

Both experts emphasize the importance of raising awareness of OSA symptoms in women to improve detection. Dr. Schaedel advises that morning headaches, new or recurring nightmares, and fragmented sleep should prompt a conversation with a healthcare provider, as these can be indicative of undiagnosed sleep apnoea. Left untreated, OSA poses significant risks, including weight gain, high blood pressure, and increased chances of heart disease and stroke.