There is a particular type of fatigue that takes hold in midlife. It is the feeling of not being fully rested, even after a full night’s sleep. Energy levels may be low and concentration may be poor. There can be a sense of functioning, rather than performing at your best.

All too often, we put this down to busy calendars, hormonal changes or simply getting older. But sometimes the cause of poor sleep is more precise: it may lie in the upper airway.

WHILE YOU WERE SLEEPING  

When you fall asleep, the muscles of your upper airway relax and the tissues of the nose, palate, tongue and throat begin to crowd the airway. As air pushes through this narrowed space, it creates a vibration. That vibration is snoring.

While it tends to be treated more as an inconvenience to your partner than to you, it is actually a sign that your airway is restricted and your body is working harder than it should simply to breathe while you sleep.

However, when the narrowing becomes more pronounced, or the airway collapses during sleep, it becomes something more than snoring: obstructive sleep apnoea. This can happen dozens, even hundreds, of times throughout the night. Your breathing stops, oxygen levels drop and your brain wakes you just enough to restart breathing. Many people have no recollection of waking at all. What they notice, however, is that sleep no longer feels restorative.

BEYOND THE BEDROOM  

The impact of fragmented sleep creeps up on you. People often describe themselves as less sharp, less patient, less motivated or simply not quite themselves. It is not usually a dramatic shift. More often, it is a gradual erosion of energy and performance.

But sleep apnoea also has significant long-term health consequences. It is associated with high blood pressure, cardiovascular disease, stroke, diabetes, dementia, daytime sleepiness and impaired cognitive performance. These are meaningful long-term costs. The good news is that snoring and obstructive sleep apnoea can often be managed effectively.

THE SYMPTOMS NOBODY MENTIONS  

The textbook picture of sleep apnoea is loud snoring, pauses in breathing and daytime sleepiness. That is how it typically looks in men.

Women, however, particularly those in perimenopause or post-menopause, may present quite differently. Often, they do not snore at all. Instead, they may complain of lighter sleep, frequent waking, insomnia, headaches, low mood or the feeling
of never waking up fully refreshed.

Unfortunately, because these symptoms do not immediately raise the sleep apnoea flag for doctors – and that is why women may be dismissed.

The fact is, women can have significant sleep-disordered breathing without the stereotypical symptoms. Hormonal changes in menopause and perimenopause can also disrupt sleep at precisely the stage in life when sleep apnoea risk rises, which only adds to the complexity. If this sounds familiar, it is worth asking whether sleep apnoea could be at play.

HELPFUL STRATEGIES

In Cayman’s hot and humid environment, there is a tendency to crank up the air conditioning and set fans at their highest speed. However, air that is too dry, too cold, or directed at the face all night irritates the nose and throat and leaves the voice rougher than usual. So keep your indoor climate balanced –  the bedroom should be cool but not chilly – and avoid directing fans and air-conditioning at the face. As mould and dust mites in indoor environments can also irritate the airway, wash bedding regularly and use hypoallergenic pillows and mattress covers. It is also wise
to clean air conditioning filters regularly and, if allergies are a factor, consider an air purifier.

THE NEXT STEP  

Occasional snoring is not necessarily a cause for alarm, but if you:

• snore regularly, or someone has noticed pauses in your breathing or gasping for air during the night

• sleep lightly, or do not feel rested, regardless of how long you have slept

• suffer from fatigue that affects your mood, work, ability to exercise, focus or drive safely. It is important to seek medical advice.

An Ear, Nose and Throat (ENT) doctor who specialises in airway and sleep-disordered breathing can assess the issue properly, arrange appropriate testing and recommend treatment tailored to the cause.