Are you a woman with obstructive sleep apnea (OSA) who has noticed an increase in joint pain? According to a recent study out of Japan, OSA and exacerbated joint pain are linked in postmenopausal women (1). The right diagnosis is essential for informed testing and treatment, and it is crucial that a comprehensive approach be taken when addressing sleep disorders and their side effects.
It is worth noting that this kind of experience, women carrying unexplained symptoms for years before anyone connects the dots, is far more common than most people realize. Stacy London, best known as the co-host of TLC’s long-running show What Not to Wear and now the founder and CEO of State of Menopause, spent years misidentifying her own perimenopause symptoms.
In a 2022 interview with Katie Couric Media, London described experiencing joint pain, muscle fatigue, rashes, and insomnia — none of which her doctors ever linked to hormonal changes. She told the outlet: “In 2018, my father passed away, and while he was sick, I started to feel these pains that he was constantly feeling — rashes, joint pain, muscle fatigue, newly developed rosacea, eczema.” (2) She assumed it was grief. It was perimenopause. London’s story is a textbook illustration of why this study matters: joint pain in postmenopausal women is a clinical clue that is being widely missed.
Why OSA Is Often Missed in Women With Fatigue and Pain
According to the lead researcher, “Women complaining about their joint pains could be good candidates for a sleep-study to investigate if they have OSAS or not, especially when they are also suffering from fatigue.” (1)
Sleep disorders, particularly sleep apnea like OSA (also known as OSAS for obstructive sleep apnea syndrome), are notoriously under and misdiagnosed. Although millions of people around the globe have received the right diagnosis for OSA, experts estimate that many more, perhaps millions more, remain without the right diagnosis (3). There are a myriad of negative complications when OSA is not treated, including an increased risk of heart attack, stroke, and diabetes (4). However, the research from Japan focuses on joint pain and fatigue, particularly in postmenopausal women.
This pattern of missed diagnoses in women has been documented far beyond the sleep medicine world. Oprah Winfrey, one of the most resourced and well-connected people on the planet, revealed in a panel conversation on OprahDaily.com in April 2023 that she had seen five different doctors about heart palpitations she began experiencing at 48, Not one of them told her it could be menopause. She states, “I went from doctor to doctor, literally five different doctors. At one point, a female doctor had given me, first of all, an angiogram and put me on heart medication and never once mentioned that this could be menopause or perimenopause,” she said (5). If five doctors missed the connection between Oprah’s heart palpitations and menopause, it is no stretch to understand why joint pain and fatigue, symptoms that feel even more vague, go uninvestigated as possible signs of OSA for years.
The Onset of OSA
OSA is the most common kind of sleep apnea and occurs when the airways become blocked during asleep. According to researchers, sleep apnea occurrences increase when women go through menopause. In fact, the prevalence is 4.5 times higher in this demographic compared to premenopausal women (6). Regardless of OSA, joint pain is also more common after menopause. Researchers suggest that both OSA and joint pain may be triggered by declining estrogen levels.
This 4.5-times increase is not a minor statistical footnote. It represents a dramatic shift in risk that many women and their doctors are not aware of. A large-scale study in 2018, tracking over 100,000 women across the Nurses’ Health Study, confirmed that surgical menopause in particular, such as following a hysterectomy or oophorectomy, is independently associated with a significantly higher risk of developing OSA (7). The researchers noted that the abrupt hormonal changes that accompany surgical menopause appear to play a direct role in destabilizing the upper airway during sleep. For women who have had these procedures, this is a critical piece of information that deserves to be part of every post-surgical conversation with their doctor.
How Sleep Studies Measure OSA Severity and Symptoms
The team of researchers analyzed the links between OSA and a variety of symptoms in 51 postmenopausal women who were diagnosed with “treatment-resistant sleep disorders.” This included seven with a current OSA diagnosis. During an overnight sleep study, the respiratory disturbance index (RDI), which counts the number of “abnormal” sleep events in each hour, as well as transcutaneous oxygen saturation, were recorded (1).
According to researchers, there was a “significant association” between higher RDI, which is connected to more severe OSA, and joint pain. The participants also completed a Questionnaire for Assessment of Climacteric Syndrome in Japanese Women (1).
What This Means for OSA Patients
The results align with a 2020 study from the same team that connects muscle and joint pain with insomnia in “middle-aged women.” (8) The lead researcher said “it may not be very surprising that OSAS was shown to be associated with joint pains in another group of women.”
However, “This study highlights an opportunity to increase identification of women with OSA, which is underdiagnosed in women who often present with vague symptoms such as insomnia, fatigue, and morning headaches.” (9) Ultimately, the researchers hope that the symptom of joint pain might be an added consideration when diagnosing OSA in women.
Think about how often women on television and in film who are dealing with fatigue, pain, and sleep trouble are portrayed as anxious, dramatic, or simply worn down by life.
From the overworked mothers in prime-time dramas to the perpetually exhausted characters in comedies, these portrayals rarely end with a sleep study. They end with a glass of wine or a deep breath. Real life deserves better than that narrative. The research coming out of Japan and elsewhere is building a case that what looks like lifestyle exhaustion may be something far more physiological and far more treatable.
Stacy London put it plainly in a Best Life interview: “There are 34 common symptoms of menopause that the FDA is ignoring” — a list that includes headaches, fatigue, joint pain, and trouble sleeping. “That’s enough to make somebody feel unhinged,” she said (10). When the FDA’s own framework for menopause omits most of the symptoms women are actually experiencing, it should come as no surprise that the link between those symptoms and a sleep disorder like OSA goes uninvestigated.
Challenges in Diagnosing Obstructive Sleep Apnea Globally
OSA remains a vastly under-diagnosed sleep disorder around the globe. It can be difficult for many people to obtain a correct diagnosis, particularly when symptoms can vary person to person. Additionally, many GPs are not equipped with the training and latest information to diagnose a sleep disorder or refer a person to a sleep specialist.
At The Insomnia and Sleep Institute, no referral is necessary to book a consultation with a sleep specialist. OSA is one of the most common sleep disorders around the world and it can present at any time.
Changes, such as hormone or weight fluctuations, can certainly be the onset of the disorder. OSA can also be difficult to suspect since the most obvious symptoms, snoring or stopped breathing while asleep, typically must be reported by a partner. However, if you think you have OSA or are not getting the quality of sleep you need, help is available.
Expert Sleep Care for OSA in Phoenix, Scottsdale, and Gilbert
The Insomnia and Sleep Institute of Arizona takes a holistic approach to sleep medicine, which is why we have unprecedented staffing levels at our outcome-driven clinic.
We are proud to serve as the Face of Sleep Medicine in Arizona, and are led by Dr. Ruchir P. Patel, triple-board certified and currently the Physician Director elected Board President of the Maricopa County Medical Society. Contact The Insomnia and Sleep Institute today to schedule your consultation. Call the office, or for the quickest response complete the online form.
References
- Odai T;Terauchi M;Umeki H;Miyasaka N;Somekawa Y. (2022). Sleep apnea in postmenopausal women is associated with joint pain severity and fatigability: a cross-sectional study. Menopause (New York, N.Y.), 29(6). https://doi.org/10.1097/GME.0000000000001974
- Nelson, E. L. (2022, April 11). Stacy London Thought She Had Alzheimer’s—This Is What It Really Was. Best Life. https://bestlifeonline.com/stacy-london-menopause-news/
- Faria, A., Allen, A. H., Fox, N., Najib Ayas, & Laher, I. (2021). The public health burden of obstructive sleep apnea. Sleep Science, 14(3), 257. https://doi.org/10.5935/1984-0063.20200111
- Girardin Jean-Louis, Zizi, F., Clark, L. T., Brown, C. D, & McFarlane, S. I. (2008). Obstructive Sleep Apnea and Cardiovascular Disease: Role of the Metabolic Syndrome and Its Components. Journal of Clinical Sleep Medicine : JCSM : Official Publication of the American Academy of Sleep Medicine, 4(3), 261. https://pmc.ncbi.nlm.nih.gov/articles/PMC2546461/
- Vivinetto, G. (2023, April 5). Oprah Details First Menopause Symptom, Which Affected Her Heart. TODAY.Com; TODAY. https://www.today.com/health/womens-health/oprah-winfrey-menopause-symptom-heart-health-rcna78365
- Odai, T., Terauchi, M., Umeki, H., Miyasaka, N., & Somekawa, Y. (2022). Sleep apnea in postmenopausal women is associated with joint pain severity and fatigability: a cross-sectional study. Menopause, 29(6), 680–686. https://doi.org/10.1097/gme.0000000000001974
- Huang, T., Lin, B. M., Redline, S., Curhan, G. C., Hu, F. B., & Tworoger, S. S. (2018). Type of Menopause, Age at Menopause, and Risk of Developing Obstructive Sleep Apnea in Postmenopausal Women. American Journal of Epidemiology, 187(7), 1370–1379. https://doi.org/10.1093/aje/kwy011
- Terauchi, M., Odai, T., Hirose, A., Kato, K., Akiyoshi, M., & Miyasaka, N. (2018). Muscle and joint pains in middle-aged women are associated with insomnia and low grip strength: a cross-sectional study. Journal of Psychosomatic Obstetrics & Gynecology, 41(1), 15–21. https://doi.org/10.1080/0167482x.2018.1530211
- Staff, S. R. (2022, March 3). Study: Joint Pain and Sleep Apnea | Sleep Review. Sleep Review. https://sleepreviewmag.com/sleep-health/demographics/sleep-apnea-may-lead-to-joint-pain-in-postmenopausal-women/
- Nelson, E. L. (2022, August 20). Stacy London Says She’s Fighting Back Against This Health “Crisis” in Exclusive Interview. Best Life. https://bestlifeonline.com/stacy-london-menopause-exclusive-interview-news/
Disclaimer: The information provided in this blog post is for educational and informational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always consult with a licensed healthcare provider for recommendations specific to your individual health needs.
