Perimenopause vs. Sleep Apnea: How to Tell the Symptoms Apart

When Your Sleep Stops Working

You are getting to bed at a reasonable hour, but you wake up exhausted. You might be sweating in the night, lying awake at 3 a.m., or simply never feeling restored no matter how many hours you log. If you are a woman in your 40s or early 50s, perimenopause is often the first explanation that comes to mind. But there is another common condition that produces almost identical symptoms and is significantly underdiagnosed in women: obstructive sleep apnea.

Separating the two matters because they have different treatments, and leaving sleep apnea unaddressed carries real health risks beyond poor sleep.

What Perimenopause Does to Sleep

Perimenopause disrupts sleep in several interconnected ways. Declining progesterone has a direct effect on sleep architecture. Progesterone has mild sedative properties and promotes slow-wave deep sleep. As it falls, sleep becomes lighter and more fragmented even without hot flashes.

Night sweats and hot flashes are the most obvious culprits. A thermal surge can wake you completely, leaving you damp, restless, and unable to get back to sleep for an hour or more. These episodes may happen once a night or several times. Even when women do not recall waking, temperature fluctuations still fragment sleep at a physiological level.

Estrogen fluctuations also affect mood regulation and the stress response, increasing nighttime anxiety and racing thoughts that make it harder to fall or stay asleep. The result is that many perimenopausal women experience light, unrefreshing sleep, frequent waking, difficulty falling back asleep after waking, and daytime exhaustion.

What Sleep Apnea Looks Like in Women

Obstructive sleep apnea happens when the airway partially or fully collapses during sleep, interrupting breathing repeatedly throughout the night. The brain briefly arouses you to restore airflow, then you fall back asleep, often without remembering it. Over a night this can happen dozens or hundreds of times, shredding sleep quality without you being aware.

Sleep apnea in women often presents differently than in men, which is one reason it has historically been missed. While men with sleep apnea often present with loud snoring and witnessed breathing pauses, women more commonly report insomnia, fatigue, headaches, mood disturbances, and unrefreshing sleep. These are almost identical to the sleep symptoms of perimenopause, which is why the two conditions are so often confused.

Estrogen and progesterone have protective effects on upper airway muscle tone. As these hormones decline during perimenopause, the risk of developing sleep apnea increases significantly. Research suggests the prevalence of sleep apnea roughly triples after menopause compared to premenopausal women of similar age and weight. This means perimenopause and sleep apnea frequently coexist, making it genuinely difficult to sort out which is responsible for your poor sleep.

Comparing the Symptom Patterns

Some symptom features can help point toward one condition over the other, though they are not definitive.

Perimenopause-related sleep disruption tends to correlate with hot flashes or night sweats. If you can identify a thermal event that is waking you, that points toward perimenopause. The sleep disruption often varies with your menstrual cycle, being worst in the days before your period when progesterone drops sharply.

Sleep apnea tends to produce a particular type of daytime exhaustion. You may feel overwhelmingly sleepy during the day, struggle to stay awake while reading or watching television, and have difficulty with attention and memory. Morning headaches are common with sleep apnea and less typical with perimenopause alone. Your bed partner may notice snoring, gasping, or breathing pauses, though as noted above, not all women with sleep apnea present with obvious snoring.

If you wake gasping or feeling as though you could not breathe, or if your exhaustion is severe and accompanied by falling asleep at inappropriate times, sleep apnea moves up the list of likely explanations.

Risk Factors and Who Is Most Likely to Have Each

Perimenopause affects all women who still have ovaries and have not yet reached menopause, typically beginning in the early to mid-40s. The severity of sleep disruption varies widely. Smoking, higher stress, and poor sleep hygiene can amplify perimenopause sleep symptoms.

Sleep apnea is more common with increasing age, weight gain around the neck and trunk, anatomical factors affecting the airway, and declining sex hormones. Weight gain is common during perimenopause, which independently raises sleep apnea risk. Women who have had pre-eclampsia during pregnancy also have higher rates of sleep apnea. If you have a BMI above 30, snore even occasionally, or have been told you stop breathing in your sleep, the probability of sleep apnea is meaningfully higher.

How Each Is Diagnosed

Perimenopause is typically assessed through symptom history and menstrual pattern changes. Blood tests for FSH can support the picture but are not definitive given normal hormonal fluctuation. Your doctor should take a full symptom history and consider your overall clinical picture.

Sleep apnea is diagnosed with a sleep study, either in a lab or at home with a portable monitoring device. A home sleep apnea test is now widely available and can detect most cases of obstructive sleep apnea. If your doctor suspects sleep apnea based on your symptoms and risk factors, requesting a sleep study is straightforward. There is no blood test for sleep apnea.

If your doctor attributes all your sleep problems to perimenopause without considering sleep apnea, it is reasonable to ask specifically about a sleep study, particularly if you have any of the risk factors described above.

Tracking Sleep Patterns to Build Your Case

Keeping a consistent record of your sleep quality, daytime energy, and accompanying symptoms gives you and your doctor real data to work with rather than a vague impression of feeling terrible.

PeriPlan lets you log symptoms and track patterns over time. Noting when you wake, whether you are experiencing night sweats, how refreshed you feel in the morning, and what your energy is like during the day helps reveal whether your symptoms follow a cyclical hormonal pattern or are more constant and unrelated to your cycle. That kind of documented pattern is useful for both perimenopause and sleep apnea assessments.

This content is for informational purposes only and does not replace medical advice. Always consult your healthcare provider about your specific situation.