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Many women with PCOS also develop sleep apnea, which causes periods of shallow or no breathing during sleep. What can they do to manage this condition?

Many women who suffer from polycystic ovary syndrome additionally have a sleep disorder. Obstructive sleep apnea, in which you experience periods of shallow breathing while sleeping, and sometimes even stop breathing for a while, is particularly common. As sleep apnea temporarily robs your body of its ability to send oxygen around the body, the condition can have far-reaching consequences, increasing patients' risk of hypertension, mood swings, cardiovascular disease, and even weight gain. Some people with sleep apnea additionally become more sensitive to pain.

What do you need to know about sleep apnea if you have already been diagnosed with PCOS?

Why is sleep apnea more common in women with PCOS?

Two words — insulin resistance. Research has demonstrated that up to 70 percent of women with PCOS have insulin resistance, but being overweight and obese makes this especially likely. Insulin resistance and sleep apnea are, in turn, strongly linked:

  • Disordered sleep leads to hormonal changes that can make your insulin resistance even more severe. 
  • When your body goes through insulin ups and downs, it makes a good night's sleep harder to achieve. 
  • Insulin resistance promotes weight gain, and being overweight or obese is a risk factor for sleep apnea.

When you consider these factors, it is no longer surprising that PCOS patients are more vulnerable to obstructive sleep apnea than the general population. There's more, however — PCOS is characterized by excessive androgen levels (including testosterone), and they also heighten your odds of sleep apnea as they change the way in which your body manages your breathing during sleep. That means that even PCOS patients who do not have insulin resistance may end up with this sleep disorder. It doesn't end here, however, as having sleep apnea creates a higher risk of nonalcoholic fatty liver disease, mood disorders like depression, diabetes, and metabolic syndrome.

How can PCOS patients know if they have sleep apnea?

Obstructive sleep apnea primarily manifests as haphazard breathing while you're sleeping — your breathing may be unusually shallow, and you can also stop breathing and then start again a little while later. This process can also lead to other symptoms, but if you're sleeping, you may be completely unaware of them. This is where your partner, if you have one, will come in handy. They're more likely to notice the number one tell-tale signs of sleep apnea, loud and invasive snoring. If you're single, you can still record yourself during sleep to figure out if you snore.

Possible symptoms of sleep apnea you may notice in yourself include:

  • Feeling fatigued in the day (because your sleep wasn't restorative), which also leads to trouble concentrating
  • Having a sore throat and a dry mouth when you wake up
  • Vague recollections of waking up unable to breathe properly
  • Morning headaches
  • Being moody (sleep deprivation or disordered sleep will do that to you)
  • Insomnia, which can mean not being able to fall asleep, not being able to stay asleep, or consistently waking up much earlier than you wanted to
If you do recognize yourself in these warning signs, don't hesitate — seek medical attention. As we've seen, sleep apnea increases your risk of other medical complications, so getting treatment is essential. If you think you could have sleep apnea, your doctor will run some tests and advise you on proactive steps you can take to reduce your symptoms. Let's take a look at what those steps entail.

1. A healthy weight: Important in treating both sleep apnea and PCOS

A large percentage of PCOS sufferers struggle with overweight or obesity, and this both increases your risk of developing sleep apnea in the first place, and makes the symptoms worse. Obesity can lead to fat deposits in the throat area, making your sleep apnea more severe. 

PCOS can, of course, make shedding pounds a special challenge — but exercise and diet do make a difference, and the drug metformin may also be suitable for you. If you do manage to lose weight, even just a bit, it will lower your odds of requiring surgery for sleep apnea, and of relying on CPAP for long periods of time. Some people who lose weight even find that their sleep apnea completely goes away.

2. What sleep position is ideal?

Good news if you hate sleeping on your back anyway — research has found that this is the worst position for people with sleep apnea. It can force your tongue into a position that blocks your airways, leading to increased episodes of sleep apnea. If you do sleep on your back, stop it.

What should you do, then? It's best to prop your head up with a nice pillow to enable your airway to remain open if you suffer from severe sleep apnea, but you can also sleep on your side. 

3. Make sleep hygiene a priority

It's no wonder that a disorder that messes with your ability to breathe while you're sleeping can have the same effects actual sleep deprivation does — things like memory loss, an inability to focus, terrible mood swings, and low energy levels. If sleep is unpleasant, you may also begin finding it hard to fall asleep in the first place. Sleep hygiene — a set of steps that promote restful sleep — should therefore be a priority. 

Go to bed at the same time each day, and get up at the same time too. Wind down with a relaxing bedtime routine that may involve a shower, some gentle music, reading a book, or some meditation, and create a restful environment in your bedroom. That means no screens, a slightly cooler temperature, and darkness. 

4. How can you regulate your progesterone levels?

Anovulation — not ovulating — leads to low levels of the important female hormone progesterone, and this is a very common problem in PCOS patients. Not only does this interfere with your fertility, it also plays a role in how well you can breathe. Talk to your doctor about getting your progesterone levels checked, and if you're low, ask about supplements that may stimulate progesterone production. Vitex is one of them, and very popular among women who live with PCOS.

5. Booze: Steer clear

People with sleep apnea should be very careful with alcohol — enjoying a drink or two may be relaxing, but that's not necessarily a good thing, as alcohol doesn't just relax the mind, but your muscles, too. That includes your throat muscles and the esophageal sphincter. When the esophagus is too relaxed, it can cause acid reflux, another thing that can make your sleep apnea worse.

6. No smoking

Nicotine is another thing that can relax your lower esophageal sphincter, something we've already established is bad news if you have sleep apnea. Should you still be smoking, make quitting a priority.

7. Sleeping pills? Bad idea

Sleeping pills or sedatives may help you get to sleep, and if that's something you struggle with, that may sound like a wonderful idea. They can also, however, relax your throat muscles, which you don't want if you have sleep apnea.

8. Regular workouts — for your tongue and throat

It may sound strange, but giving your tongue and throat muscles a "workout" can help strengthen those muscles, and that means that sleep apnea will affect you less intensely. Believe it or not, this is especially true for people who have large tongues, which can block airflow when relaxed. 

Try:

  • Simply holding your tongue up to the roof of your mouth for several minutes, multiple times a day. 
  • Holding a pencil or toothbrush between your teeth and biting down hard for five to 10 minutes a day to strengthen your jaw muscles.
  • Chewing chewing gum. 
  • Garling with water for five minutes. 
  • Tucking your chin in, and alternately press your tongue to the back of your top teeth, and then the back of your mouth. Repeat this multiple times. 
It may take a while for the results of your exercises to "kick in", just as with any other muscles you work. Be patient, though, and keep at it!

9. Consider getting a humidifier

If your air in your bedroom is very dry, it can lead to irritation within your airways, which — you guessed it — impacts your sleep apnea negatively. A humidifier can help fight this problem, and it will also come in handy if you have a common cold or seasonal allergies. Do remember to clean your humidifier regularly, however, as microbial buildup can instead make it a treacherous irritation machine.

10. Medical approaches to sleep apnea treatment

PCOS sufferers who have more severe sleep apnea that doesn't improve with lifestyle changes may find it is time to take more drastic steps. Your doctor may suggest:

  • CPAP, which stands for Continuous Positive Airflow Pressure, is one of the most well-known treatments for sleep apnea. You may be reluctant to use it, as you will have to wear a mask that blows air to keep your airways open while you sleep, and it may be difficult to sleep comfortably. Many patients get used to this device over time and find it helps them sleep a lot better, not to mention more safely, however.
  • Other devices, like a mandibular advancement device or a tongue retaining device, keep your tongue in a steady position so it doesn't obstruct your breathing.
  • Specialized pillows to help you attain a healthy position for sleeping.
  • Nerve stimulation devices, also called "sleep apnea implants", are inserted into your chest surgically and can help keep your airways open as you sleep.
  • Other surgical options that benefit some people with sleep apnea include a tonsillectomy, jaw reconstruction, and rhinoplasty. These treatments are reserved for patients who didn't benefit from other treatments. 

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