Jennifer Martin, PhD: Boosting CPAP Adherence in Women with Sleep Apnea

Men are more likely to develop sleep apnea than women but that doesn’t mean treatment like continuous positive airway pressure (CPAP) for women can be dismissed.

“It’s very interesting because in the United States, women are less likely to use PAP therapies compared to men, but that's not true everywhere in the world,” Jennifer Martin, PhD, from UCLA, told HCPLive at SLEEP 2024, the 38th annual meeting of the Associated Professional Sleep Societies. “In some other countries, rates of CPAP use are similar between men and women, and one of the reasons might be because there are differences in healthcare and access to healthcare.”

At SLEEP 2024, Martin presented on how women with sleep apnea tend to have lower rates of using positive airway pressure therapy compared to men and explained the reasons for that. She also discussed what a healthcare provider might do in an office visit to increase the likelihoods of their female patients with sleep apnea obtaining treatment.

Martin explained how in the US, women have greater responsibilities for healthcare, supporting their family, so they may need to sacrifice their routine health care. As Martin said, women might view it as a burden to add putting on a CPAP mask to their bedtime routine after setting their children to bed.

Other reasons why women might feel less inclined to use a CPAP mask is because balancing mental health struggles or health behaviors like diet and exercise along with having to wear mask might just feel like “one more challenge,” as Martin said. Women are also more likely to have depression than men, and depression may impact CPAP adherence.

Women also tend to have milder sleep apnea, so they might not feel like they need to seek treatment because their disease is not as severe as in men.

“Another factor that might come into play is just that I think wearing a CPAP mask might be more stigmatized in women, so women may feel more uncomfortable wearing it around their partners than men do, although that's speculation,” Martin said.

Not only that, but some women struggle to find a CPAP mask that fits their face.

“There could actually be technical challenges in terms of fitting the mask because of their craniofacial structure, but again, there aren't a lot of research data on that,” Martin said. “It is something that's likely, given that most of the masks were originally developed for patients who are men.”

Sleep apnea presents its differently in men versus women. Men with sleep apnea tend to feel very sleepy, and the CPAP reduces sleepiness. In contrast, women with sleep apnea tend to feel fatigue, but it is not yet confirmed whether CPAP improves fatigue symptoms.

Martin believes it’s important to explore how sleep apnea creates daily barriers, and healthcare providers should talk to their patient before starting treatment about what is important to them and assess the benefits of the treatments regarding those values. For instance, if a provider wants a patient to use CPAP to control high blood pressure but a patient values their relationship with their spouse more, then a patient should not have to go through CPAP treatment.

“One of the really important things healthcare providers can do is, when a person has sleep apnea, to take time to understand what their goals for treatment are and how having an untreated sleep disorder affects the things that matter to that person in their daily life,” Martin said.

References

^{Martin, J. CPAP Adherence in Women with Sleep Apnea. Session presented at SLEEP 2024. Houston, TX. June 5, 2024.}