Is It Normal To Gain Weight In Your Early 20S Women and Heart Disease – What Most Doctors Don’t Know

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Women and Heart Disease – What Most Doctors Don’t Know

If you​​​​are a woman with chest pain or shortness of breath, it will take longer for you to be evaluated by EMS and taken to the emergency room than if you are a man. This finding was reported this month in Circulation: Cardiovascular Quality and Outcomes, and summarized for the lay public in the New York Times. What’s worse is that even when women get to the emergency room quickly, a heart attack diagnosis is made much more slowly than men.

However, what this article does not address is how to prevent heart disease in women in the first place. Sleep apnea is a very common condition that if left untreated can cause anything from depression, anxiety, high blood pressure, diabetes, obesity, heart disease, heart attack or stroke. It is estimated that up to 1/4 of all men and 1/10 of all women may have at least some degree of sleep apnea. The scary statistic is that about 90% of women with sleep apnea are not diagnosed. Instead, they are treated for the complications of untreated sleep apnea, rather than the cause itself.

There are three major issues regarding women that prevent a proper diagnosis of sleep apnea: the sleep apnea myth, the hormonal factor, and the insomnia factor.

Myth #1: Sleep apnea is mostly a male problem

One of the biggest myths about sleep apnea is that you have to be a middle-aged to elderly, heavy-snoring man with a big neck. This stereotypical view of sleep apnea is still common among most doctors, so unless you’re at the extreme end of the disease spectrum, a sleep breathing condition won’t even be considered a possibility if you’re a woman. When obstructive sleep apnea was first described in the 1960s, it was initially described in older, heavy snoring men. Even today, medical lecturers continue to put up pictures of these types of patients, and sometimes a picture of Joe the Fat Boy from Dickens’ The Pickwick Papers. Paper after paper continues to report associations between weight, neck size, and male gender and increased risk for sleep apnea.

However, it has recently been shown that even young, thin women who cannot snore have significant obstructive sleep apnea. I see patients like this daily in my practice. This also applies to young thin men. When these people are officially diagnosed on a sleep study, they always comment that their medical doctors comment, “you don’t look like you have sleep apnea.” This just goes to show that there is no “typical” sleep apnea patient.

Myth #2: Men can’t have menopause

It is common knowledge that as women progress through menopause, their rates of heart disease begin to catch up with men (although not completely). The common symptoms of menopause include night sweats, hot flashes, mood swings, weight gain, insomnia and irritability. However, as I mentioned earlier, young men in their 20s can have the same exact symptoms. How is this possible? It is because these men, as they gradually gain weight, advance the continuum of sleep breathing, gradually developing obstructive sleep apnea. It is the relative change in the anatomy that confuses the involuntary nervous system, causing the so-called vasomotor symptoms to arise. Your involuntary nervous system is what controls your heart rate, blood pressure, body temperature, sweating, digestion and sleep.

In women as they approach the pre-menopausal years, one of the first changes they go through is that progesterone levels gradually drop starting in their early 40s. One of the known interesting properties of progesterone is that it acts as a muscle dilator and stimulant of the upper respiratory tract. This is why pregnant women breathe harder and faster. It also stretches your upper airway muscles by promoting more muscle tone.

As I pointed out in my book Sleep, Interrupted, most modern human tongues are prone to partially recede when on our backs. When you add muscle relaxation during deep sleep, our tongues can fall back and hinder our breathing. That’s why so many people can’t sleep on their backs. So as you gradually decrease progesterone in women, the tongue relaxes more and more, and wakes up more and more, usually from deep to light sleep. Inefficient sleep promotes weight gain, and weight gain narrows the throat even more. These multiple obstructions and arousals lead to a confusion of the involuntary nervous system. Later, as the period of pauses after one obstruction increased, oxygen levels begin to drop, and obstructive sleep apnea worsens.

This is why women generally sleep better when they are on hormone replacement therapy, and they also have a lower chance of heart disease. Now, because of all the conflicting studies regarding hormone replacement options and a possible increased rate of cancer, this is a very delicate and controversial topic that is beyond the scope of this discussion. Nevertheless, peri-menopausal women have been using bio-identical progesterone creams for years to improve their quality of life and their quality of sleep.

Myth #3: Insomnia affects everyone equally

Finally, an older study showed that women who complain about sleep problems to their doctors resulted in a diagnosis of insomnia more often than men. Often these women were prescribed sleeping pills. Men who complain about sleep problems are more likely to be asked if they snore, and it is safe to say that obstructive sleep apnea is recorded more often in men due to this situation. Again, this brings up the OSA stereotypes that doctors have of men versus women.

There are a number of other reasons why women receive less than optimal cardiac care compared to men. I have addressed only three reasons that prevent women from being promptly diagnosed with obstructive sleep apnea. Untreated obstructive sleep apnea can lead to heart disease. As long as the medical community separates medical conditions without looking at the whole picture, we will continue to have disparities in the quality of care for not only women, but men as well.

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