Perimenopause, Snoring & Sleep: Could Your Airway Be Changing?

September is Perimenopause Awareness Month, and while hot flushes, changing periods and brain fog receive plenty of attention, there is another change I think we should be talking about:

Sleep and breathing.

Perhaps you've started snoring during perimenopause when you never did before. You're grinding or clenching your teeth more. You wake with a dry mouth or morning headache. Or you sleep for eight hours but still wake exhausted.

As an airway-focused dentist, I see these symptoms through a slightly different lens.

Hormonal changes can affect sleep, but oestrogen and progesterone also interact with the systems involved in breathing and upper-airway function.

So if your sleep has suddenly changed during perimenopause, your hormones may be part of the picture but your airway may be worth looking at too.

How can perimenopause affect your airway and breathing?

Your upper airway isn't simply a passive tube.

When we sleep, muscle activity naturally reduces and the tissues surrounding the upper airway become more susceptible to narrowing. Upper-airway dilator muscles help maintain the space available for airflow. One of these is the genioglossus, a major tongue muscle that contributes to maintaining upper-airway stability.

This is where oestrogen and progesterone become particularly interesting.

Progesterone acts as a respiratory stimulant, influencing ventilatory drive and the body's response to oxygen and carbon dioxide. Research also suggests that progesterone and oestrogen influence upper-airway muscle activity and responsiveness.¹˒²

During perimenopause, levels of these hormones can fluctuate considerably before becoming consistently lower after menopause.

This does not mean that falling oestrogen or progesterone automatically causes snoring or sleep apnoea.

Instead, hormonal change may alter some of the physiological mechanisms that previously helped maintain stable breathing during sleep.

Why can snoring start during perimenopause?

This is a question many women don't realise is worth asking:

“Why have I suddenly started snoring?”

Snoring occurs when airflow causes tissues within a narrowed upper airway to vibrate.

You may already have anatomical or functional factors influencing your airway without ever having noticed symptoms.

Then the physiological environment changes.

Hormonal fluctuations occur alongside changes in sleep, ageing, upper-airway muscle responsiveness and, for some women, changes in body composition.

An airway that previously compensated well may begin to behave differently during sleep.

So rather than thinking: Low oestrogen = snoring

I think about the interaction between:

Hormones + airway anatomy + tongue and muscle function + breathing + sleep

Perimenopause, menopause and sleep apnoea

This becomes particularly important when we consider obstructive sleep apnoea (OSA).

Research suggests that sleep-disordered breathing becomes substantially more common after menopause.

In the population-based HypnoLaus Sleep Cohort, moderate-to-severe sleep-disordered breathing, defined as an apnoea-hypopnoea index (AHI) above 15 events per hour, was identified in 8.6% of premenopausal women compared with 29.4% of postmenopausal women.³

This doesn't prove that menopause itself causes sleep apnoea. Age, anatomy, body composition and other factors are also important. But it does demonstrate why new snoring or worsening sleep around perimenopause shouldn't automatically be dismissed as “just hormones.”

Why sleep-disordered breathing can be missed in women

OSA isn't always the stereotypical picture of loud snoring and obvious pauses in breathing. Women may present with less typical symptoms, including fatigue, insomnia, morning headaches and difficulties concentrating.⁴

And not all sleep-disordered breathing is OSA. Upper Airway Resistance Syndrome (UARS) can fragment sleep without the breathing pauses typically associated with sleep apnoea.

This overlap means sleep-disordered breathing can potentially be overlooked. When these symptoms occur alongside snoring, mouth breathing, dry mouth or changes in night-time breathing, I think the airway deserves consideration.

Can perimenopause make teeth grinding worse?

Teeth grinding and jaw clenching are particularly relevant to my work as a dentist.

Grinding does not automatically mean you have an airway problem or sleep apnoea.

However, if your grinding has increased alongside snoring, mouth breathing, dry mouth, disturbed sleep or morning headaches, I don't want to look only at the wear on your teeth.

Protecting the teeth may be important.

But I also want to understand the person behind the grinding.

How can an airway-focused dentist help?

This is where my approach differs from a conventional dental examination.

I provide Comprehensive Airway & Myofunctional Assessments for adults and children experiencing concerns including snoring, mouth breathing, teeth grinding, jaw tension and poor-quality sleep.

I look at the relationship between your:

airway • breathing • sleep • tongue mobility and function • lip seal • palate and dental arches • jaw function • muscular tension • clenching and grinding

I also use recognised sleep screening measures where appropriate.

The aim isn't to assume everything is caused by your airway. It's to identify what may be contributing and connect the dots.

Depending on your findings, your personalised plan may include myofunctional techniques, breathing retraining, addressing oral muscular tension and jaw function, appliances or collaboration with other healthcare professionals where appropriate.

Assessment comes before treatment.

Has your sleep changed during perimenopause?

If you're finding yourself saying:

“I never used to snore.”

“Why am I suddenly grinding my teeth?”

“Why do I wake with such a dry mouth?”

“Why am I exhausted even after a full night's sleep?”

it may be worth looking beyond the individual symptoms.

Hormones matter. Your airway might too.

Dr JJ | Airway-Focused Dentist

Camberley, Surrey • Berkshire • Hampshire

References

1. Popovic RM, White DP. Upper airway muscle activity in normal women: influence of hormonal status. J Appl Physiol. 1998;84(3):1055–1062.

2. Saaresranta T, Polo O. Hormones and breathing. Chest. 2002;122(6):2165–2182.

3. Hirotsu C, et al. Menopausal transition and sleep-disordered breathing: factors influencing the association. J Clin Sleep Med. 2018.

4. Franklin KA, et al. Sleep apnoea is a common occurrence in females. Eur Respir J. 2013;41:610–615.