Gender differences in sleep disorders—including obstructive sleep apnea, obesity hypoventilation syndrome, insomnia, restless legs syndrome, and REM sleep behavior disorder—are characterized by hormonal influences, underdiagnosis, and atypical symptom presentation in women, highlighting the need for improved screening tools and further research.
Key Findings
Results
Obstructive sleep apnea is underdiagnosed in women due to atypical symptom presentation compared to men.
Women with OSA more commonly present with atypical symptoms rather than the classic presentation of loud snoring and witnessed apneas.
Hormonal influences are identified as a recurring theme in the pathophysiology and presentation of OSA in women.
The review highlights differences in prevalence, symptoms, pathophysiology, diagnosis, and treatment between women and men with OSA.
Underdiagnosis is identified as a recurring theme across sleep disorders in women.
Results
Hormonal influences are a recurring theme across multiple sleep disorders affecting women, including OSA, insomnia, and restless legs syndrome.
The review identifies hormonal influences as a unifying factor in gender differences across obstructive sleep apnea, obesity hypoventilation syndrome, insomnia, restless legs syndrome, and REM sleep behavior disorder.
Hormonal changes are implicated in differences in prevalence, symptom presentation, and pathophysiology between women and men.
The review calls for further research into how hormonal influences affect diagnosis and treatment outcomes in women.
Results
Insomnia shows gender differences in prevalence and symptom presentation, with digital cognitive behavioral therapy for insomnia identified as an emerging therapy.
The review examines differences in insomnia between women and men including prevalence, symptoms, and pathophysiology.
Digital cognitive behavioral therapy for insomnia (dCBT-I) is highlighted as a current and emerging treatment option.
Hormonal influences and atypical symptom presentation in women are noted as factors contributing to differences in insomnia diagnosis and treatment.
Results
REM sleep behavior disorder, traditionally considered more prevalent in men, is discussed in the context of gender differences that may contribute to underdiagnosis in women.
The review includes REM sleep behavior disorder among the sleep disorders examined for gender differences.
Differences in prevalence, symptoms, pathophysiology, diagnosis, and treatment between women and men are discussed.
Underdiagnosis and atypical symptom presentation in women are identified as recurring themes applicable to REM sleep behavior disorder.
Results
Obesity hypoventilation syndrome is reviewed for gender differences, with weight-loss medications identified as an emerging therapeutic approach.
The review examines gender differences in obesity hypoventilation syndrome including prevalence, symptoms, and pathophysiology.
Weight-loss medications are highlighted as emerging therapies relevant to obesity hypoventilation syndrome treatment.
PAP therapy is identified as a current treatment for obesity hypoventilation syndrome alongside emerging options.
Results
Neuromodulation is identified as an emerging therapy across sleep disorders, alongside PAP therapy, weight-loss medications, and digital CBT-I.
The review discusses current treatments and emerging therapies including PAP therapy, weight-loss medications, digital cognitive behavioral therapy for insomnia, and neuromodulation.
These therapies are discussed in the context of gender differences in treatment response and applicability.
The emerging nature of neuromodulation is highlighted as a future research direction for women's sleep health.
Conclusions
Improved screening tools are needed across all examined sleep disorders to address underdiagnosis and atypical symptom presentation in women.
The review emphasizes the need for improved screening tools as a cross-cutting theme across OSA, obesity hypoventilation syndrome, insomnia, restless legs syndrome, and REM sleep behavior disorder.
Atypical symptom presentation in women is identified as a key barrier to accurate diagnosis using existing screening approaches.
The article frames improved screening as a priority future research direction for women's sleep health.
Results
Restless legs syndrome exhibits gender differences in prevalence and presentation, with hormonal influences playing a role.
The review examines restless legs syndrome alongside other major sleep disorders for gender-based differences.
Hormonal influences are identified as contributing to differences in RLS between women and men.
Differences in prevalence, symptoms, pathophysiology, diagnosis, and treatment are discussed, consistent with the review's framework for all included disorders.
What This Means
This research suggests that women experience major sleep disorders—including sleep apnea, insomnia, restless legs syndrome, a condition called obesity hypoventilation syndrome, and a disorder involving abnormal movements during dreaming (REM sleep behavior disorder)—differently than men do. Women tend to present with less typical symptoms, and hormonal changes throughout their lives appear to play an important role in how these conditions develop and manifest. Because current diagnostic tools and screening methods were largely developed based on how these conditions appear in men, women are frequently underdiagnosed or diagnosed later than men.
This research suggests that existing treatments such as CPAP machines for sleep apnea and cognitive behavioral therapy for insomnia are important options, while newer approaches including weight-loss medications, digital therapy programs, and neuromodulation (using electrical stimulation to affect nerve activity) represent promising future directions. The authors highlight that more research is needed to understand how these treatments work specifically in women, particularly given the influence of hormonal factors.
The practical implication of this review is that healthcare providers and researchers need better screening tools designed to capture the ways sleep disorders actually present in women, rather than relying solely on criteria built around male symptom patterns. Addressing this gap could lead to earlier and more accurate diagnoses for women suffering from sleep disorders that significantly affect quality of life and long-term health.
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Christine M. Ly, Nancy A. Collop. (2026). Future Research Direction for Women's Sleep Health.. Sleep Medicine Clinics. https://doi.org/10.1016/j.jsmc.2026.02.011