Dr. Chelsie Rohrscheib Spills the Tea on the Women's Sleep Apnea Crisis

[00:00:04] Welcome to HITea With Grace, where we spill the tea on HIT. Today, I'm honored to welcome to the pod Dr. Julie Wood, PhD, sleep expert and scientist at Westboro. Thanks for joining us today. Thank you so much for having me. I'm really excited to have this conversation. This is a topic that I have been wanting to have someone on for a long time. We have heard so much about sleep apnea. We know someone with sleep apnea and we've known it's been studied for decades,

[00:00:33] but women are still falling through the cracks on diagnosis. What are some of the underrated challenges in women's sleep medicine that you feel are just not being talked about right now? Yeah, that's a really good question. So traditionally, when we started classifying sleep apnea and what it actually looks like in a patient, we were primarily focused on men. And the reason for this is because men have much more obvious symptoms than women.

[00:00:59] So just to kind of go back a little bit, so sleep apnea is a disorder of breathing. So when you're asleep, people with sleep apnea have pauses in their breathing throughout the night. They can have many pauses per hour and every time they stop breathing, their oxygen levels drop. And this causes a wide range of issues in the body and brain. And so men, they have a very stereotypical set of symptoms. They might snore loudly.

[00:01:28] They might gasp and choke. They might complain more about how they feel during the day. Whereas in women, it's a lot more subtle. So they might have no snoring at all. Their breathing pauses might not be as obvious. You might not get all the gasping and choking. And so for a really long time, scientists thought that this was really a disorder of men. And so the research has really only caught up in the last 10 years or so. But now we know that anyone can get sleep apnea.

[00:01:58] Women, men, young people, old people, even children. So now that we're aware that women can get sleep apnea and can be treated, it's our job as sleep professionals to really help educate the public about what sleep apnea looks like in women.

[00:02:14] What women can actually look for the signs and symptoms, how it can be confused with other disorders like insomnia and other health conditions, and how to actually get women's feet in the door of their physician to get tested. That is so fascinating. Now, I think when most people think of sleep apnea, they picture this like loud snoring old guy, right? Right. So women are, like you said, they're kind of just presenting differently.

[00:02:41] So can you walk us through what that looks like then and why that matters? Yeah. So typically with women, everything is a little bit more subtle. So you can take all of the signs and symptoms that men have and kind of rein them in a little bit. So generally speaking, women might have some daytime sleepiness. They might have some cognitive dysfunction during the day, which means they have issues with paying attention. They might start having some memory issues.

[00:03:10] They might find that their mood is reduced. A lot of times women will present without dramatic snoring or no snoring at all. So this is a big stereotype that you have to snore to have sleep apnea and this simply isn't true. Women might also have shorter, less dramatic pauses in their breathing. And another thing that we typically see with women is sleep apnea can often look like insomnia in women.

[00:03:39] So they might have difficulty falling asleep. They might have a lot of sleep fragmentation. They might wake up too early in the middle of the night and not be able to fall back to sleep. So a lot of women will unfortunately be told they have insomnia and they need to do all of the traditional things like work on their sleep hygiene, change their lifestyle, change their sleeping environment. Meanwhile, it's really their breathing. That's the problem. Wow. Wow. Yeah.

[00:04:07] So what is the typical story then of a woman who finally gets diagnosed? After she finally, after all of that trickiness of getting to the point of diagnosing her, how long is she typically bouncing around the system? And what is she, yeah, what does that look like for her typically? So people can have sleep apnea for many years before they finally get tested and diagnosed. This can be anywhere from a couple of years to I've seen patients who have had issues for decades and they had no idea.

[00:04:36] Nobody ever told them that it might be sleep apnea. Oftentimes they're told, well, you just need to improve your sleep health and your sleep habits. They might be told that it's just hormones. It's just menopause. So because these symptoms are a lot more subtle for women, they tend to remain undiagnosed and untreated for much longer than men. I will say this about women though.

[00:05:03] We are a little bit better at actually going and talking to our doctor. So if you do have a doctor that is aware of sleep apnea and is more educated on the signs and symptoms in women, they might actually recommend a sleep study sooner. That's interesting. You mentioned menopause. Now I've heard that there is growing evidence that perimenopause and menopause increase a woman's risk for sleep apnea.

[00:05:30] And yet people don't really know that when they don't realize that their hormone, sometimes they attribute things to just hormones. So what is that connection between hormonal transitions and sleep disordered breathing? And where are we kind of missing that diagnostic moment? The primary, there's two types of sleep apnea. There's obstructive sleep apnea, which is caused by literally something blocking your upper airway. So this is usually in the throat or the nasal passage.

[00:06:00] Generally, this is going to be soft tissue. So things like your tonsils, your tongue, you might have a naturally narrow airway that is just more prone to blockage and collapse. There's also a different type of sleep apnea called central sleep apnea. That's more of a nervous system dysfunction. When your brain is not telling your body that you need to breathe. So there's no obstruction. You're just not getting those signals from the brain to actually take a breath at night. By far, obstructive sleep apnea is the most common type.

[00:06:29] And as far as women in perimenopause and menopause, they are more at risk for the obstructive type of sleep apnea. Now, the reason for this is as your hormones start to decline, so your estrogen and progesterone, what this does is this affects the muscles around your upper airways. So we have a set of muscles that help keep our airways open. And when you're not getting access to the estrogen or progesterone, those muscles lose tone over time.

[00:06:59] And so basically, you can think of it as like going from being somebody who's working out in the gym all the time to going to a very sedentary lifestyle. You're going to start losing the muscles required to keep your airways open. And so that increases the risk of airway blockage over time. Another issue is some women do start gaining weight in perimenopause and menopause.

[00:07:22] And weight gain and obesity is associated with an increased risk for sleep apnea as well. That actually makes a lot of sense. I can imagine that. On this show, we talk a lot about delayed diagnosis. I personally had a delayed diagnosis, incorrect diagnosis experience myself that led to years of just huge challenges for me. And I have found my diagnosis and treatment and thankfully I'm doing well.

[00:07:49] But others, it's just, it's a huge challenge unless you're an advocate for yourself. When sleep apnea goes unrecognized for years, what are some of the consequences that you guys are seeing show up later? Yeah, so sleep apnea is a major driver of many chronic health conditions. And these are chronic health conditions that we're all familiar with.

[00:08:10] So the longer you've had untreated sleep apnea, the higher your risk for developing diseases like cardiovascular disease, stroke, hypertension, type 2 diabetes, neurodegenerative disorders like dementia and Alzheimer's disease, various mental health conditions, especially depression and anxiety. There's even evidence that sleep apnea raises your risk for certain types of cancers.

[00:08:37] And studies are also looking into how it affects your immune system as well. So people who have sleep apnea tend to get sick more frequently or when they do get sick, it takes them a little bit longer on average to recover from that illness. In very serious cases, sleep apnea also decreases your lifespan. It really depends on how severe it is and how long you've had it.

[00:09:02] And there's also increased risk for accidental death from like motor vehicle accidents and workplace accidents and things like that. So it is a very serious disease. It's kind of like being a lifelong smoker or being somebody who doesn't exercise or has a poor diet. So physicians and specialists from every type of area of medicine are really starting to take sleep apnea seriously. Incredible.

[00:09:30] And to think it's just sleep. I'm sure people say all the time, it's just my sleep. That's okay. I'll just be restless and exhausted every day of my life. But you're right. It's like smoke, chain smoking. You have to really see it that way. Now let's talk tech, that innovation. So what innovations in this space are exciting you right now? I'm sure home sleep testing, wearables, biomarkers. There has to be stuff that is just getting you up in the morning and getting you excited about where this area is heading.

[00:10:00] Yeah, it's the science and tech industry is moving really fast in the sleep space. It's kind of exploded over the last 10 years. So definitely the home sleep testing is probably the big one that we're looking at right now. Traditionally, if you needed a sleep study, your PCP or a sleep physician would have you go to a clinic or a sleep lab. You would get connected to a bunch of wires and sensors. And then you would sleep in the clinic overnight while a sleep technician monitored you.

[00:10:30] It's very expensive. It's very expensive. It's very time consuming. Most patients don't find it very comfortable. And a lot of times patients won't sleep as well as they usually do at home. So you might get kind of mixed results on your tests. Nowadays, we have very small, non-invasive technology that you wear on your body that gets delivered straight to your home.

[00:10:53] And these are devices that maybe only have one or two attachments to your body as opposed to 20 or 30. You get to sleep in your own bed. So you get to have a pretty typical night of sleep for you. These devices connect wirelessly, usually to a mobile device through an app. While you're sleeping, it transmits the data. And then in the morning, it uploads it usually to a cloud where it's analyzed. These devices are really inexpensive.

[00:11:20] So the cost to the patient and the provider is much lower. And the other nice thing about these devices is because they're so small and non-invasive and easy to use, you can perform multiple nights of testing, which just gives doctors and physicians a better understanding of how that patient sleeps. Not just for one night, but maybe up to a week, two weeks, however long they want to test for. So it's really becoming a game changer.

[00:11:48] And at this point, these devices are almost as accurate as an in-lab sleep study. So there's a stereotype that they're not as accurate. But right now, that's simply not true. The technology has moved quite far. And these devices are definitely making sleep testing more accessible and easy. And it's also helping people who maybe wouldn't necessarily get prescribed a lab study. It's a much easier way to check for something like sleep apnea.

[00:12:17] Other things that are pretty exciting, wearable technologies. Physicians have kind of a love-hate relationship with them. They can provide inaccurate data. They're not FDA cleared for medical diagnostics. But they are helping people be more alerted to sleep issues that they can then talk to their doctor about to actually get a formal sleep study. Some wearables are even looking at oxygen data. So they're actually looking at things related to sleep apnea now, which is kind of nice.

[00:12:46] The biomarkers is interesting. So biomarkers is essentially looking at anything in the body. So like blood labs, antibodies, certain molecules that may be indicative of certain sleep disorders and how dangerous it is. Biomarkers isn't really that much of a thing in the sleep apnea space. But it certainly is in other sleep disorders like narcolepsy, a variety of other disorders as well. So that'll be interesting.

[00:13:14] And basically what that means is if a physician suspects that you have a sleep disorder, they might be able to take like a blood or saliva sample and look at those specific markers to indicate whether or not that person might have that disorder. And it also might tell you more about how severe that disorder is, what type of disorder it is, things like that. So fascinating.

[00:13:36] When you think about like 20 years ago, I feel like so few people were diagnosed with sleep apnea and that diagnosis is starting to get a little bit more. People are starting to get that a little bit more. And it's very fascinating to hear how innovation is coming into play to help support people to understand their sleep better and really help people that do have sleep apnea. So I'm wondering what is shifting as things shift? What is shifting in how clinicians are being trained to recognize sleep apnea to make them diagnose it more?

[00:14:05] Particularly in women. And what still needs to change? What still needs to have a big impact there? Yeah. So I think the main thing that has shifted is traditionally when a sleep disorder is suspected, usually you would get a referral to a sleep physician. Your PCP would not really handle that. Your other specialists would not really handle that.

[00:14:30] But now more and more, we are actually training these other specialties to understand and recognize these disorders. More and more PCPs are actually prescribing these home sleep tests. Even if they don't have the ability to actually do the in-lab studies, it's very easy to prescribe these home sleep tests directly to your patient. So basically what that means is the patient doesn't have to wait to see the specialist. Sometimes these waits are horrendous.

[00:14:58] I mean, I'll give you an example. My three-year-old needs a sleep study. She's got very large tonsils. And she was prescribed the sleep study in February, but they cannot get her in until October. So it's a long wait for her to actually get that sleep study. And this is pretty typical if you need an in-lab. Whereas if you're prescribed a home sleep test, it literally shows up within the next two days. You can test, get your results back all within a week.

[00:15:27] It's a very quick turnaround. And that also means that we can get people on therapies much earlier. In regards to women, we're seeing more OBGYNs. We're seeing more endocrinologists, more women specialists in particular, especially people who do work in the perimenopause, menopause, HRT space, looking into sleep apnea.

[00:15:53] Because the issue is when you have these issues like perimenopause and menopause, they themselves can raise your risk for sleep apnea. And sleep apnea can make your symptoms of perimenopause and menopause much worse. This also is true for fertility. So women who are seeking fertility treatments, you want to make sure you get on top of those sleep disorders and manage your sleep quality well before you start hormonal therapy,

[00:16:22] before you start fertility treatments, because your poor sleep can actually adversely affect how well those therapies work. Wow. Now, I know you're tapped into the sleep medicine and women's health communities. And like, what trends or shifts are you hearing about the field in general that our listeners should have on their radar? And what do you see happening within this field within the next year or two years, five years?

[00:16:46] So more of these companies who don't specialize in sleep medicine are starting to include a sleep niche into their program. So we're certainly seeing more with telehealth, especially as HRT therapy explodes for women in perimenopause and menopause. So if you meet with that provider, yes, initially you will discuss symptoms of your perimenopause.

[00:17:12] You might discuss hormone replacement therapy, but they usually have somebody on staff who can work with you from the sleep standpoint. So they might be able to test your sleep with a home sleep test. You might be able to see a sleep therapist that can do behavioral sleep medicine. So they'll work with you about things like insomnia and your lifestyle and behaviors you can change to improve your overall sleep quality.

[00:17:38] We're also seeing specialists really talk to each other a lot more. So cardiologists are now working directly with sleep specialists who are working with other specialists. So it's a lot more interconnected than it used to be. Of course, we also have a lot more ways to monitor people's sleep over time. So back in the day, we used to just ask people to keep sleep diaries. So keep a diary, keep a notebook by your bed, keep track of how well you slept.

[00:18:05] This was fine, but it's very subjective. You're asking the patient to write how they slept, but this isn't necessarily a really comprehensive way to understand what is actually going on. Whereas these devices, we can send them home and we can have them wear them for the duration of their study and really get extremely detailed about how well they slept, what time they went to bed, what time they woke up. Was their sleep restless? Did they get enough deep sleep? Did they get enough room sleep?

[00:18:35] Were they waking up frequently throughout the night? How's their breathing? Things like that. So it gives us a much more well-rounded picture of that individual and that helps us treat that individual better. So fascinating. I am just so thrilled to be able to learn from you. I feel like I should pay you for your time, honestly. I'm so grateful that you're willing to just teach us so much about what's happening in this space. And I know even for me, I'm like, I need to go get a sleep specialist, even though I sleep fine.

[00:19:03] But I mean, I feel like everyone should really prioritize this and really think through it. And take your advice to heart. Now, while my listeners love to hear about what's going on in the industry, they also love to hear about what drives women leaders like yourself. So I have to ask you, you are a busy woman leading things over there at Whisper and other companies as a scientist and woman leader in STEM. What are things that you do in your daily life that help you work your best to make a difference?

[00:19:31] So I always like to say sleep is my waking passion. I think about sleep pretty much all day, every day, even on weekends, even on holidays, I'm thinking about sleep. And the reason I wanted to go into sleep is because sleep affects every aspect of your life. It accomplishes so many biological functions in the body that just simply cannot occur while you're awake.

[00:19:59] And if we're not getting proper sleep, this is going to impact almost every area of our health. So just like diet and exercise, you need good sleep to live happily and maintain health throughout your entire lifespan. So I got into sleep because it's an area that's going to impact everybody. Everybody sleeps. It's universal. Not everybody has a cardiovascular disease. Not everybody has diabetes, but everybody needs good sleep.

[00:20:29] And it's my passion to communicate this and educate the public on what to look for when they do have sleep issues and how to address those issues. Now, as far as how I keep myself motivated and keep myself healthy, I mean, I definitely practice what I preach. So I make sure that I'm getting good quality sleep every single night because a rested mind is a sharp mind. I always aim for eight hours of sleep. That's my personal sleep need.

[00:20:58] Everyone else's sleep need is a little bit different. But aiming for seven to nine hours of good quality sleep is absolutely essential. I also maintain a really consistent bedtime. So I go to bed and I wake up at the same time every single night, even on weekends, even on holidays, no exception. Just maintaining my general health is also very important because your overall health does affect how you sleep. So I exercise frequently.

[00:21:25] I'm involved in a pretty intense sports. I eat very healthy or as healthy as I can. And that's not to say that I don't let myself have a treat every now and then, but I do. I practice really good sleep hygiene. I don't smoke. I don't drink. And I also do things that I enjoy because mental wellness is just as important. Now, another aspect of my work that's really important is I stay on top of the research.

[00:21:54] I stay on top of the information. So I'm constantly reading new articles that have come out about sleep scientific articles. I talk to people in the industry that are the big players who are doing the big research in the background. I go to a lot of conferences and I also talk to other medical professionals because it's really, it's very important. And I'm a huge advocate that we should all be working together.

[00:22:21] It's medicine used to be very disjointed where you'd have your PCP over here and then your cardiologist over here and your sleep specialist over here and your OBGYN over here. That doesn't work anymore because it's all, it all needs to be integrated. So working with other specialties and understanding what they do and how that impacts sleep and vice versa is incredibly important as well. So cool.

[00:22:48] And I love that your waking passion is sleep. That is the best. That is fantastic. I'd love to hear a little bit more too about the career path that led you to your role at Westboro and what you do at Westboro. Yeah, sure. So when I was in my undergrad, I did a degree in biomedical science. Basically, it's exactly like it sounds. It's just the science of medicine. So when you're doing biomedical science, you're really studying every body system. It's not just one in particular.

[00:23:17] So we did immunology, we did cardiology, we did neuroscience, psychology, nephrology, you name it. I was really taken by neuroscience. I think the brain is fascinating. It's by far the most complex organ in the body. The brain is the master. It controls everything. So if something goes wrong in the brain, everything else kind of goes wrong afterwards.

[00:23:42] And so I decided I wasn't sure if I was going to go to med school or stay in research, but I did a summer internship during my undergrad year where we did specifically neuroscience research looking at infections of the brain. And I just caught the research bug. Then I went on to do a master's and PhD. I continued looking at infections of the brain.

[00:24:07] But one of the things I looked at was how these infections actually affected sleep. So not only how that organism slept with that infection, but also how it affected the genes, the regulation of genes and specifically genes that control things like neurotransmitters and other neurochemicals as well. When I finished with that, I specifically focused on sleep genetics.

[00:24:34] So I looked at how things like sleep deprivation affected expression of genes, how certain sleep disorders were related to these genes. What happened when we tweaked these genes? Did it actually affect sleep or not? And this was very fascinating. And we did publish a lot of data. But the entire time I was thinking to myself, well, I'm going to publish all this data, but it's not really going to be utilized, at least not yet. I mean, people might read it.

[00:25:02] People might find it interesting, but this might not actually translate to helping actual human beings. So that's when I took a huge pivot and went into human sleep medicine and started specializing in sleep disorders. And that's really where I got my big introduction to diseases like sleep apnea and insomnia and narcolepsy. And this led to eventually specializing in clinical trials for sleep apnea specifically.

[00:25:29] And eventually down the road, that's how I was introduced to our CEO and founder, Amir. And I got more into the diagnostic side of sleep medicine. And I've been here with Westberg probably going on five years at this point. And I love it. I wouldn't change a thing. I love that I get to work directly with patients and we have a real measurable impact. That is so inspiring.

[00:25:57] Now, looking back on this amazing journey that you have had that has led you to this point at Westberg and the work that you've done. And if you could give your younger self a piece of advice, what would you tell her? I would tell myself to go directly into medicine, working with patients instead of taking this kind of long road through basic bench science. Because from the time I started my undergrad to actually getting to Westberg, it was probably

[00:26:26] like a good 15 years. And I just, I feel like I would have had a lot more satisfaction if I had gone straight into more of the clinical side of things. I also would have focused more on human medicine as far as my education standpoint. Before I was definitely working more in model organisms like mice and insects and things like that. So it took me a little bit longer to get to where I am today.

[00:26:52] And I also really like working in industry. I really like working in technology where we are actually treating patients as opposed to the academic side of things where you're constantly writing for grants and publishing and that whole cycle. I really think my time now at Westberg has a bigger impact than what I was doing before.

[00:27:17] But I also think it's really important to just keep in mind that there's other body systems in play and you need to keep up and have a good understanding of everything else that's going on in the body as well. Not just sleep. You can't hyper-focus. You have to take the whole body into consideration. Fascinating. Now, to finish this conversation off right, where can our listeners find you online? Yeah. So you can find me on our website. So that's www.wesper.co.

[00:27:46] You can also find me on LinkedIn. I post a lot of sleep-related content and I'm always happy to answer sleep questions to individuals who reach out to me. Terrific. Now, before I forget, did you happen to bring tea with you today? And if so, tell me about your mug. I did. So this is my bee mug. My two-year-old daughter picked this out for me because she knows I like bees. I used to work with insects back in the day when I was doing my master's and PhD.

[00:28:11] So it's just kind of a little throwback to my earlier years where I got my start. And yeah, it's a big mug. I love it. It holds a lot of tea. I love it. It's a big bumblebee mug that could fit a lot in it. And it has little sunglasses and a smiley face on it, which is just so happy and amazing that your daughter bought it for you and something you can remember her by too. Too good. Well, thank you so much for joining us today. It was awesome having you. Thanks for having me. It was a great chat.

[00:28:40] And thanks to you folks for joining us too. Check out the Hi Tea with Grace podcast for more interviews with great guests like Dr. Chelsea today. Cheers. Like a Girl Media is more than a media network. It's a community. We want to meet you and amplify your voice and the voices of outstanding women innovating in healthcare. Interested in starting your own podcast or hosting an event near you? Connect with us online or in person. We're here to support and empower you.