Is Sleep Apnea Overlooked in Women? (And What’s Changing)

This episode explores the overlooked connection between sleep health and cardiovascular outcomes, especially for women. Dr. John Kim, ER physician and venture capitalist at Aphelion Capital (American Heart Association), shares insights into gender biases in diagnosing sleep disorders and the emerging technologies reshaping treatment.

We can't stop talking about:

Women being less likely to be referred for sleep apnea testing — even when they show symptoms. Fatigue, mood shifts, and headaches in women are often misattributed to hormones or depression instead of sleep disorders.

Untreated sleep apnea putting serious strain on the heart. When breathing repeatedly stops or slows during sleep, the heart works harder to supply oxygen — increasing cardiovascular risks over time.

Estrogen's potentially protective role against sleep apnea. After menopause, a woman’s risk increases — suggesting hormones are a key factor in sleep-related health changes.

Standard CPAP machines having only a 50% adherence rate. Many patients find them too uncomfortable or claustrophobic — especially women, who may drop off early in treatment.

Personalized nerve stimulation treatments on the horizon. Startups are developing minimally invasive, tailor-fit sleep apnea devices that adapt to a person’s anatomy — with some aimed specifically at women’s needs.

Most sleep apnea marketing targetting men — but women are a growing, underserved market. New technologies aim to be more discreet, effective, and aesthetic to appeal to this overlooked group.

Connect with John:

• Visit: Aphelion Capital's Website
• LinkedIn: Dr. John Kim

Have an idea or story to share?

We’d love to hear from you! Visit: her-house.com/your-stories — 100% anonymous submissions welcome.

Contact: [e-mail]
Visit: her-house.com
Instagram: @herhouse.forwomenshealth

Episode Transcript

Melissa (00:00):
Thanks for joining Her House, where we celebrate
innovations related to femalebiology and health. In this
conversation, we gain insightsinto the connection between
sleep and heart health,differences in how women may or
may not be evaluated, diagnosed,and treated for sleep disorders,
and new technology for thosesuffering from sleep apnea.

John (00:21):
We're still trying to understand all of the
pathophysiology for women, butthey don't present as obviously
as men. And we try to identifyother things besides sleep
first, but for men it's like,no, you gotta get sleep studies
right away.

Melissa (00:34):
I'm Melissa D'Elia, and today we have someone super
brilliant and fun to chat withus. After completing a dual
MD/MBA program, he spent decadesbetween Wall Street and the
hospital. Today, he is ManagingDirector at Aphelion Capital, a
healthcare VC that's investingto improve patient outcomes and
continues to practice as adoctor in the emergency

(00:56):
department, keeping up with thelatest medical trends.
I'm excited to welcome Dr. John Kim. You have somewhat
of a superhero story. ER doctorby night, venture capitalist by
day, probably by night as well.How is Aphelion Capital
structured? What types of dealsare you doing?

John (01:15):
Our main mission is to find interesting medical
devices, health IT, med tech.The main point is to try to
drive down health care costs.Our major fund is called
Cardiation, where our anchor LPis the American Heart
Association and we try to findopportunities that meets their
mission statements aroundcardiovascular health. They're
also finding associations withcardiovascular health and sleep

(01:38):
and so they've been asking us totry to find really interesting
opportunities in sleep becauseagain that would down the road
again help out withcardiovascular health as well.

Melissa (01:48):
How does that research and product synergy really come
into practice?

John (01:53):
The partnership with us and the American Heart
Association has been tremendous.You know, obviously they have a
wealth of other physicians andnetworks that we can kind of tap
into and really seeing how itmay impact the leaders within
cardiovascular health and theirpractices. We can talk to them,
seeing what the opportunitiesare, what the challenges are,
whether or not specifictechnologies are working or not

(02:15):
working, and then go back andprovide feedback to the
companies that we're looking ator have already invested into
and to try to help them alongand creating a really nice
ecosystem for our portfoliocompanies to thrive.

Melissa (02:27):
We often talk about diet and exercise as it relates
to our hearts, but what happensfor our hearts as it relates to
giving ourselves rest or not?

John (02:38):
Rest and sleep is immensely important for
everybody, especially as we age.We're finding a lot of
correlations between really goodsleep and cardiovascular health.
We're finding that if you haveincreased episodes of apnea or
hypopnea, meaning you stopbreathing or you have very
shallow breathing, your heart isstraining to provide enough

(03:00):
oxygen and blood flow to bothyour brain and the rest of your
body. Sleep kind of providesthat reset for the rest of your
body to kind of relax andrecuperate. And but if you stop
breathing while you're sleepingand not getting good sleep, your
heart is under a lot of strengthto try to provide that rest of

(03:20):
your body.
So that's why we we feel thatopportunities in sleep and sleep
medicine to improve sleep isimmensely important, for
everybody.

Melissa (03:28):
And that stopping breathing, that's sleep apnea,
correct?

John (03:31):
Yeah.

Melissa (03:31):
Commonly a subject for men, older men, overweight men,
but the resources I came acrossdid mention an increased risk
for women after menopause.

John (03:41):
You're at higher risk of stopping breathing or long term
consequences if you're AHI,which is apnea hypopnea index,
meaning you stop breathing oryou have very shallow breathing
above a level of five so if youhave more than five episodes per
hour every night you're atincreased risk. When we say that
you're very severely affected iswhen you're around 15 episodes

(04:05):
per hour. As you said, it'seasier to identify men because
as you get older and and bigger,your anatomy and your neck
anatomy changes and you snoremore. For women, they present a
little bit differently than men,and that's kind of on us as
clinicians. We're trying toidentify what the risk factors

(04:27):
are for women.
They typically have probablylower AHIs than men, but they
don't get referred to sleepstudies as more frequently as
men as they should be. Theypresent more as fatigue,
tiredness, and some of that getswrapped into perception that,
hey, maybe it's not sleep, maybeit's depression, or maybe it's

(04:49):
because your hormones arechanging, your perimenopausal,
and we try to identify otherthings besides sleep first, and
then eventually they may getdown to a sleep study. But for
men, it's like, no, you've gotto get sleep studies right away,
and so we refer them right awaypretty quickly. I think that
gender differences is somethingthat we as clinicians have to

(05:10):
try to identify much morequickly, and to get them into a
sleep study and to say that,hey, know, for women, their HR
may be not as high, but they'regoing to eventually develop
symptomatic issues such ascardiovascular issues that we're
identifying right now and thatmaybe we need to, try to tackle
this, you know, much earlierthan we are currently right now.

Melissa (05:31):
Tired, headaches, those could be symptoms of so many
things, but if sleep problemsaren't at the forefront of a
doctor's mind, there couldpotentially be an under
diagnosis of women who couldhave sleep apnea.

John (05:43):
Yeah, that historically has been the case, but
postmenopausal women definitelyhave a higher prevalence of
sleep apnea than premenopausalwomen. And again, that needs to
be identified much more quicklyin the pathophysiology, whether
it's hormones and body changes,that really needs to be
understood. There has beenstudies over the past decades
trying to assess whether hormonetreatment after a certain age

(06:06):
would reduce the amount ofobstructive sleep apnea. There
are data showing that estrogenmay be protective in women for
sleep apnea. It may be thatwomen, because of their anatomy,
may not develop snoring asloudly or be as concerning to
their spouses and therefore theywon't be referred to sleep
clinics as readily.

(06:27):
Overall, if you do have theseepisodes over time, it's all
cumulative And if you havestarted starting to creep up
into these episodes of hypopneaand and, apnea, the consequences
in cardiovascular health willeventually occur in both, you
know, men and women, butprobably more silently in women
if they don't get treated.

Melissa (06:47):
That silence is what's scary and what I think is also
compelling about thisconversation in bringing to the
forefront something that hasn'treally been traditionally top of
mind for women as they'rethinking about their overall
health. How is it treated? Whatis the landscape for those
treatments?

John (07:04):
The landscape for treatment for obstructive sleep
apnea is pretty vast dependingupon what stage apnea that,
you're in. For mild cases,currently we try initially
positional changes. There's bedsthat kind of rise and fall.
There's like things that you cankind of wear to kind of turn you
on to the side. As it getsworse, there are dental

(07:26):
appliances that you can try touse to try to force your jaw up
front, then it becomes astandard CPAP is what, you know,
has been used and, what has beenstudied significantly.
And the mask technology hascontinued to improve over time
to be, you know, as comfortableas they can be. There's a lot of
patients that really gets alittle claustrophobic, so if you

(07:47):
can't tolerate within, I wouldsay, like the first couple of
weeks, it's going be reallydifficult for you to continue to
tolerate it and because ofcompliance issues with the CPAP
machines, which is currentlyaround 50, newer therapies have
been developed and evolved. Thefirst one was Inspire, which is
a hypoglossal nerve stimulator.So it's, there's a battery pack

(08:08):
attached to a wire and the endof the wire is attached around
your hypoglossal nerve whichforces your tongue to kind of
protrude forward while you'resleeping. Some of the issues is
it's a big procedure, there is alittle bit of cut down you know,
along the neck.
This has been a therapy I thinkmore favorable for men than
women. A lot of women kind ofbalk a little bit at a cut down

(08:32):
along the neck. The newer stuffthat are coming down are trying
to stimulate but less invasivesmaller cut downs. And what we
invested into is a companythat's working through the
development process of whichwould be a needle based system
that's targeting specifically atthe hypoglossal nerve and other
areas of the body to providestimulation that's not

(08:54):
necessarily needing to have abattery pack placed in but can
be charged at night. And sothose are coming down the road
and which would provide a lotmore opportunities for both men
and women and to be donepossibly down the road in an
office based setting rather thancurrently right now, which is in
either ambulatory surgery centeror within the hospital.

Melissa (09:13):
That's what makes me excited about what you guys are
investing in, in trying toprovide a product that people
don't have that three weekhurdle to start to get
comfortable with it and canstart finding relief right away.
I mean, if you have sleep apnea,you've probably been suffering,
especially as you're sayingwomen may be suffering silently
longer.

John (09:32):
They're still in a little bit of stealthy mode, but the
results have been, spectacular.The therapy eventually can be
tailored, to provide opening ofthe airways that may be able to
differentiate between therequirements for men versus
women. The opportunity fordifferentiation is post implant,

(09:54):
is that you can turn on certainareas of the stimulation and or
have multiple injections intoareas of the neck and chin and
then tailor the therapy down theroad, which is the hope to
provide the best means ofreducing the AHI over time.
Because again, I thinkpersonalization is going to be a
benefit to everybody and to havesomething that's kind of one

(10:17):
size fits all for everybodyinitially, but then adjusted
down the road, I think patients,physicians would be pretty
jazzed about technology likethat.

Melissa (10:26):
Personalized medicine is a huge topic, and driving sex
differentiation into theconversation early makes a lot
of sense. We've talked beforethat there's pushback about
investing in women's health,saying it's only 50% of the
market. But in this case, itsounds like the company that you
invested in and even some of theexisting players would be able
to expand their patient market.

John (10:48):
This is, you know, again something that we really like,
not necessarily coming in andsaying that this is a device or
an opportunity specifically forwomen. What we like is an
opportunity that's both for menand women, but because women
have been so underrepresented orunder identified trying to come
at it a different way sayingthis is for everybody, you know,

(11:11):
men and women, tailor thetherapy or do something or do
some additional studies toexpand the market into women for
investors to quickly grasp, oh,what's the return? What, you
know, I can see it growing, it'snot going to be cut in half and
that's, you know, one of thereasons why we feel that this,
you know, this company that weinvested into, Restera, is it
has a unique opportunity to,again, find a better technology

(11:33):
and expand the market byaddressing some of the issues
that are specific for what weneed.

Melissa (11:37):
What would it take to get this new technology into the
hands of people? Or in thiscase, into the beds of people?

John (11:43):
What's great about this is that there's already
technologies available out therethat have already paved the road
in terms of reimbursement. Youknow, how do you pay for this?
To get this level of technologyinto the hands of a larger
population, it does requirepossibly a little bit of a
better marketing. Currentmarketing for simulators like
Inspire have mostly been gearedtowards men. It was always

(12:06):
about, hey, you know, yourpartner is snoring.
If your partner has been onCPAP, here's a different
technology that was, you know,quieter and so it felt more kind
of geared towards men. I thinkmarketing the newer technologies
that expands it and say, youknow, it's this is a problem not
just for men, but for women aswell. That is aesthetically more

(12:29):
appealing than what's availableright now. Something that's very
silent, you don't notice thatit's there, but it still does
the same thing in terms oftrying to open up the airway.

Melissa (12:38):
Exactly. It's something that helps patients and also is
an opportunity for the companiesand its investors. Your LinkedIn
profile mentions always tryingto make those around be better.
How does that way of thinkingand being apply to you now as an
investor?

John (12:55):
For me, that means my colleagues around me, whether or
not they're in, you know, in atAphelion or in the hospital,
and the companies that we investinto and the folks that are
really trying to build thesecompanies up. Because at some
point, they will also try tomake me better. The more you
give, the more you get back. Andit they'll help me out by
providing a really goodenvironment to work with and

(13:18):
also insights into technologiesopportunities that I've been
seeing. And I'm gonna bereceiving a return on that two,
three times that much.

Melissa (13:28):
I hope to find many examples of that mindset on this
show. Our closing ask is for youto give a shout out to another
innovator in the women's healthspace.

John (13:38):
I'd love to give a shout out to Andy Doraiswamy. He is
the CEO of Koya. What they havedeveloped is a sleeve for
lymphedema. The issue is that alot of women with breast cancer,
know, have their lymph nodestaken out. When you remove the
lymph nodes, you're developingsignificant amounts of
lymphedema to that arm.

(13:59):
Treatment has always been othersleep stocking and pneumatic
compression, but with thisdevice you can get out of the
house and wear as much as youwant and you're not confined to
having this plugged into thewall which has resulted in
significant improvements incomfort, fit, compliance.

Melissa (14:18):
Allowing people to live their lives and be healthier at
the same time is the goal. Thankyou much for joining us today.
If people want to follow yourwork or get in touch, what's the
best way to do so?

John (14:31):
Go on to our company website, aphelioncapital.net ,
and I'll be kind of going aroundthrough all the circuits of
meetings and again, I'll be atall the American Heart
Association conferences, so itwould be great to meet you guys
there if you are available.

Melissa (14:47):
Thank you, John.

John (14:48):
Thanks, Melissa.

Melissa (14:49):
Join us next time to learn about another innovation
in women's health. And if youhave ideas for the show or an
experience you'd care to share,we'd love to hear from you.
Please reach out.

John (15:03):
If I start a conversation, he starts barking, wanting a
treat