The Surprising Truth About Women and Heart Disease
March 24, 2026 | Episode 59
Producer’s Note: The following is an AI-generated transcript of The Wellness Conversation, an OhioHealth Podcast
SPEAKERS: Marcus Thorpe, Lindsey Gordon, Dr. Richard Ko
Marcus Thorpe 0:06
Welcome back to another episode of the wellness conversation, an OhioHealth Podcast. I'm Marcus Thorpe, joined by my co host, Lindsay Gordon. We're glad you're with us, and today we are talking about something that every single one of us has to deal with, and probably not very good at. It, is sleeping, whether you're tossing and turning, maybe you wake up groggy, or you want to understand what makes sleep restorative. We've got an expert that is just right for that. It's Dr. Richard Ko, sleep specialist with OhioHealth working every day with patients who want to understand why we're so exhausted. Dr. Ko, this is going to be a great episode. We are so glad you're here with us.
Dr. Richard Ko 0:38
Glad to be here.
Lindsey Gordon 0:39
Dr. Ko, sleep is something that is everything, and all too often we don't get enough of it. So I'm sure in your personal life, when people know what you do, you probably get so many questions at cocktail parties, out and about the grocery store, if someone recognizes you, is this something that you find you're talking about all the time in your everyday life.
Dr. Richard Ko 1:00
Absolutely, I get questions all the time from friends, family members, guys on the golf course, people, randomly I just met, they're like, Oh, your sleep doctor. I got some questions, of course. A lot of it is centered around sleep apnea, of course. And you know, people with insomnia, especially friends, they'll reach out to me when they're really struggling with insomnia.
Marcus Thorpe 1:24
Seems like that is what we're all struggling with, is how to get not just sleep, but really good sleep. Can you talk about what you're seeing the most inside of some of the patients that come in and see what's the one thing, or couple things that people really are struggling with.
Dr. Richard Ko 1:38
So by far and away, not just for my practice, but for virtually every sleep physician. Sleep apnea is by far and away the most common diagnosis. If you look at sleep clinics, 70 to 80% of our diagnoses involve sleep apnea in some form or another. Next would be insomnia, and then you get kind of this significant drop of other hodgepodge diagnoses, whether it's narcolepsy, restless leg syndrome, circadian rhythm disorders, but by far and away, it's sleep apnea.
Marcus Thorpe 2:07
Yeah, I have sleep apnea. Actually. Dr Ko read my sleep study from a while ago, and I've been on my machine ever since I tell you what it it's game changing when you find what's going on and how it's impacting you, and then you're consistent with the machine and doing it the right way. I feel different, and it's been really great. I'm sure you hear that from a lot of people.
Dr. Richard Ko 2:30
Absolutely. So you certainly hear the vocal minority who are having a poor experience with CPAP. So what I tell people when they first get started on CPAP, I tell them, hey, I'll see you in two months. We'll see how things are going. I give them some tips on starting CPAP, but I tell them at that two month fall visit. 10% of people, it's love at first sight, the greatest sleep they ever had. They're mad that they didn't pursue this earlier. 10% of people want to strangle me. But the vast majority of people, 80% of people, there's an acclimation period, typically four to eight weeks, where they just need reps with the CPAP until they get acclimated to It's like wearing glasses or a watch. When you first put on glasses, you're very aware of them. You get headaches. There's blind spots, but then, you know, I can't go day without my glasses anymore.
Lindsey Gordon 3:15
Let's talk about what happens when we're sleeping. Like, why is sleep so vital to how we function.
Dr. Richard Ko 3:22
So a common misconception is that sleep is a very passive process that you just kind of are unconscious and nothing's going on. Nothing could be further from the truth. When you're sleeping, your body is recovering. It's good for everything. Essentially, as you were alluding to, sleep is one of those things that affects everything, affects mental health, affects cognition, cardiovascular health, endocrine health, it boosts your immune system. So all those things are kind of getting reset, and all those things suffer when you're not getting good sleep.
Marcus Thorpe 3:55
Can we talk about disruptors for people's regular sleep? What are we finding that is causing such big bumps in the night, so to speak.
Dr. Richard Ko 4:03
Yeah, so there's two things. There's two ways of looking at that. One would be, if somebody doesn't have any problems with their sleep, they don't have a sleep apnea, for instance, or narcolepsy or something like that, and they're introducing stuff like screens would be the most common thing these days, alcohol, other things that would be disrupting sleep, you know, this day and age, I'd say, but far and away, the screens having two teenagers, I can tell you for sure that that is a big disruptor, where people are staring at the screens right before they go to bed. Guilty, yeah. I think all of us are, you know, and in particularly the kids, the adolescents, you know, I'm just thinking about this on the way over. My daughter probably has five screens in her bedroom, you know, and you try to be a good parent and try to take some of this stuff away, but she's like, Dad, I can't do my homework. Then if you're taking that away, I'm like, That's good point. So, but the screens. Disrupt sleep in so many different ways. The first that I think most people are familiar with is the blue light from any light, whether it's sunlight, by the way, is the most powerful ambient light of the room, or, you know, staring into a screen. So it essentially fools your brain into thinking that it's not time to go to sleep. And so that can cause insomnia in and of itself. Secondly, obviously, the content that you're reading, if you're reading something political, reading something politically charged, it gets you fired up, or super funny or what have you, that certainly can keep you up. And tied to that is dopamine. So anytime you look at your screen, if you eat a great meal, you get the surge of dopey. It's part of this reward circuit in your brain. And when you're looking at a screen, you're getting this feedback mechanism that this is something you want to keep doing. And the moment you put the screen down, the dopamine drops, and so you want to pick it right back up. Dopamine is awake promoting neurotransmitter, so it causes you to stay awake. And in addition to all of that, you have all the anxiety that comes with social media and all that stuff. So there's been multiple studies done at this point where they look at screens, and they certainly are disruptors of sleep. To get back to your original question, both with difficulty falling asleep and difficulty maintaining sleep. You know, I'm seeing these recommendations now where they want kids to spend less than two hours outside of their homework per day on screens. And I was like, oh, that sounds reasonable, but then I think back to our childhood, and like, we had zero minutes of screen time. So it's kind of crazy how our life has adapted with these things.
Lindsey Gordon 6:34
And then life obviously, you know, there's times where, like, you have a newborn and sleep, forget it, right? I my daughter. I love her, but she was a tough sleeper. Didn't sleep for 11 months or the night. And I just remembered, just my judgment was off, like I was driving the wrong way down a one way one day. And just was like, Okay, this is dangerous, you know?
Dr. Richard Ko 6:55
Yeah, when you're sleep deprived for whatever reason, yeah, you'll have these little, what are called micro sleeps, where you actually, kind of, your brain partially goes to sleep for it could just be for a few seconds, but in those few seconds, you know, in a car, that could be 500 feet. You know, it certainly can be a major cause of accidents. It affects your cognition. If we're talking about that with executive functioning, meaning that you could be you think you're fully awake, and you're making a decision, but it's a bad decision because you're not well rested. It affects your memory. A big thing is learning. There's this interesting study done by this guy named David dingus. He's at University of Pennsylvania now, but he used to be at University of Chicago, but he's made a career out of doing research with what happens to individuals when they're sleep deprived. And so he would take individuals that were getting eight hours of sleep per night, would truncate them to six and then to four, and do all kinds of cognition testing on them. When you go from eight hours to six hours after five nights of doing that, and this is like strict where you can't take little naps, they're actually monitoring you for that entire time in the laboratory. It mimics five nights of getting six hours of sleep. Mimics pulling an all nighter when you compare cognition. And if you're getting down to four hours of sleep per night, that happens after just three nights. So I never realized it could add up like that. Yeah. So a lot of people that's a common misconception that, like, if you're getting a little bit of truncated sleep each night. It's not as harmful as just pulling an all nighter or a couple all nighters. It can be equally harmful.
Lindsey Gordon 8:26
Wow. Okay, I have this debate all the time with my husband, Marcus. Do you know what I'm going to ask? It's not in the script, but I'm asking it, do women need more sleep than men?
Dr. Richard Ko 8:35
So when you're talking in broad strokes, because there's obviously individual variations. Women tend to sleep more than men. Women have more insomnia than men. There's gender differences in Sleep Medicine.
Lindsey Gordon 8:52
Interesting. Tell me more.
Dr. Richard Ko 8:54
Yeah, there's different reasons. Yeah, there's different reasons for insomnia women. Number one, there's a series of hormonal changes that women undergo, that obviously men do not the onset of menses, premenstrual syndrome, pregnancy, breastfeeding, perimenopausal state, menopause, they are all associated with hormonal changes, and they're all associated with fragmentation of sleep. So these are unique to women, obviously and certainly put women at risk for higher rates of insomnia. In addition to that, women have twice the likelihood of developing restless leg syndrome, which is a known cause of insomnia, where you just get this irresistible urge to move your legs at night, and there's a circadian rhythm where it happens primarily at night. And so that causes insomnia. It's thought to be due to you know, women being more predisposed for iron deficiency anemia, which can spark Restless Leg Syndrome. So there's an on the male side, you know, if you look at all the epidemiological studies, men have a two to three times more higher prevalence of sleep apnea than women do. But when women hit menopause, interesting. Be interestingly, they catch right up. There's something protective about estrogen with sleep apnea.
Marcus Thorpe 10:05
So you're saying that she needs more sleep than her husband.
Lindsey Gordon 10:10
It's funny, because on the weekends, right? It's like, you know, the elbow you get up with the kids and the dog I need, I need my hour or two more.
Marcus Thorpe 10:17
That's what she's fishing for, hoping that you would say that, let's talk about sleep cycle. Cycles. We hear about them all the time. You know, you hear about rem and you hear about I'm in my deep sleep stage, and all of these different things. Can you walk us through what those cycles are, and then how to recognize if you're not getting enough
Dr. Richard Ko 10:37
Absolutely, so stage of sleep, stage one sleep is very light sleep. Nobody drives a stick shift anymore, but it's like first gear in a car. You're in it for just a short time period. It's there to transition you from wakefulness to sleep. It's just a short amount of time that you're in stage one sleep each night. Stage Two sleep is also considered light sleep as adults, that's where we spend the majority of our sleep, over 50% of our sleep, typically as an adult, is spent in stage two sleep. Stage three sleep is deep sleep. This is the kind of sleep if you have little kids are getting a lot of the sleep. It's where you feel more restorative after you get a lot of slow wave sleep. It's where growth hormone is released. It's where testosterone is released, and it makes you feel really good. If you don't get slow wave sleep, you tend to get little aches and pains as an adult. And then there's what you refer to REM or REM sleep. This is where the vast majority of our dreams happen. If you have a lack of REM sleep that's not medication induced, you tend to have, tend to have a short temper. You get more more snappy, and tend to kind of have a very short temper and get set off really easily. So you typically walk through a series of these stages each night about every 90 to 110 minutes or so, and certain stages of sleep are front loaded, and certain are back loaded. So almost all of our slow wave sleep, the deep sleep, happens in the first third of the night, and then the REM sleep happens in a short burst in the first 90 minutes, and it picks up in intensity. And that's why in the morning, a lot of times, we'll be like I was just in the middle of dream when I woke up, because you're having a lot of REM sleep in the early morning hours. So walking through these stages of sleep is what makes us feel refreshed in the morning. And there's debate, as far as you know, learning what stage of sleep that happens in it's been proposed that REM sleep is where we take information from our RAM memory. You know, your memory on your computer screen, and you download it into your hard drive. During REM sleep, this is where you kind of ingrain learning. And so if you truncate sleep, one of the first things to go is learning tasks and learning things.
Marcus Thorpe 12:48
Such a cool way to put it, to the computerized sense of understanding how it's then being imprinted into your life.
Dr. Richard Ko 12:55
Absolutely, so you know, every day I have a patient show me their Fitbit data, or their Apple Watch data. I was going to ask about this, or the aura ring, yeah, or the aura Yeah, it's another one so, and they asked me about the stages of sleep. First thing I'll say is you have to be careful as far as staging asleep with those devices. To truly stage sleep, you need EEG wires on your head and all that stuff. And obviously you can't really do that with a day to day device. Those devices are using movement of your wrists and hand and a heart rate to kind of guess at what stage of sleep that you're in. There is, from what I hear, a version of the Apple Watch that's coming out that measures body temperature too. That can also be helpful, but those are guesstimates as far as staging of sleep. And the other thing I'd say about that is it's not really helpful to try to shoot for a certain stage of sleep, because you have zero control over that, and plenty of medications affect staging of sleep, and most people are completely unaware of that. For instance, antidepressants suppress REM sleep, and they shove all the REM sleep in the last portion of your sleep cycle all the way towards the morning. So a lot of people will show me this thing and say, I get virtually no REM sleep. And I'll look at their medication list, and it's like, well, that's why something as innocent as ibuprofen or an Advil, it decreases your slow wave sleep. So it's not really helpful to try to shoot for stages sleep, because you have zero control over it.
Marcus Thorpe 14:22
Fascinating.
Lindsey Gordon 14:23
Oh, yeah, I need, like, a second to process that. Because, yeah, I mean, it's, I think about disruptors in my life that caught, like my kids, a glass of wine will cause me to have horrible, you know, I'll be tossing and turning. What are some practical ways, you know, obviously limiting screen time before bed. But, like, what are some other things that can help us get a better night's rest?
Dr. Richard Ko 14:45
Yeah, so great question. So you mentioned the alcohol. So alcohol certainly affects sleep in so many different ways. Number one, a lot of people will use alcohol as sleeping pills, so to speak. If they have insomnia, they'll have. Um, you know, down a glass of whiskey or some wine or something like that. That's actually incredibly common thing. Alcohol will get you to sleep, but about five hours after you drink it, your brain actually withdraws from it. It becomes activating, and people just like, pop out a bit.
Lindsey Gordon 15:15
That's what happens to me.
Dr. Richard Ko 15:16
Exactly like, I'm wide awake. I could start my day right now, but the problem is that eventually catches up with you by the end of the day, and you might be a little bit more testy that day, you know, just because of, you know, like what we'd mentioned before, as far as getting less REM sleep, but also, most people with who drink alcohol, they'll get a little bit of nasal congestion, so that compromises your breathing when you're sleeping, plus the muscles in the back of your throat and your tongue are relaxing, and so you'll have more snoring or obstructive sleep apnea on a given night that you're drinking alcohol. You may know people who only snore when they drink alcohol, and that's the reason why. So there's a myriad of different reasons you know why alcohol can disrupt sleep. Getting exercise is something that you can do that helps sleep. If you get exercise, you don't want to do it right before bed, because it raises because it raises your body temperature. Can cause some insomnia, but getting exercise does improve your ability to fall asleep, and oftentimes stay asleep, so that's something you could do if you're trying to consolidate your sleep and try to get it all in one chunk at night, which is what most people desire daytime napping, could actually, you know, be something that causes insomnia? I think most people have figured this out. You know, you know, patients tell me all the time, why try not to nap? Because I know I can't sleep at night when I do that. So that if you're having problems with insomnia, difficulty falling asleep, or difficulty staying asleep, cutting out naps is some low hanging fruit. So those are certainly things you could do. As far as caffeine goes. We were all just talking about drinking coffee earlier. That certainly can fragment sleep as well. Caffeine has a half life of about six hours. So if you feel like you have insomnia, then you know, I would cut out caffeine a solid eight hours prior to bedtime. If you can.
Marcus Thorpe 17:05
We reached out to our audience on social media, asked if they had any questions, and we did get quite a few. So I want to run a couple of these by you. The first one is, what's the difference between normal, tired versus what might be considered a sleep disorder?
Dr. Richard Ko 17:18
So there's a number of ways to answer that question. The first is looking at your sleep schedule and figuring out how much sleep are you actually getting. If you're fully rested, you're getting a full night's rest every single night, and you feeling you're feeling excessively sleepy, that would be a potential sign that maybe there's something there that you need to investigate further with. You know, the sleep evaluation by sleep medicine specialist or sleep study, that would be one thing, and then listening to your bed partner. Despite most people not wanting to hear this, the bed partner is usually right when they're telling you something about your sleep, whether you're snoring heavily or you're pausing breathing, you know, they're the best person to kind of be a witness and see what's going on, so listening to them. So the combination those two are two things that would be potential signs that, you know, feeling sleep is abnormal.
Lindsey Gordon 18:12
The other question we got from social media was about melatonin. Is it okay to take every night it does, it lose its efficacy over time if you take it every night.
Dr. Richard Ko 18:25
So melatonin is one of those things where, if somebody tells me that it's working for them, like, okay, because it's pretty harmless, and I don't really, you know, try to change it too much, but if you're taking it every night, I think at some point you need to take a step back and say, Why do I need this to fall asleep? And that's when you need to take a step back and figure out if there's another potential underlying reason that you have insomnia that can be addressed, or is there an underlying problem with your sleep itself that needs to be addressed which can cause insomnia? So yeah.
Marcus Thorpe 18:56
And we know a lot of women listen to this podcast, and some of them are pregnant. So we had a question from somebody who is pregnant, asking about, how do I work on getting some normal sleep during pregnancy, and when do I think I might need to go talk to a specialist because I'm not getting enough?
Dr. Richard Ko 19:11
Yeah, so pregnancy can affect sleep in a myriad of different ways. Number one, just the hormonal imbalance that we touched on earlier can cause insomnia. Certainly can make you feel sleepy during the day. I'm sure you guys have had obstetricians on here before, but that first trimester, you know, you know, women obviously feel excessively sleepy due to hormonal changes. There's also increased nasal congestion for most pregnant women, and that can obstruct the airway, just as like we were alluding to with alcohol earlier. And as pregnancy progresses, women can be at risk for sleep apnea as well. For all these reasons, they can develop increased sleepiness, plus insomnia, just the discomfort of you know, as. Pregnancy progresses, just the increasing girth of the abdomen and the baby can certainly contribute. When is it abnormal? I think that's a conversation with the obese as far as figuring out, is this pathologically abnormal, or is this something that is just something you see with pregnancy? I think that's a conversation that's individual to each woman.
Lindsey Gordon 20:23
And then our last question we got from social was, if I have to wake up often to go to the bathroom through the night? You know, it was that, and that's obviously affecting sleep. Yeah, what can be done about that?
Dr. Richard Ko 20:33
So getting up to go pee in the middle of the night is one of the most treatable symptoms of sleep apnea. That's actually a symptom of sleep apnea. So what happens when you have obstructive sleep apnea? And just to be clear, that's when you go to sleep at night. The back of the airway collapses as you're sleeping, so it blocks the flow of air temporarily. So you have problems getting oxygen into your body, your problems clearing carbon dioxide out of out of your body, and there are pressure swings that are happening inside the chest, which aren't good for the heart, because you're trying to breathe through a closed intake valve, so you're opening up the accordion, so to speak, but the intake valve is closed, so you have this box of negative pressure inside your chest, which is tugging on everything. But when the oxygen levels drop at night, your vessels in your lungs, they'll clamp down. So it's kind of like putting your thumb on the end of the hose, so it causes a back pressure on the heart, and the heart, in response to that, releases this hormone called atrial natriuretic peptide that makes you go pee. And so when you treat somebody sleep apnea, it's usually that and snoring are the two things that we see immediately resolve for most individuals.
Marcus Thorpe 21:31
Yeah, I love that you said, you know, listen to your partner, whoever you're in the bed with, because they know what's going on. That's kind of what jump started it for me. You know, my wife was like, You're You're gasping, you're snoring, you need to get it done. Can we talk about sleep studies real quick? For people that don't know what a sleep study is, what they have to do to get it and a lot of times, you can get some coverage from your insurance company on this and then kind of moving forward with whatever the treatment plan is, let's talk about sleep studies.
Dr. Richard Ko 21:59
Absolutely, so in general, there's two kind of big umbrella classifications of sleep studies. There's the traditional in lab sleep studies, which I think a lot of people have in their mind, this going to a lab. Of all these wires hooked up to them, there certainly are a lot of wires, and we do that a small percentage of the time. These days, the vast majority of initial sleep studies are done by at home these days, where you there's a whole bunch of different home sleep studies out there. Some are as simple as wearing a wrist watch that has an extension of an oxygen monitor on your finger. There's one that we commonly use at OhioHealth that has something that looks like a nasal cannula oxygen, but it's not oxygen that measures the flow of air. There's a belt that goes around the chest that measures the effort of breathing. There's an oxygen monitor on your finger, so that's the most common one we use at OhioHealth, but they're usually done at home. Now, unless there's a reason not to and reasons not to do it at home and to do it in the laboratory, would be if someone's on oxygen, if they advanced, if they have advanced cardiopulmonary disease, those would be a couple of different reasons. I won't bore you with the entire list, but yeah, the vast majority of sleep studies these days are home sleep studies initially.
Marcus Thorpe 23:08
Look into it. I think it is something that far too many people sit and wait and go, I don't know about this, like, just figure it out. I mean, I think it's one of those things where it may not be right for you, but it may be just what you're looking for to kind of change your life.
Lindsey Gordon 23:20
Do they do sleep studies for kids?
Dr. Richard Ko 23:21
Absolutely, yeah. Sleep studies for kids are only done in the laboratory, because you might imagine you're probably going to get unreliable data when you are doing it at home? But yeah.
Lindsey Gordon 23:32
When you were describing the peeing overnight. I went into a spiral in my head about my son's is six. He's been snoring. He has, you know, we've been talking with our pediatrician. We have a plan in place for it. But when I was researching this, I was finding that a common thing is bed wetting with the snoring, and that could indicate something. And so when you were explaining that I was just I went into a little spiral in my head, which is why I was quiet.
Dr. Richard Ko 24:02
I'm not. I don't really practice pediatric medicine, but you know, there are some kind of differences in kids and adults as far as apnea. Okay, kids tend to, instead of adults, particularly men, have this classic presentation of heavy snoring, these loud snorting sounds and feeling excessively sleepy, interesting as we're as we're talking about differences in presentation. Women tend to present with more fatigue, more anxiety, more insomnia. When they have sleep apnea, kids, when kids get tired, as you probably know, having kids, they get hyperactive. Yeah, so it's behavioral stuff, typically and oftentimes, getting wet, bed wetting, or getting up to go pee and mill the night is a common symptom for kids, so it presents differently in kids versus adults and men versus women. Classically speaking, not everybody reads the book, but yeah.
Lindsey Gordon 24:54
Right, so interesting. I had to say it in case somebody else was listening and they were on the same spiral I was on Absolutely. Because you never know so interesting. Oh my gosh, we could have you on for an hour.
Marcus Thorpe 25:04
We might sometime. We're gonna bring you back.
Lindsey Gordon 25:06
This is amazing. Thank you so much. Dr Koh, this has really been incredibly helpful. I hope for everyone listening, there's at least one thing you take away from this. Sleep is something so many people struggle with. So your insights make it you know, just everything for everybody.
Marcus Thorpe 25:20
Yep. And if you want to learn more about sleep health or scheduled time with an OhioHealth provider, you can find all that @OhioHealth.com don't forget you can find every episode of The OhioHealth Wellness conversation on Apple podcast, Spotify, or really, wherever you listen. As always, we thank you for joining us, and we'll see you next time.