Sleep Matters Podcast

Dr. Keith Thornton has spent several decades challenging how dentistry thinks about sleep, breathing, and the airway. In this episode, he joins Jason Tierney and Dr. Erin Elliott to look back at the origins of his work and explain why he sees oral device therapy as much more than a dental treatment.

Dr. Thornton traces his approach to his early training in Navy anesthesia, where airway management meant understanding how the jaw, tongue, and surrounding anatomy influence airflow. That experience shaped the way he later approached sleep patients and eventually led him to view devices such as the TAP as tools for managing the airway rather than simply repositioning the teeth or jaw.

The conversation also explores nasal breathing, mouth position, CPAP leak, titration, long-term patient management, and the evolution of dental sleep medicine. Dr. Thornton shares his perspective on where the field has improved, where he believes it has fallen short, and why dentists should think beyond delivering an oral device and instead build systems that follow the patient over time.

What’s on the Menu

• How anesthesia shaped Dr. Thornton’s approach to airway management
• Why he sees oral devices as breathing and airway devices
• Nasal breathing, mouth position, and CPAP leak
• The importance of titration, testing, and follow-up
• Moving from appliance delivery to lifetime airway management

The Value Add

One of the clearest ideas in this conversation is that the device itself is only one part of treatment. Dr. Thornton repeatedly brings the discussion back to airway function, breathing, patient response, and what happens after the device is delivered.

His approach challenges clinicians to think beyond a single intervention and consider how oral devices, nasal breathing, CPAP, testing, follow-up, and collaboration with medical providers can fit into a broader system of care.

Clinical Concepts & Terminology

Airway Management
Dr. Thornton uses this term to describe maintaining or improving an open airway through attention to jaw position, tongue position, breathing, and other anatomical and functional factors.

Physiologic Breathing Device
Keith’s preferred framing for devices designed around breathing and airway function rather than traditional dental or orthodontic concepts alone.

Titration
The process of gradually adjusting an oral device and evaluating the patient’s response rather than assuming the initial position will provide the best outcome.

Mouth Shield
A component discussed by Dr. T that is intended to encourage nasal breathing and reduce mouth breathing while using an oral device.

CPAP Mask Leak
Dr. Thornton discusses both intentional and unintentional air leakage and argues that leakage should be considered when evaluating CPAP tolerance and breathing.

Professional Organizations & Collaboration

The conversation touches on the American Academy of Dental Sleep Medicine, the American Academy of Sleep Medicine, the American Dental Association, dental schools, ENTs, sleep physicians, and primary care providers.

Keith and Erin both emphasize the need to reduce professional silos and create more practical pathways for patients to receive appropriate evaluation, treatment, and follow-up.

Recommended Tools & Topics Mentioned

TAP and TAP-PAP
Devices discussed in relation to airway management, titration, and combining oral device therapy with positive airway pressure.

myTAP
Discussed as an accessible starting point for some patients and as part of a broader treatment pathway.

FlexTAP
Dr. T describes the FlexTAP as a breathing-focused device designed around tongue space, jaw position, and airway function.

Mouth Shield
Discussed as a way to encourage nasal breathing while managing mouth position.

AM Aligner
Discussed in relation to morning bite management after oral device use.

The Big Idea

Dr. Thornton’s central argument is that dental sleep medicine should not stop at delivering an oral device. He believes clinicians should focus on the airway, evaluate how the patient is actually breathing, titrate and test therapy, collaborate when additional treatment is needed, and continue managing the patient over time.

In his view, the goal is not simply to make an appliance. It is to build a system capable of managing the airway throughout the patient’s changing needs.

Sleep medicine has gotten very good at diagnosing conditions. Dr. Dave McCarty thinks the bigger challenge is remembering that the diagnosis is only part of the story.

McCarty started as a primary care internist before finding his way into sleep medicine, eventually training under Dr. Andrew Chesson and becoming deeply involved in the field. But one patient changed the way he thought about care. She had spent years using CPAP because she had been told she had sleep apnea and feared having a stroke. The problem was that her real issue had been missed. She actually had type 1 narcolepsy.

That experience eventually led McCarty to develop what he calls the five-finger approach, a framework designed to keep clinicians from getting trapped by the first diagnosis that seems to fit. Instead of caring for the label, he argues that providers need to keep coming back to the patient's story, asking what still isn't working and what else could be going on.

He also gets into why sleep care needs better communication between physicians, dentists, primary care providers, and other disciplines. McCarty's work with the Empowered Sleep Apnea Project and Rebis Health is built around creating a common language so those different worlds can stop operating in silos and start solving the patient's actual problem together.

The bigger lesson is about agency. The goal shouldn't be getting someone onto a machine or forcing compliance. It's helping people understand their situation, identify their reasons for treatment, see their options, and make an informed decision about what happens next.

What's on the Menu

• How a primary care internist found his way into sleep medicine
• The patient story that led to the five-finger approach
• Why a diagnosis can become a cognitive trap
• The difference between diagnosis-based and narrative-based care
• Why "compliance by coercion" misses the point
• What crows can teach healthcare providers about collaboration
• Bringing dentistry, sleep medicine, and primary care into one conversation

A Few Threads You'll Hear

Don't confuse the diagnosis with the patient. McCarty explains how clinicians can find an answer that seems satisfactory, stop looking, and spend years managing the label instead of revisiting whether it actually explains the patient's experience. His five-finger approach grew directly out of seeing how badly that can go wrong.

Give patients their agency back. The goal isn't simply getting somebody to use CPAP, a device, or any other treatment. McCarty wants patients to understand why they might treat, what their options are, and what matters to them personally. Sometimes an informed decision may even be to do nothing.

Be a crow, not the smartest person in the room. McCarty uses crows as a model for lateral learning. Instead of one expert handing down every answer, he wants clinicians from different disciplines to share a common structure, teach one another, and bring their individual expertise to the same problem.

Different disciplines need a common language. Airway dentistry, traditional sleep medicine, primary care, and integrative medicine often look at the same patient from very different angles. Rebis Health is McCarty's attempt to bring those "rivers" together so treatment planning starts with the whole person rather than whichever silo they entered first.

Resources & Links

• Dr. David McCarty - physician, sleep medicine educator, creator of the five-finger approach, and founder of the Empowered Sleep Apnea Project
• Empowered Sleep Apnea Project - McCarty's educational platform designed to make complex sleep concepts understandable through conversation, storytelling, illustrations, and unconventional teaching
• Rebis Health - McCarty's clinical project focused on creating a common language across sleep medicine, airway dentistry, primary care, and integrative care
• The Beautiful Blue Book - the Empowered Sleep Apnea handbook for patients and the people who care about them, built around the five-finger approach and five reasons to treat
• Empowered Sleep Apnea Presents The Nose Rules - a children's picture book created to start conversations about nasal breathing earlier
• Dr. Andrew Chesson - sleep medicine physician and past AASM president who trained McCarty during his transition into sleep medicine
• Tom Colquitt - early airway-focused dentist McCarty credits with helping shape his appreciation for collaboration between medicine and dentistry..

The Big Idea

Good sleep care isn't about finding a diagnosis and then spending the rest of the patient's life managing that label. It's about continuing to ask whether the story still makes sense.

Listen to the patient. Understand their reasons for treatment. Expect more than one moving part. Bring the right disciplines into the conversation. Then give the patient enough understanding to decide what they want to do next.

As McCarty puts it: “My goal is not to get you onto a machine, my goal is to help you find your agency.”

Press play.

Sleep apnea, for sleep professionals, feels EASY to diagnose - but what about when it isn’t cut and dry? For patients who don't fit the stereotype, don't respond perfectly to CPAP, or need more than one provider involved in their care, the path can feel impossible.

Emma Cooksey spent roughly a decade living with undiagnosed obstructive sleep apnea. She was exhausted, waking with headaches, struggling to stay awake, and treating anxiety and depression without getting to the underlying problem. It wasn't until she fell asleep at the wheel with her newborn baby in the car that she finally received a referral to a sleep specialist and got diagnosed.

In this episode, Emma joins Jason Tierney and Dr. Erin Elliott to share how her experience eventually led to Sleep Apnea Stories and her advocacy work with Project Sleep. What started as a podcast became a much broader look at the gaps patients face, from insurance problems and disconnected providers to limited awareness of treatment options beyond CPAP.

They also get into one of the biggest disconnects in sleep care: what the numbers say versus how the patient actually feels. Emma explains why a great AHI or strong CPAP data doesn't necessarily mean the patient feels great, and why clinicians need to ask what outcome the patient is actually looking for instead of assuming the metric tells the whole story.

The bigger lesson is about creating a system that works for real people. That means breaking down silos between providers, making more treatment options accessible, educating primary care providers, listening to patient experiences, and ensuring people can see themselves represented in the sleep apnea conversation.

What's on the Menu

• Emma's 10-year journey with undiagnosed obstructive sleep apnea
• Why sleep symptoms can be mistaken for anxiety, depression, or personal failure
• What happens when patients need options beyond CPAP
• Why great sleep data doesn't always mean a great patient outcome
• The importance of asking patients what success actually looks like
• Breaking down silos between sleep physicians, dentists, and other providers
• How Project Sleep is working to challenge stereotypes and expand awareness

A Few Threads You'll Hear

Listen to the patient, not just the numbers. Emma spent years telling her sleep specialist that she was still significantly sleepy while being reassured that her CPAP data looked great. Her point is simple: good numbers matter, but the person sitting in front of you matters too.

Patients need more than one pathway. CPAP worked well enough for Emma to make a major difference, but it wasn't the end of her treatment journey. She explains how difficult it can be to coordinate multiple treatment options across providers, even when you have knowledge, resources, and connections.

Stop deciding who "looks like" they have sleep apnea. Emma's Sleep Apnea: Let's Face It campaign is built around breaking the stereotype of who gets the condition. Patients are still avoiding testing, and even being dismissed by providers, because they don't fit the expected profile.

Patient voices can change the system. Through Project Sleep, Emma has moved from sharing her own story to helping other patients speak up, educating providers, advocating for research and funding, and pushing for patients to have a seat at the table when sleep care is being shaped.

Resources & Links

• Emma Cooksey - sleep apnea patient advocate, creator of Sleep Apnea Stories, and staff member with Project Sleep
• Project Sleep - patient advocacy nonprofit supporting education, awareness, research advocacy, and programs for people living with sleep disorders
• Sleep Apnea: Let's Face It - Project Sleep awareness campaign focused on challenging stereotypes around who can have sleep apnea
• Sleep Apnea Squad & Coffee with Emma - free Project Sleep education and support resources for people navigating sleep apnea care

The Big Idea

Sleep apnea care can't stop at getting the diagnosis, handing someone a CPAP, or bringing their AHI down. The real question is whether the patient is getting the outcome they need.

Ask how they're functioning. Ask what they're still struggling with. Make sure they understand their options. Build relationships with other providers so patients aren't left to connect the dots on their own.

As Emma puts it: “This journey was hard enough for me, but for most people out there, it's impossible. So we have to do better.”

Dentists have a habit of making sleep harder than it needs to be. They get buried in medical insurance, device details, referrals, and clinical workflows before they've even figured out how to consistently get patients tested.

Dr. Tarun Agarwal has spent years building a successful sleep practice and teaching others how to add sleep into their general practice, and his approach is refreshingly direct: treat it like a real business inside your business. In this episode, he joins Jason Tierney and Dr. Erin Elliott to break down why so many dentists never get their sleep program off the runway.

For Tarun, success didn't happen in the first few months. It took six months, nine months, even a year before the program started gaining real traction. Instead of squeezing sleep between existing appointments, he funded it like a startup, gave a team member ownership, and built a process that could eventually run with very little intervention from him.

They also get into one of dentistry's biggest blind spots: money. Tarun explains why dentists shouldn't make financial decisions for their patients, why leading with insurance often creates unnecessary friction, and why understanding the patient's real reason for wanting treatment matters more than explaining every clinical detail.

The bigger lesson is about how dentists define success. You don't need to become a sleep-only practice or match the biggest names in the industry. Sometimes success is adding a few thousand dollars, stacking small wins, and building something sustainable over time.

What's on the Menu

• Why dentists overcomplicate sleep before they ever get started
• The runway most practices underestimate when building a sleep program
• Treating sleep like a startup inside your existing practice
• Why financing belongs in the treatment conversation
• The difference between a chief complaint and a chief disability
• Why your team shouldn't be asked to "sell" sleep devices
• The comma-not-decimal mindset for making better business decisions

A Few Threads You'll Hear

Give the program a real runway. Tarun didn't see meaningful success overnight. He explains why sleep needs time, resources, clear goals, and someone who actually owns the process, rather than trying to squeeze it between other responsibilities.

Stop making financial decisions for patients. Patients may have insurance and still choose to pay. Tarun's approach is to explain the benefit, present the price, offer monthly payment options, and let the patient decide what works for them.

Find the chief disability. The clinical details matter, but they're rarely what moves someone to act. Tarun explains why the better question is how sleep is affecting the patient's actual life, whether that's getting kicked out of the bedroom, feeling exhausted, or wanting to be around for their kids.

Think in commas, not decimals. Dentistry can get obsessed with saving a few dollars while missing much bigger opportunities. Tarun shares the mindset his father taught him: stop chasing home runs, stack smaller wins, and make decisions based on the bigger picture.

Resources & Links

• Dr. Tarun Agarwal - practicing dentist, practice owner, educator, and co-host of sleep apnea implementation training through 3D Dentists
• Dr. Erin Elliott - general dentist and dental sleep educator who teaches alongside Dr. Agarwal through 3D Dentists
• 3D Dentists - referenced throughout the episode for its sleep apnea training and business education
• Paul Homoly - credited by Dr. Agarwal for the concept of focusing on a patient's "chief disability" rather than only the traditional chief complaint

The Big Idea

Sleep doesn't fail because dentists can't learn the clinical side. It fails when they treat it as an occasional procedure rather than something that requires attention, ownership, and time.

Give it a runway. Put someone in charge. Get more patients tested. Understand what actually matters to them. Then let the process build.

As Tarun puts it: if you treat it like a stepchild in the practice, you will get stepchild results.

Press play.

Most dental sleep courses are built for sleep-only practices. So when a general dentist tries to copy that model, the workflow buckles, the team stalls, claims get denied, and less than 5% ever make it off the starting line.

Dr. Erin Elliott runs a thriving general practice and treats a lot of sleep. In this episode, she and Jason Tierney get into what actually works when you want to do both, and why the way most dentists start almost guarantees they'll quit.

Her first year? Three appliances. Then she stopped forcing the sleep-only playbook and built a process that fit a general practice. She talks through the long runway it takes, why leading with insurance is a trap, and how she went from three cases a year to blocking off whole days for sleep.

The turning point wasn't a system or a billing hack. It was getting out of her own way and handing the program to a sleep champion who owned it, plus a hard look at the small early mistakes that were quietly killing case acceptance.

If you want to treat more sleep patients without going all-in on sleep, this one's for you. And if you're weighing full-time sleep, you'll hear the other side of that argument too.

What's on the Menu

• Why less than 5% of practices ever get their sleep program off the ground
• The one thing to stop leading with, and what to lead with instead
• Building a workflow that fits general dentistry instead of fighting it
• The hire that changes everything, and where to find them
• The early mistake that was quietly killing her case acceptance
• Reading a sleep study so the patient has the light-bulb moment
• When medical insurance actually belongs in the picture

A Few Threads You'll Hear

Give it a long runway. Sleep isn't a graft class you implement the Monday after. Dr. Elliott explains why the practices that quit almost always quit right before it clicks.

Lead with value, not insurance. An oral appliance can look like a piece of plastic or like a life back. The difference is entirely in how the conversation is run, and that's a soft skill most dentists were never taught.

Make it team-led. The dentist can't be in every op at once. Hear how she got hygienists, assistants, and the front desk speaking about sleep with real confidence, starting with the team's own families in the chair.

Find your sleep champion. The single biggest unlock in her practice, usually someone promoted from within, given autonomy and the freedom to fail.

Resources & Links

• Dr. Erin Elliott — speaker, educator, and dental sleep bio:https://www.erinelliottdds.com/
• Sleep Apnea Implementation Course (Dr. Elliott's hands-on training, via 3D Dentists):https://www.3d-dentists.com/courses/sleep-apnea-implementation
• Dr. Tarun "T-Bone" Agarwal / 3D Dentists — credited for the "don't give away sleep studies" lesson, and a future guest:https://www.3d-dentists.com/
• Episode 18 with Dr. Mark Murphy — the communication and body-language conversation Dr. Elliott references: https://open.spotify.com/episode/1UiyHJMcTBgwMJ2rnwZCTA?si=6465280bef01484d

The Big Idea

You don't need a sleep-only practice to change lives. You need a reason to help, a realistic runway, and a team that owns it.

Even three to five cases a month is a handful of people who sleep better, and who tell everyone they know.

Dr. Elliott's challenge to every dentist on the fence: if not us, who?

Press play.

Dentists take the course. Fill the notebook. Nod at all the right moments.

Then they go home and do nothing with it.

Dr. Jamison Spencer has watched that happen for 25 years, and in this episode he tells Dr. Erin Elliott and Jason Tierney exactly why it keeps happening. Along the way: PRF and why he refuses to stop talking about it, the fear that keeps good dentists from helping obvious patients, an AADSM membership number that should bother all of us, why direct-to-consumer companies aren't the villain, and his new book, which he cheerfully calls a cookbook.

Fair warning. If you've been getting ready to get ready on dental sleep medicine, this one stings a little.

What's on the Menu

• The myth of "20 years of experience"
• PRF, and why there's no smoke and mirrors
• Why courses don't change practices
• The "what ifs" that stop good dentists cold
• 3,000 members. 200,000+ dentists.
• Direct-to-consumer as proof of demand
• Treat 100 people before you touch insurance
• Practical Dental Sleep Medicine (free audiobook code inside)

"20 Years of Experience" Is Sometimes One Year, Twenty Times

Spencer's been saying it for years:

"There's a big difference between 20 years of experience and one year of experience repeated 20 times."

He watched it play out when sleep showed up. A chunk of the TMD world called it a fad and put their heads down. The people paying attention noticed that a lot of TMJ patients also had sleep apnea, and you can't unsee that.

Then he nearly did the exact same thing to himself.

A Spencer Study Club member kept pushing him to look at PRF. Spencer had lived through prolotherapy, wasn't impressed, and blew him off. The guy kept coming back. Spencer finally bought the book, went into the literature, found more evidence than he expected, and started doing it.

Twenty-five years in and he still got talked out of a position he was certain about. That's the point.

PRF: No Smoke and Mirrors

The thing Spencer likes most about PRF is how boring the mechanics are. Draw the patient's blood. Spin it in the centrifuge, in the room. Put it back in the same patient.

"There's no smoke and mirrors."

Nobody disappeared into a back room. Nothing got switched. No sourcing questions about whose cells these were.

The part that got his attention: it doesn't seem to depend on whose hands are doing it. Dentistry is full of techniques that work beautifully for one gifted operator and nobody else. Spencer says roughly 150 to 200 dentists have now been taught to perform PRF injections and the reports keep coming back the same. He's careful not to oversell it, and then he tells you about patients who were quoted joint replacement as their only remaining option and are now pain free without it.

Erin's a believer for personal reasons. Golf gave her a bilateral tennis elbow bad enough that she stopped doing extractions and could barely lift a glass. She got injected, was told to skip the ibuprofen for eight weeks, and at week seven she was ready to call it a failure. Then it was gone. It hasn't come back.

Meanwhile most orthopedic surgeons have never heard of PRF. Spencer describes a hand surgeon calling it “fringy” in one sentence and mentioning a friend from training who does nothing else in the next.

Square that circle.

What Actually Separates the Dentists Who Make It

Jason asked what the successful dentists have in common. Spencer pointed at Erin.

She heard about something. She took the course. Then she scheduled a patient.

That's it. That's the whole differentiator.

"I know I don't know everything, but I know enough to get started."

Erin books a patient for the week after any CE course, before she takes it. Reduced fee or free. Ready to go.

Spencer's least favorite question from a dentist who just took his course is what he charges for the procedure. His standard answer:

"When I used to suck like you do, I charged a lot less."

He's joking. Mostly.

The "What Ifs" Are Doing More Damage Than the Procedures

Erin has a name for it. Dentists get a case of the what ifs. They think through every terrible outcome before they think through a single good one, and they talk themselves out of helping someone.

She posted about using an ampule to reduce the gag reflex and got a wave of questions behind the scenes. Did they sign a consent? Do you have acupuncture licensure? Her guess about where those questions were coming from was correct.

Here's the kicker: Spencer got licensed as an acupuncturist in Idaho because he thought he had to. His license lapsed by accident. He went in front of the Board of Dentistry to plead his case, and they asked him who exactly told him a dentist couldn't do this for dental purposes.

Then there's the one that should be embarrassing for all of us. A meaningful number of dentists believe that making an oral appliance for themselves without a physician's prescription is an FBI-level crime.

To be clear, none of this is an argument for practicing outside your training. Spencer is the guy moving toward ultrasound guidance specifically so that nobody he's ever taught calls him with a board complaint. Safety is the whole reason he's careful.

Anxiety isn't the same thing as safety. His reality check on oral appliance therapy:

"How many people have I killed with oral appliance therapy? Zero."

"I Can't Do Sleep Because of Medical Billing"

Erin's rebuttal is the best one in the episode.

Practices sell clear aligner therapy at $5,000 all day long without flinching. Nobody looks at the trays and asks how a piece of plastic costs that much. Somehow the same practice can't say $2,500 out loud for a device that treats a life-threatening condition.

Spencer got a call from a boutique concierge practice in Georgia saying medical billing was the reason they couldn't do dental sleep medicine. His question back was why they could talk to patients about every other thing in the practice.

Some of the blame lands on the education side. When someone at a podium describes Medicare and insurance policy in the same tone they'd use for board-of-dentistry law, dentists leave the room believing they'll get in trouble for things that aren't illegal.

Time is the other excuse. Erin's answer is to look at what the time is actually going toward. If you can't find an afternoon to train your team or treat one patient, look at what's on the schedule instead.

3,000 Members. 200,000+ Dentists.

Jason went to his first AADSM meeting in 2006, when the organization was proud of having 1,000 members. Today it's somewhere around 3,000. Spencer notes it's been roughly 3,000 for years, because about as many people leave every year as join.

There are more than 200,000 dentists in the United States. The AADSM is a worldwide organization.

Spencer's not guessing about the opportunity. Working with a DSO in North Carolina, he'd see one or two dead-obvious cases in the morning and one or two in the afternoon. Not "I wonder if." Snoring, bed partner has watched them stop breathing, the whole picture.

...

In this episode, Dr. Erin Elliott and Jason Tierney sit down with Dr. Madan Kandula to explore a part of airway care that too often gets overlooked: the nose.

Dr. Kandula is a board-certified ENT and the founder/CEO of ADVENT, an ENT practice built around treating airway concerns across what he calls the "breathing triangle." In just a few years, what started as a single location in Milwaukee has grown into 40 clinics across 6 states.

The conversation makes the case that nasal breathing is one of the foundations of successful sleep treatment. Dentists are often the first to notice nasal obstruction in their patients, but the field hasn't always given them a clear next step or a trusted ENT partner to hand it off to. Dr. Kandula explains how improving nasal function can help patients better tolerate and benefit from CPAP or oral appliance therapy, and how the right partnerships can close that gap.

This one is for anyone who has ever spotted an airway problem they weren't equipped to solve alone.

What's on the Menu

• Why nasal breathing is essential to airway health
• Understanding the breathing triangle
• Expanding access to nasal and oral appliance treatment
• Strengthening collaboration between dentists and ENTs
• Balancing clinical quality, growth, and mission

The Breathing Triangle
Dr. Kandula describes the breathing triangle as a simple framework for understanding the airway.

The two nostrils form the top points of the triangle, and the back of the throat forms the bottom point. Together, these areas represent the three passages through which a person can breathe.

Patients dealing with snoring, sleep apnea, nasal obstruction, or recurring sinus concerns may have problems in more than one part of this connected system. Treating the throat without evaluating the nose can leave an important part of the airway unaddressed.

The framework gives patients and providers a clearer way to see how the nose and throat work together.

Nasal Breathing as the Foundation

Dentists working in airway care already understand how much nasal breathing matters. What's often missing is a clear path for what to do once a concern is identified.

Without a trusted ENT who understands sleep, oral appliances, and collaborative care, a provider may have little choice but to note the obstruction and move forward with treatment.

Dr. Kandula argues that nasal breathing can play a major role in maximizing the effectiveness and tolerability of both CPAP and oral appliance therapy. His goal with ADVENT has been to provide patients access to effective outpatient nasal and sinus treatments while partnering with dentists who provide OAT.

Good breathing starts with nasal breathing.

Simple Solutions Before Bigger Surgery
One of ADVENT's central principles is to start with the simplest appropriate treatment.

Dr. Kandula explains that many nasal and sinus procedures can be performed in the office under local anesthesia. Depending on the patient, these may include turbinate reduction, treatment of the nasal swell body, or balloon sinuplasty.

The point isn't to claim every patient can avoid an operating room. It's to make sure patients have access to less invasive options before moving straight to more intensive surgery.

Dr. Kandula describes this as harvesting the low-hanging fruit first. Address the internal obstruction, evaluate the result, and move further up the treatment ladder only when necessary.

Nasal Collapse and Root Causes
The same principle applies when a patient experiences nasal sidewall or valve collapse.

External nasal dilators and similar products can provide relief in the right situation. But Dr. Kandula cautions against assuming the visible collapse is the only concern.

Internal narrowness may be increasing the effort required to breathe through the nose. Treating that internal obstruction first can reduce or eliminate the collapse without requiring additional treatment to the nasal valve.

When the valve still needs support, options may include radiofrequency treatment to stiffen the cartilage or a small dissolvable implant placed beneath the tissue.

The sequence matters: identify the root cause, begin with the simplest effective option, and escalate only when needed.

Oral Appliance Therapy and Access
Oral appliance therapy has an important place within ADVENT's breathing triangle approach.

Opening the nasal passages can improve breathing, but it doesn't automatically resolve the throat-related obstruction associated with sleep apnea. Patients may still need CPAP, an oral appliance, surgery, or another appropriate treatment.

As ADVENT expanded, partnering with local sleep-focused dentists became more complicated and difficult to scale. The availability and experience of potential partners varied from one market to the next.

That raised a bigger question: how can an organization consistently provide appropriate oral appliance therapy across dozens of locations without sacrificing quality?

Dr. Kandula doesn't claim to have the final answer. He describes it instead as an ongoing effort to expand access while continuing to work with capable clinicians, companies, and technologies.

The Direct-to-Consumer Debate
The conversation also takes on direct-to-consumer oral devices.

Dr. Kandula views these companies as attempts to solve a legitimate problem: many patients simply don't have access to oral appliance therapy. Their goal of expanding access has real value, even when providers disagree with how the service is currently delivered.

Jason adds an important distinction. The goal of delivering treatment at scale may be admirable, but some current models raise concerns about impressions, clinical oversight, fit, and the quality of care.

The challenge isn't choosing between access and quality. It's building a model capable of delivering both.

Collaboration Across ENT and Dentistry
Dr. Kandula believes sleep and breathing concerns give ENTs a real opportunity to make a difference in patients' lives. Yet many specialists stay focused on the narrower set of procedures they were trained on.

Dentists can find themselves in the same position, and for the same understandable reason.

A general dentist may be comfortable providing a familiar appliance, while sleep testing, airway evaluation, medical collaboration, and long-term follow-up sit outside the systems the practice was built around. That's a training and infrastructure gap, not a lack of ability.

Better airway care asks professionals on both sides to look beyond their own corner of the problem. Dentists need dependable partners for nasal and sinus concerns. ENTs need to recognize when a patient may benefit from oral appliance therapy or another sleep-focused intervention.

Patients do better when the providers responsible for the nose, throat, teeth, and sleep condition stop treating those areas as separate territories.

Retraining Mouth Breathing
Opening the nose doesn't automatically undo a long-standing mouth-breathing habit.

A patient may have relied on mouth breathing for years because nasal breathing was difficult or impossible. Once t...

In this episode, Dr. Elliott and Jason Tierney sit down with Dr. Mark Murphy to discuss the skill no one wants to talk about that goes ignored at your detriment: communication.

Dr. Murphy has spent more than 30 years in dental sleep medicine, from teaching alongside Dr. Keith Thornton at the Pankey Institute to practicing in Michigan, working in education, and helping launch a sleep program at the University of Detroit Mercy School of Dentistry.

The conversation centers on Dr. Murphy’s “learning ladder,” a framework for helping patients move from being unaware of a problem to understanding it, becoming interested in it, building trust, and eventually deciding what to do next.

Too often, dentists identify a concern and immediately jump to the solution. They explain testing, treatment, or devices before the patient fully understands why the issue matters. Dr. Murphy explains why better conversations begin with questions, listening, and helping patients discover the concern for themselves.

This episode also tackles the discomfort many dentists feel around selling. The hosts argue that presenting a meaningful health solution is not pressure or manipulation. When communication is rooted in care, the goal is not simply to close a case. It is to help someone make an informed decision that may improve their health.

What’s on the Menu

• Dr. Murphy’s career journey and lessons from dental sleep medicine
• Bridging the gap between clinical expertise, communication, and business leadership
• Building patient trust through education, questions, and the Learning Ladder
• Improving case acceptance through needs-based conversations
• Strengthening physician relationships and team performance

The Learning Ladder
Dr. Murphy describes a series of steps patients move through before they are ready to accept a recommendation:

• Unaware: The patient does not recognize the concern.
• Aware: The patient begins to understand that a problem may exist.
• Interested: The patient wants to know more about how it affects them.
• Trust: The patient believes the provider understands the issue and cares about their health.
• Commitment: The patient asks what they should do next or shows readiness to act.
• Solution: The provider recommends testing, treatment, or another appropriate step.

The mistake many dentists make is moving directly from awareness to the solution. The patient has not yet had time to understand the concern, become interested, or trust the recommendation.

Co-Discovery
Instead of overwhelming patients with information, Dr. Murphy encourages dentists to ask questions that help patients connect the dots themselves.

The provider and patient discover the problem together. This makes the conversation feel collaborative rather than like a lecture or sales presentation.

Ethical Selling
The group reframes selling as helping someone move toward a solution that may improve their health.

Dr. Murphy explains that he would not feel comfortable using sales skills to promote something harmful. But he can get excited about helping someone say yes to testing, better health, or a device that may support their airway.

As Dr. Elliott puts it, when you do the right things for the right reasons, the money follows.

Needs-Based Communication
The learning ladder also applies to physician relationships.

Rather than walking into a referral meeting and immediately explaining what the practice offers, Dr. Murphy recommends beginning with questions:

• What are you currently doing?
• What is working well?
• What do you wish worked better?
• Who is involved in the decision?
• Is there a solution we can provide that addresses that need?

This keeps the conversation focused on the physician, their patients, and their workflow rather than on the dentist’s desire for referrals.

Professional Organizations & Collaboration

The Pankey Institute
Dr. Murphy originally attended the Pankey Institute expecting advanced technical training. Instead, he found a broader focus on communication, personal philosophy, relationships, and building a balanced career.

The experience helped shape his belief that clinical excellence alone is not enough. Dentists also need to understand people.

University of Detroit Mercy School of Dentistry
Dr. Murphy helped establish a sleep program at his alma mater that included student education and clinical experience for orthodontic residents.

He also explains why sleep remains difficult to fit into dental school curricula. When a topic is not included on board examinations, schools have little accountability for it or space to teach it within an already crowded curriculum.

Physician and Team Collaboration
Better communication is just as important with referral partners and team members as it is with patients.

Physicians are more likely to collaborate when dentists begin by understanding their needs. Team members are more likely to grow when leaders provide clear expectations, useful feedback, and the freedom to make honest mistakes.

The Big Idea
Communication is not an optional soft skill. It is part of good patient care.

Dentists spend years learning science, clinical techniques, and how to work inside a small clinical space. Then they graduate and are expected to lead teams, build referral relationships, discuss money, earn trust, and help people make important health decisions.

Those skills do not appear automatically.

The answer is not to educate harder or talk longer. It is to understand where the other person is on the learning ladder.

Create awareness before presenting the answer.

Build interest before asking for action.

Earn trust before offering the solution.

Whether the conversation is with a patient, physician, or team member, the same principle applies: ask better questions, listen carefully, and help people take the next right step.

In this episode, the co-hosts take a step back and tell you who they are, how they got here, and why Sleep Matters.

Jason's path into dental sleep started nearly 20 years ago at a large dental lab. Early demand for snore devices sent him down a rabbit hole that never ended — device inventors, sleep labs, key opinion leaders, CE courses, software, publishing, and eventually Transform Dental Sleep, an annual meeting built around one core idea: practical education that actually works in the real world.

Erin's story is even better. From Orange County to Houghton College to Creighton Dental School to a practice in Post Falls, Idaho — she heard a sleep physician and Dr. Jamison Spencer speak at the Idaho State Dental meeting and it clicked. Even after a consultant told her "this doesn't work," she pushed forward. She figured out medical billing, built sleep into her practice from the ground up, and eventually started teaching other dentists how to do the same.

This episode sets the tone for everything the show is building: honest stories, real implementation, and a simple filter applied to every conversation — So what? Now what?

What's on the Menu

• Who they are and how they got here — Jason's path through dental labs, devices, and education; Erin's path through dental school and a practice in Idaho
• Why sleep matters — Drowsy driving, sleep deprivation, and why this field is bigger than most dentists realize
• Transform Dental Sleep — What it is, why Jason built it, and what makes it different
• Erin's lightbulb moment — The state dental meeting that changed her dental career
• Real-world implementation — Medical billing, home sleep testing, physician relationships, and making it work in an actual practice
• The "So what? Now what?" framework — The filter Jason and Erin apply to every guest and topic on the show
• Building a career worth having — Why dental sleep medicine can make dentistry more rewarding and more sustainable

Clinical Concepts & Terminology

• Dental Sleep Medicine — The area of care where dentists help identify and manage sleep-related breathing concerns through screening, education, devices, and collaboration with physicians. This is the world both hosts have built their careers around.
• Sleep Apnea — The central clinical issue that pulled both Erin and Jason deeper into the sleep world and the condition driving most of the work dentists can do in this space.
• Oral Sleep Appliances — Jason walks through early experience with devices like TAP and EMA and explains how these tools introduced many dentists to sleep-related care long before it became mainstream.
• Home Sleep Testing — Erin's practice invested early in a home sleep test unit. She explains how it became a key part of building a real sleep workflow rather than just referring patients out.
• Medical Billing — One of the biggest implementation hurdles in dental sleep, and one of the first things Erin figured out in her own practice and later built into her two-day course for other dentists.
• CE and Practical Education — Both hosts push hard for education that skips the theory and hands dentists something they can actually use on Monday morning.

Professional Organizations & Collaboration

• Transform Dental Sleep — Jason's annual meeting focused on bringing experienced, practical, and engaging voices in dental sleep medicine together for education that moves the needle.
• Post Falls Family Dental — Erin's practice in Idaho, where she proved the concept in a real clinical setting before ever teaching it to anyone else.
• Idaho State Dental Meeting — Where Erin first heard Jamison Spencer and a sleep physician speak, setting off a chain of events that reshaped her entire career.
• Dental Sleep Community — The educators, clinicians, vendors, physicians, and colleagues across the industry who have helped shape both hosts' paths — and who show up throughout the show.

The Big Idea

Sleep affects nearly everything. And dentists have a real shot at being part of the solution.

That's the premise behind Sleep Matters, and it's what this episode is really about. Jason came to dental sleep through labs, devices, and education. Erin came through clinical practice and figuring it out in real time. Different paths, same destination: this work matters, and most dentists are still leaving it on the table.

Sleep Matters isn't here for abstract ideas or academic conversations. It's here to give listeners the so what and the now what — every episode, every guest, every topic. Knowing something is interesting is fine. Knowing what to do with it is the whole point.

In this episode of Sleep Matters, Dr. Erin Elliott and Jason Tierney are joined by inventor Jim Marsh and sleep researcher Dr. Poppy May Gardiner to explore an unconventional but increasingly talked-about sleep technology: SleepVibe.

Jim Marsh, a mechanical engineer turned sleep device inventor, shares the touching personal story that led him to develop SleepVibe after a period of extreme sleep deprivation while caring for his wife. What began as experimentation with binaural beats and low-level magnetic fields evolved into a simple bedside device designed to support sleep without sound, wearables, or medication.

Dr. Poppy May Gardiner brings a research lens to the conversation, discussing how her team is currently conducting early-stage trials in shift workers using validated sleep surveys and research-grade actigraphy to better understand outcomes beyond anecdotal reports.

Throughout the discussion, the group explores binaural beats, brainwave entrainment, magnetic field stimulation, and how emerging sleep technologies compare with existing approaches such as white noise, vagus nerve stimulation devices, and clinical interventions like TMS (transcranial magnetic stimulation).

The conversation balances personal experience, early user feedback, and scientific caution, raising important questions about how sleep technologies should be evaluated, validated, and communicated to clinicians and patients alike.

What’s on the Menu:

• Origin Story: Severe caregiver sleep deprivation led Jim Marsh to develop SleepVibe, a prototype utilizing binaural beats and low-level magnetic fields.
• Binaural Beats: The group explains how presenting different frequencies to each ear creates a perceived third frequency, impacting sleep and mood.
• Magnetic Stimulation: Marsh transitioned from audio to silent, low-power magnetic fields, inspired by low-intensity transcranial magnetic stimulation (TMS).
• Research Status: Dr. Gardiner notes that while literature exists, her team is currently gathering controlled data from healthcare shift workers.
• Placebo Testing: Marsh’s informal A/B testing with blinded users showed improvements only with active devices, not placebos.
• Cognitive Impact: The discussion covers how sleep loss impairs memory, emotional regulation, and overall cognitive performance.
• High-Risk Populations: Dr. Gardiner focuses on ongoing clinical trials assessing sleep quality and daytime function in shift workers.

Professional Organizations & Collaboration:

• Washington State University – Dr. Poppy May Gardiner’s research affiliation
• SleepVibe – Developed by Jim Marsh as a consumer sleep technology based on binaural beats and low-level magnetic fields
• Ongoing clinical-style trials in shift-working healthcare populations using actigraphy and validated sleep questionnaires
• Collaboration between engineering, clinical dentistry, and sleep research to evaluate non-pharmacologic sleep interventions

The Big Idea:

Sleep is not just a passive biological process; it is deeply tied to cognition, emotional regulation, and overall health. While traditional sleep medicine focuses on airway, behavior, and pharmacology, a growing wave of consumer technologies seeks to influence sleep through neurophysiological pathways such as sound-frequency entrainment and low-level magnetic stimulation.

This episode highlights both the promise and the caution needed when evaluating emerging sleep tools. Personal experience and early user feedback can be compelling, but rigorous clinical validation is essential before drawing conclusions about efficacy.

Ultimately, the conversation underscores a broader shift in sleep health: from isolated treatments to an ecosystem approach that combines airway management, behavioral interventions, and emerging neurotechnology to pursue better, more restorative sleep.

In this episode, Dr. Anthony Bolamperti joins Dr. Erin Elliott and Jason Tierney to talk about how laser dentistry transformed his practice, why tethered oral tissues are often overlooked in sleep medicine, and how functional frenuloplasty can become a powerful tool for treating airway patients.

After years of trying different laser systems and struggling to find the right technology, Dr. Bolamperti built a niche practice in Omaha, Nebraska, centered on airway health and treatment of tethered oral tissues via laser dentistry for both children and adults. The conversation explores how laser dentistry evolved from restorative procedures into a full-body, airway-centered approach to patient care.

Dr. Bolamperti explains the difference between a superficial tongue-tie release and a true functional frenuloplasty, why myofunctional therapy is essential for long-term success, and how dentists can begin to recognize airway signs they may have previously missed during routine exams.
This episode is especially valuable for dentists interested in airway management, laser dentistry, sleep medicine, tethered oral tissues, or in building a more comprehensive and less invasive approach to patient care.

What’s on the Menu:

• How Laser Dentistry Changed His Practice: Dr. Bolamperti shares how years of trial and error with different laser systems eventually led him to build Omaha Laser Dentistry into a thriving airway-focused practice.
• Why the Right Technology Matters: The conversation explores how different laser wavelengths interact with tissue differently, and why understanding the science behind the technology is critical before investing.
• From Drill, Fill, and Bill to Airway-Focused Dentistry: Dr. Bolamperti reflects on moving beyond traditional restorative dentistry into a practice centered around sleep, breathing, and functional health.
• The Difference Between a Frenectomy and Functional Frenuloplasty: He explains why many tongue-tie procedures fail because they remain superficial and do not address deeper fascial restrictions.
• Why Myofunctional Therapy Is Essential: Dr. Bolamperti discusses how myofunctional therapists help retrain tongue posture, breathing patterns, and muscle function before and after treatment.
• How Tethered Tissue Impacts Sleep & Airway: The episode dives into how low tongue posture, mouth breathing, and restricted tongue mobility can contribute to airway obstruction and poor sleep quality.
• Educating Patients on Why They Have Sleep Apnea: Rather than simply prescribing a CPAP or oral appliance, Dr. Bolamperti focuses on helping patients understand the anatomy and root causes behind their sleep-disordered breathing.
• Signs Dentists Should Look for During Exams: The hosts discuss common airway indicators, including scalloped tongues, excessive rugae, anterior wear patterns, tori, mouth breathing, dry mouth, and low tongue posture.
• Why Patients Are Seeking Laser Dentistry: Dr. Bolamperti shares how patients increasingly seek less invasive, less traumatic alternatives to traditional dental procedures, especially treatments that reduce the need for anesthesia and improve comfort.
• The Business Impact of Becoming “The Laser Dentist”: By creating a unique niche around laser dentistry and airway care, Dr. Bolamperti has attracted patients from across the region seeking specialized treatment.
• Hands-On Training for Dentists: Dr. Bolamperti discusses his small-group courses in Omaha, where dentists receive hands-on education in airway evaluation, anatomy, laser protocols, functional frenuloplasty, and patient communication.

Professional Organizations & Collaboration:

Omaha Laser Dentistry: Dr. Bolamperti discusses how his airway-focused laser practice evolved into a regional referral destination for restorative laser dentistry and tethered tissue treatment.

The Big Idea:

Sleep-disordered breathing is rarely just about snoring or a CPAP prescription. Dentists who understand airway anatomy, tongue posture, nasal breathing, tethered tissues, and functional therapy can uncover root causes that many patients have never had explained to them before.

Dr. Bolamperti’s approach is a reminder that modern dentistry is moving beyond simply fixing teeth. The future belongs to clinicians who educate patients, understand the connection between oral function and whole-body health, and build treatment systems that improve the way people breathe, sleep, and live.

In this episode, Dr. Craig Harder joins Dr. Erin Elliott and Jason Tierney to talk about the kind of career shift most dentists hope they never have to face, but every practice owner should be prepared for.

After nearly 30 years in private practice, Dr. Harder was diagnosed with Parkinson’s disease. The diagnosis changed his timeline, his relationship with clinical dentistry, and the way he thought about identity, ownership, retirement, and what comes next.

Our hosts explore what happens when dentistry is not just your job, but a major part of who you are. Dr. Harder shares what it felt like to sit in his car after receiving the diagnosis, how he moved from panic to planning, and how dental sleep medicine gave him a way to keep using his clinical mind when his hands could no longer carry the same load.

This episode is especially valuable for dentists who are nearing a transition, considering a shift in their schedule, dabbling in sleep medicine, or avoiding the hard planning conversations around disability, retirement, practice value, and life outside the operatory.

What’s on the Menu:

A Real Career Transition Story: Dr. Harder shares how he built a successful practice in Moses Lake, Washington, after purchasing it in 1996 and spending nearly 30 years in private practice.

The Diagnosis That Changed the Timeline: He walks through the early hand tremor, the essential tremor diagnosis, and the eventual Parkinson’s diagnosis that forced him to rethink how long he could continue practicing.

When Dentistry Becomes Your Identity: Dr. Harder talks honestly about what it feels like to lose the version of yourself that was known as “the dentist” in your community.

The Three Emotional Stages After Diagnosis: He describes moving from selfishness to panic over his family and team, to finally accepting the diagnosis.

Why Sleep Medicine Became the Bridge: As hand skills became less reliable, Dr. Harder began shifting toward dental sleep medicine, telemedicine, sleep study review, and patient education.

The Difference Between Dabbling and Going All In: Dr. Harder reflects on his earlier attempt to “half-ass” sleep medicine and why the field requires systems, commitment, and real ownership.

What Practice Owners Should Prepare Now: The episode highlights the importance of keeping a practice ready to sell, maintaining strong systems, updating equipment, training the team, and protecting the people who depend on the business.

Why Financial Safety Nets Matter: Dr. Harder discusses disability insurance, long-term care insurance, wills, investments, and the painful reality of realizing too late that some options are no longer available.

Living Before Retirement: One of the strongest themes in the episode is not waiting until 65 to take the trip, write the book, coach your kids, or make time for the things that bring you joy.

Professional Organizations & Collaboration:

Star Sleep & Wellness: Dr. Harder discusses joining Dr. Kent Smith’s team and moving into a structured dental sleep medicine environment.

The Big Idea:

Do not wait for a diagnosis, retirement, or crisis to start planning your next chapter.

Dr. Harder’s story is a reminder that dentistry can become deeply tied to identity, but life can change the timeline without asking permission. The dentists who protect themselves best are the ones who build strong systems, plan early, care for their health, and create a life that is not postponed until “someday.”

In this episode, Ryan Javanbakht joins Jason Tierney and Dr. Erin Elliott to break down one of the biggest issues in dental sleep medicine: patient follow-through on testing.

Most practices think they have a testing problem. They don’t; they have a communication problem.

Patients drop off because they don’t fully understand why it matters, what happens next, or what it will cost. Without that clarity, even motivated patients hesitate and disappear.

Sleep testing is the inflection point. It’s where patients either connect the dots and commit, or get confused and disappear. Clarity creates momentum. Confusion kills it.

What’s on the Menu:

Why Patients Drop Out of the Funnel
Ryan breaks down the real failure points: unclear communication, a lack of urgency around the problem, and poor expectation-setting regarding process and cost. When those pieces are missing, drop-off is inevitable.

The “Magical” Moment: Diagnosis
Dr. Elliott highlights the moment everything clicks, when patients see their results and connect the data to how they feel. That’s when urgency builds, motivation increases, and cost becomes less of a barrier.

Why Communication Beats Technology
Tools don’t drive case acceptance; conversations do. Patients move forward when they feel heard, understand the process, and know what to expect at each step.

The Two-Option Close That Works
Ryan shares a simple framework: give patients two clear paths, a traditional referral or an immediate home sleep test. Clear options reduce hesitation and increase follow-through.

Why Dental Patients Resist
Dental patients aren’t expecting a sleep conversation; they’re expecting a cleaning. That mismatch creates friction. The solution is to slow down, separate consults, and build trust before making recommendations.

How to Handle Objections Effectively
Ryan outlines a simple structure: empathize, clarify, isolate, respond. It keeps conversations human and builds trust instead of pressure.

The Power of “Selling the Next Step”
Dr. Elliott emphasizes a key shift: don’t sell treatment. Don’t even sell the test. Focus on the next step. That’s how momentum builds without overwhelming the patient.

Why Patients Need to “Want It”
The goal isn’t compliance, it’s ownership. When patients reach the point of “I want this” and “I need this,” moving forward becomes natural.

Clinical Concepts & Terminology

Home Sleep Test (HST)
A diagnostic tool that allows patients to test for sleep apnea at home, improving accessibility and completion rates.

Sleep Testing Funnel
The patient journey from awareness to treatment. Breakdowns at any stage reduce overall case acceptance.

Conversion Rate
The gap between patients referred for testing and those who actually complete it is a key measure of system effectiveness.

STOP-BANG Screening
A widely used screening tool to identify patients at risk for sleep apnea.

Professional Organizations & Collaboration

Third-Party Testing Partnerships
Services like SleepTest.com help streamline insurance verification, patient communication, test completion, and physician review—reducing friction across the process.

Featured Experts to Follow
Ryan C. Javanbakht: CEO of SleepTest.com, focused on improving access and conversion in sleep diagnostics

Recommended Tools & Resources

STOP-BANG Questionnaire
A simple way to begin identifying patients at risk for sleep apnea.

Home Sleep Testing (HST)
A patient-friendly diagnostic option that improves follow-through.

SleepTest CRM
A platform designed to manage patient communication, insurance verification, test coordination, and reporting.

Communication Frameworks
Empathize → Clarify → Isolate → Respond
Two-option close strategy
Consult-first workflow

In this episode, Jason Tierney and Dr. Erin Elliott talk with Dr. Johnny Ukich about the slow shift from focusing mainly on cavities and traditional pediatric care to recognizing the early signs of sleep-disordered breathing in kids.

What does it take for a busy pediatric dentist to start seeing airway differently?

For Dr. Ukich, that shift didn’t come from one lecture or a EUREKA! moment. It came through years of conversations, his father’s background in early orthodontic thinking, and eventually what he began noticing in his own child. Once the pieces connected, he started seeing open-mouth breathing, snoring, bedwetting, poor sleep quality, and arch development in a completely different light.

This is a grounded conversation for dentists who may not feel ready to treat every airway case, but do need to know what to look for. Dr. Ukich makes the case that awareness alone can change lives, especially when it leads to earlier questions, better screening, and stronger collaboration.

What’s on the Menu:

• A Real Conversion Story: Dr. Ukich shares how airway was not part of his early training and how it took years in practice before the dots finally connected.
• Why Personal Experience Changed Everything: Like many clinicians, the turning point came when he began seeing these patterns in his own child and could no longer dismiss them as isolated issues.
• What Early Treatment Started to Reveal: Once he began expanding earlier, he saw changes parents could notice quickly, including better nasal breathing, less bedwetting, and improved sleep.
• Screen Even If You Don’t Treat: One of the clearest takeaways is that pediatric dentists do not need every tool or every service in-house, but they do need to recognize the signs and start the conversation.
• How He Talks to Parents Without Sounding “Salesy”: Dr. Ukich focuses on sleep quality, growth, and what parents are actually seeing at home rather than jumping straight into treatment.
• Why This Has to Be a Team Approach: The episode highlights the need for collaboration with orthodontists, ENTs, lactation consultants, myofunctional therapists, and other providers.

The Value Add:

• It Makes Pediatric Airway Feel Practical: This episode shows what early airway awareness can look like in a real pediatric office, not just in theory.
• It Reminds Providers They Can Start Smaller: Dr. Ukich makes it clear that simply asking better questions and knowing when to refer can make a real difference.

Clinical Concepts & Terminology

• Pediatric Sleep Questionnaire (PSQ): A screening tool Dr. Ukich uses to identify symptoms that may point to sleep-disordered breathing.
• Early Expansion: Discussed as a way to support arch development, nasal breathing, and better sleep patterns when started young enough.
• Myobrace: A removable appliance mentioned as part of habit correction and functional development, especially around breathing and oral posture.
• Myofunctional Therapy: Referenced as part of follow-up care to help children use their lips, tongue, and oral muscles more effectively after expansion.
• Acoustic Rhinometry: A tool Dr. Ukich uses to help measure nasal capacity and airway function.
• Tongue-Tie Release: Discussed in the context of infant feeding, latch, and early oral development.

Professional Organizations & Collaboration

• AAPD Guidelines: Dr. Ukich and Dr. Elliott discuss the importance of pediatric dentistry guidelines now addressing airway screening and treatment more directly.
• Collaborative Pediatric Airway Care: The conversation emphasizes working with orthodontists, ENTs, lactation consultants, craniofacial chiropractors, and myofunctional therapists rather than trying to solve everything alone.

Featured Experts to Follow

• Dr. Johnny Ukich: A pediatric dentist sharing a practical perspective on how airway awareness changed the way he screens and treats children.
• Dr. Erin Elliott: Co-host of the episode and one of the early voices who helped push this conversation forward in her community.
• Dr. Boyd Simpkins: Mentioned in the episode as another pediatric dentist involved in this space.

Recommended Tools & Reading

• Gasp: The book Dr. Ukich credits as the moment everything clicked for him.
• Breath by James Nestor: A recommended read for clinicians who want a more accessible entry point into breathing and airway concepts.
• Pediatric Sleep Questionnaire (PSQ): A practical screening resource for identifying airway-related symptoms in children.
• Myobrace: Mentioned as a tool for encouraging better breathing habits and oral function.
• CO2 Laser: Discussed as a valuable tool for infant tongue-tie releases because of comfort, speed, and healing.

Why do the thousands of dollars you spend on dental consultants evaporate the moment your team gets busy? Dr. Max Kerr breaks down the real reason your practice falls back into bad habits, office drama, and useless meetings. Learn how the EOS framework forces total team accountability, kills breakroom gossip, and builds a structural foundation that permanently solves your biggest operational headaches.

What We Discuss with Dr. Max Kerr:

• The Issues List: Why an organization with a lot of issues is actually a healthy one—as long as you have a system to capture them instead of letting them fester in the breakroom.
• IDS (Identify, Discuss, Solve): The exact psychological framework to prevent endless meeting debates and force actual, tangible solutions with assigned to-dos.
• Stopping Office Drama: How to empower your team to bring problems to the light, and why you should enforce a strict "don't vent to me, do something about it" culture.
• The 80/20 Rule of Process: Why you don't need a 100-page SOP manual that no one reads. Learn how documenting just 20% of your core processes gets 80% of the work done safely.
• The Level 10 Meeting: The strict 90-minute weekly agenda that guarantees accountability, keeps everyone on track, and eliminates the "this could have been an email" feeling.
• The Foundation First: Why getting EOS off the ground takes a solid two years, and why expensive clinical consultants won't save your business if your foundational "underwear and socks" aren't properly in place.
• And much more…

Episode Summary:

You’ve hired the consultants, read the books, and maybe even had a few productive team meetings. But two months later, the demands of the practice get in the way, and everyone reverts to their old habits. Your team is venting to each other in the hallways, administrative balls are being dropped, and your clinical excellence is being overshadowed by 1-star reviews complaining about billing errors.

In this episode, Jason Tierney and Dr. Erin Elliott welcome back Dr. Kerr to dive deep into the final key components of the EOS (Traction) framework: Issues, Process, and Traction. Dr. Kerr explains why avoiding problems is a recipe for disaster and how implementing a strict, time-blocked "Level 10" weekly meeting can completely transform your practice's culture. He shares exactly how to track issues, force actionable solutions instead of allowing endless discussion, and hold team members accountable week over week.

Whether you are running a single dental sleep practice or managing multiple locations, this conversation strips away the "rainbow unicorn mumbo jumbo" and gives you the essential blocking and tackling strategies needed to run a highly profitable, stress-free business.

Resources and References Mentioned:

• Traction: Get a Grip on Your Business by Gino Wickman

• Value Add: This is the foundational textbook for the Entrepreneurial Operating System (EOS) discussed in this episode. If you are tired of hitting a ceiling in your practice growth, start here to understand the Six Key Components of a successful business.

• EOS Worldwide (Find an Implementer)

• Dr. Kerr mentions that while you can self-implement EOS, the most successful and busiest dental sleep practices in the world often hire a professional implementer. Use this directory if you want a professional to hold your leadership team accountable and fast-track your success.

• Productive Dentist Academy (PDA)

• Mentioned by Dr. Kerr as an incredible resource for patient interaction and team alignment. However, as Dr. Kerr notes, PDA is "downstream" from EOS. Build your EOS communication lanes and business foundation first, so that when you bring in heavy-hitting consultants like PDA, your team can actually execute their strategies.

• Connect with Dr. Max Kerr:

• Reach out directly via email at: mkerr@sleepbetteraustin.com

The "business of dental sleep medicine" shouldn’t feel like a dirty secret - and PROFIT shouldn’t be a curse word in sleep. In this episode, Jason Tierney, Dr. Erin Elliott, and Dr. Max Kerr stop apologizing for building healthy businesses. Dr. Kerr explains how his own "rheostat regret"—a deep-seated dislike for traditional drilling and filling—led him to master the Entrepreneurial Operating System (EOS) and scale a massive sleep practice.

From identifying the "Toxic Tammys" in your office to setting the 90-day "Rocks" that move the needle, this conversation is a roadmap for any dentist who wants to stop being the bottleneck in their own business.

What’s on the Menu:

• The Handpiece Allergy: Why Max traded the handpiece for systems and how that shift allowed him to scale patient care without burning out.
• The Foundational “Underwear” of Business: Max explains why EOS is the "base layer" of a successful practice—if your socks and underwear have holes, your whole outfit (and your day) is ruined.
• The "Screw Tammy" Protocol: How to handle the high-performing "Toxic Tammy" who is a hit with patients but a cancer to your team culture.
• Vision vs. Hallucination: Why a mission statement isn’t enough. You need the Vision Traction Organizer (VTO) to ensure your team is actually following the map.
• Setting DSM "Rocks": A breakdown of the 90-day sprint and how to keep your team focused on big-picture projects instead of just daily fires.
• Voted Off the Island: Erin and Max discuss building a culture so strong that toxic employees self-select out before you even have to fire them.
• Managing by the Scorecard: How to use objective data to predict your month's success before you even look at a revenue report.

The Value Add:

• It Connects Business Health to Patient Care: This episode makes it clear that strong care and strong operations belong together. A healthy practice can serve more people, more consistently.
• It Gives Owners a Clearer Leadership Framework: Instead of living in constant reaction mode, listeners get a practical model for building alignment, accountability, and better decision-making.
• Cross-Functional Buy-In: Dr. Kerr emphasizes involving key team members in vision and accountability so the practice runs with more alignment and less confusion.

The Wisdom of Max:
"None of us are doing this for free. If you don’t care about people, dentistry will eat you alive—but you can quantify that you’re helping someone live years longer. What is that worth to bring to market?"

Clinical Concepts & Terminology:

• EOS (Entrepreneurial Operating System): A proven set of simple concepts and practical tools used by entrepreneurs to get what they want from their businesses.
• Rocks: The 3 to 7 most important things (objectives) the company must get done in the next 90 days.
• The People Analyzer: An EOS tool used to clarify if you have the "Right People" in the "Right Seats."
• VTO (Vision Traction Organizer): A powerful tool that helps a leadership team get 100% on the same page with where they are going and how they are going to get there.
• Scorecard: A weekly tracking tool of 5–15 high-level numbers that allow you to feel the pulse of your business.

Featured Experts & Resources:

• Dr. Max Kerr: Clinical Director of Sleep Better Austin and a certified EOS implementer.
• Traction by Gino Wickman: The essential reading for any practice owner looking to implement EOS.
• Sleep Better Austin: The systems-driven sleep practice referenced as a case study in this episode.

Dental Sleep Medicine is like Groundhog Day. Why?

In this episode, Jason Tierney and Dr. Erin Elliott sit down with the "fierce advocate" himself, Dr. Steve Carstensen, to examine why the field is moving at the speed of a dial-up modem.

Steve has been in the room where it happens—serving on boards, teaching the masses, and pushing the rock up the hill—and he’s got some thoughts. If you’ve ever felt like a "second-class citizen" in the medical world or wondered why we’re still arguing over home sleep tests in 2026, this one is for you.

What’s on the Menu:

• The "Orange Jumpsuit" Syndrome: Why the fear of regulatory "monsters" has kept dentists from practicing to their full potential. (Spoiler: You probably won’t go to prison for ordering a ferritin test).

• The MD-DDS Discord: Why does the sleep physician love your outcomes but forget your name when it’s time to refer? We talk about bridging the "silo" gap without needing a medical degree.

• Beyond the "Plastic Provider": If you think your only job is "mandibular advancement," you’re missing the 4th dimension. Steve breaks down Developmental Dental Facial Orthopedics and why we need to care about the brain and heart, not just the airway closure.

• The Tipping Point: Is the AI-informed patient actually the one who will finally force the medical and dental communities to play nice?

The Value Add:

Stop playing small. Steve makes the case for moving from "cautious participation" to "meaningful leadership." You'll walk away with a clearer understanding of the structural barriers holding the industry back—and how to kick them down in your own community.

"All of us is smarter than any one of us." — Dr. Carstensen’s closing wisdom

Clinical Concepts & Terminology

• Developmental Dental Facial Orthopedics: A term coined by Dr. Kevin Boyd and Dr. Dave McCarty to shift the focus from just "straightening teeth" to the 4D growth and development of the airway.
Learn more via Dr. Kevin Boyd’s work

• The "Leaky Syndrome" Concept: Referenced in the context of functional dentistry—looking at the tube from "here to here" (mouth to gut).
Dr. Witt Wilkerson’s "The Shift": A guide to health-centered dentistry and the "leaky" body systems.

Professional Organizations & Collaboration

Steve emphasizes joining groups where "nobody cares what’s on your badge."

• World Dentofacial Sleep Society (WDSS): Founded by Dr. Audrey Yoon and Dr. Leopoldo Correa to unite dentists and surgeons globally.
Website: dentofacialsleep.org

• World Sleep Society: The premier international organization for sleep professionals. Steve recommends their biennial congress for true interdisciplinary learning.
Website: worldsleepsociety.org

• AAPMD & AAOSH (Collaboration Cures): The home for the "Collaboration Cures" movement, focusing on the airway, oral-systemic health, and functional medicine.
Website: aapmd.org |https://www.aaosh.org/

• Sleep Education Consortium: Founded by Dr. Jerald Simmons, providing the 3-day comprehensive courses Steve mentioned for MD/DDS collaboration.
Website: dentalsleepconference.com

Featured Experts to Follow

• Dr. Shane Creado: The sleep physician mentioned who "loves our world" and focuses on peak sleep performance and psychiatry.
Website: shanecreado.com

• Dr. Audrey Yoon: A leader in pediatric dental sleep medicine and orthodontics at Stanford.
Link to Clinical Profile

Recommended Tools & Reading

• Open Evidence: The AI tool Steve used to research "Evidence-Based Medicine" and alternative clinical trials.
Website: open.evidence.com

• The Tipping Point by Malcolm Gladwell: The book Steve cited when discussing how the industry will eventually shift its attitude toward airway care. Buy on Amazon.

You did your job. You addressed the patient’s breathing and airway issues. But they are still spending their days feeling like they haven’t slept. What’s the deal?

This week, sleep expert and psychiatrist Dr. Shane Creado joins Jason Tierney and Dr. Erin Elliott to solve the mystery of the "tired-but-treated" patient. We are diving into the "busy brain," the trap of sleep trackers, and why your bedroom might be training you to stay awake.

Whether you are a doctor helping patients or just someone tired of being tired, this episode is a wake-up call. It is time to stop focusing on how long you stay in bed and start focusing on how well you actually sleep.

What We Discuss in This Episode

• Pills vs. Skills: Why retraining your brain with CBT-I is better than using sleeping pills like Ambien or Xanax.
• The Airway Isn’t Everything: Why opening the "pipe" does not always turn off the "alert" button in the brain.
• Bedtime Math: Why spending too much time in bed can actually make insomnia worse.
• The Busy Brain Problem: How to stop your brain from treating 2:00 AM like a stressful business meeting.
• The Tracker Trap: Is your Oura Ring or Apple Watch giving you "Orthosomnia"? This is when you are so stressed about your sleep data that you cannot actually sleep.
• Sleep Like a Pro: How small changes can turn an average person into an elite athlete.
• Social Jet Lag: Why sleeping in late on Saturday feels like a five-hour flight delay for your brain.
• The Golf Secret: How to talk to patients about sleep so they actually listen. (Hint: Talk about their golf score, not their blood pressure.)

The Big Idea

Most people think sleep is just something that happens when you aren't awake. Dr. Creado explains that sleep is actually a skill. If your brain has "learned" how to stay awake and anxious, a CPAP machine or a dental appliance cannot fix that on its own.

This episode is about moving past the hardware (the airway) and fixing the software (the habits and the mind).

Resources and Links Mentioned

Dr. Creado’s Tools

• The Book:Peak Sleep Performance by Dr. Shane Creado
• The Course:Overcoming Insomnia Program(Search "Amen University")
• Dr. Creado’s Patient Resource Guide: Download Here

Research and Studies

• The Stanford Sleep Extension Study: Research showing that getting just 30 minutes more sleep can improve athletic accuracy by up to 40%. Link: https://pmc.ncbi.nlm.nih.gov/articles/PMC3119836/
• The MLB Sleep Study: Data showing that 72% of "sleepy" Major League Baseball players are out of the league within two years. Link: https://www.sciencedaily.com/releases/2013/05/130531105506.htm
• The Sauna Study: Research indicating that regular sauna use can improve sleep quality in 83% of users. Link: https://pubmed.ncbi.nlm.nih.gov/31126560/

Key Concepts for Further Reading

• CBT-I (Cognitive Behavioral Therapy for Insomnia): Find a specialist via theSociety of Behavioral Sleep Medicine.
• Paradoxical Intent: The psychological trick of "trying to stay awake" to lower sleep anxiety, famously used by psychiatrist Viktor Frankl.
• Orthosomnia: A term for the unhealthy obsession with achieving "perfect" sleep data from wearable devices.

What if your referral sources keep sending patients, but your delivery numbers never match up?

Scott Craig joins hosts Jason Tierney and Dr. Erin Elliott to break down a glaring reason many sleep practices stall: they track activity, not conversion. This isn't about "doing more marketing"—it’s about plugging the leaks in your pipeline. Scott shares how he transitioned from a general dental setting to a 5-location sleep powerhouse by swapping "gut feelings" for cold, hard data and a dedicated team that lives and breathes sleep.

What We Discuss:

• The Clean Break: Why moving sleep out of the general practice and into a standalone environment kills friction and creates instant momentum.
• The 3 Conversions That Matter: How tracking Referral-to-Consult, Consult-to-Delivery, and Delivery-to-Efficacy reveals exactly where you’re losing patients (and revenue).
• Stop Managing by "Vibes": How to read the story the numbers are telling—from the referral source tanking your close rate to the insurance type quietly killing your margins.
• The Intake Engine: Why your front desk is either your biggest growth driver or your most expensive bottleneck.
• Metrics as a Team Sport: Using transparency and EOS (Entrepreneurial Operating System) to turn data into a tool for trust rather than a weapon for blame.
• Winning the Skeptics: A masterclass in handling the "it won’t work for severe patients" physician with calm, specific proof.

The Story

The episode kicks off with Scott’s personal "why"—a story that starts with his father identifying Scott’s own OSA after a sleep course. Treating his own apnea took Scott’s world from black and white to full color, sparking a 20-year mission to make oral appliance therapy a first-line reality.

But mission alone doesn't pay the rent. Scott walks us through the "ruthless" business framework required to scale. When a primary referral source passed away, his team didn't panic; they rebuilt. By treating the patient pathway like a high-performance pipeline and implementing a leadership structure that demands accountability, they turned a "side hustle" into a Chicago-area behemoth. This is an episode for clinicians tired of "hope" as a strategy and ready for a measurable, scalable system.

Resources and References

• EOS (Entrepreneurial Operating System): The framework for leadership used to scale the practice.
• Transform Dental Sleep:Specifically, Scott’s chapter on metrics and practice management.

What if that "cute" childhood snore is actually the sound of your child gasping for air, struggling to stay alive?

In this high-energy, eye-opening episode, Dr. Stacy Becker—one-third of the powerhouse team behind ASAP Pathway—joins us to dismantle the myth that kids "just grow out of it." After witnessing her own father struggle with CPAP intolerance and watching her own children show the classic "red flags" despite doing everything "by the book," Stacy realized that dentistry isn't just about teeth—it’s about the very air we breathe. This isn't a lecture on complex orthodontics; it’s a playbook for becoming the "triage hero" your smallest patients desperately need.

Jason Tierney and Dr. Erin Elliott sit down with Stacy to move the conversation from "niche mystery" to "everyday essential." They explore why a generation raised on applesauce pouches is facing a "melting face" epidemic and how you can start saving lives before a child even hits the first grade.

The Meat of the Episode

• The Death of the Crunch: We dive into the "Industrial Revolution" of the jaw. Learn how soft diets and "pouch culture" are causing muscles to atrophy and faces to literally melt, leaving no room for adult teeth (or oxygen).
• The 95% Rule: Why Dr. Steven Sheldon says nearly all ADHD is actually sleep deprivation in disguise. We discuss the heartbreaking reality of "broken brains" and why waiting until age 13 to fix an airway is often seven years too late.
• "We Now Know": The magic script for talking to long-term parents. Stacy shares how to pivot from "just checking for cavities" to "checking for life-altering airway issues" without the guilt trip of what you might have missed in the past.
• Kissing Frogs & Finding Princes: Referral reality checks. Not all ENTs or Orthodontists are created equal. Stacy explains how to hunt for the "airway-aware" specialists in your town by asking the right questions and trusting your gut.
• Clinical Clues Hiding in Plain Sight: From chapped lips and "crusty noses" to tartar buildup on a six-year-old. Learn to spot the secret signals of mouth breathing that are sitting right in your hygiene chair.
• Permission to be a Dentist: Why you don’t need a "mother may I" from a physician to expand a maxilla. We talk about the courage to lead your community and the dental levers that can actually shrink tonsils and adenoids.

A Note from Dr. Stacy Becker

"A worried mom does better research than the FBI. If you see the craniofacial deficits and a child is struggling, you cannot stick your head in the sand. By age six or seven, the brain is mostly done. You can grow out of large tonsils by thirteen, but you might be growing into a lifetime of cognitive deficits and ADHD. We have to act now."

Why This Episode Matters

This conversation is for every "Jill or Joe Dentist" who is doing "just fine" but wants to do better. Stacy reminds us that we are the front-line scouts in a pandemic of poor sleep. You don’t have to become a full-time pediatric surgeon to make a difference; you just have to stop "unseeing" the red flags. By the end of this episode, you won't just be looking at a child's bite—you'll be looking at their entire future, and you'll have the "Thunderstruck" energy to help them protect it.

Would you like me to create a "Checklist for the Chair" based on the clinical signs Stacy mentioned to help your hygiene team start screening tomorrow?

Resources and References Mentioned

Here are the links and references for the resources mentioned in the podcast:

Community & Directories

• ASAP Pathway (Airway, Sleep, and Pediatric Pathway): *https://asappathway.com/

• Find a Provider Map:https://asappathway.com/map/

• AAPMD (American Academy of Physiological Medicine & Dentistry):

• Main Site:https://aapmd.org/
• Find a Professional Directory:https://aapmd.org/find-aapmd-professional

Clinical Research & Articles

• The Atlantic Article: * Title referenced: "Are we cranking kids' jaws open for no reason?" (Published January 2026).

• Context: Discusses the controversy between "airway-focused" orthodontics and traditional evidence-based dentistry.

• American Academy of Pediatrics (AAP) Snoring Policy:

• Clinical Practice Guideline:Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome
• Key Takeaway: The AAP recommends screening for snoring at every well-child visit (the "zero tolerance" approach mentioned by Dr. Becker).

• Dr. Audrey Yoon (Stanford University):

• Stanford Profile:https://profiles.stanford.edu/audrey-yoon
• Research Focus: Her work bridges the gap between pediatric dentistry and orthodontics, focusing on how expansion affects pediatric airway volume and sleep outcomes.

• The CHAT Study (Childhood Adenotonsillectomy Trial):

• Study Overview:ClinicalTrials.gov - NCT00560859
• Context: This is the landmark study that evaluated "watchful waiting" vs. surgery for mild-to-moderate pediatric OSA, which Dr. Ron Mitchell helped lead.

Expert Viewpoints

• Dr. Stephen Sheldon (Lurie Children’s Hospital):

• ADHD & Sleep Link: Dr. Sheldon is a pioneer who famously posits that a vast majority of ADHD cases are actually misdiagnosed sleep-disordered breathing. You can find his lectures on theAAPMD YouTube channel.

• Dr. Ron Mitchell (UT Southwestern/Children's Medical Center):

• Expert on the surgical management of pediatric sleep apnea.UTSW Profile.