Episodios

  • Orange Jumpsuits, Evidence-Based Constraints, and the Provider Divider with Dr. Steve Carstensen

    Orange Jumpsuits, Evidence-Based Constraints, and the Provider Divider with Dr. Steve Carstensen
    Mar 18 2026
    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 & TerminologyDevelopmental 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 workThe "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 & CollaborationSteve 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.orgWorld Sleep Society: The premier international organization for sleep professionals. Steve recommends their biennial congress for true interdisciplinary learning.Website: worldsleepsociety.orgAAPMD & AAOSH (Collaboration Cures): The home for the "Collaboration Cures" movement, focusing on the airway, oral-systemic health, and functional medicine.Website: aapmd.org | aaosh.orgSleep Education Consortium: Founded by Dr. Jerald Simmons, providing the 3-day comprehensive courses Steve mentioned for MD/DDS collaboration.Website: dentalsleepconference.comFeatured Experts to FollowDr. Shane Creado: The sleep physician mentioned who "loves our world" and focuses on peak sleep performance and psychiatry.Website: shanecreado.comDr. Audrey Yoon: A leader in pediatric dental sleep medicine and orthodontics at Stanford.Link to Clinical ProfileRecommended Tools & ReadingOpen Evidence: The AI tool Steve used to research "Evidence-Based Medicine" and alternative clinical trials.Website: open.evidence.comThe 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.
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    39 m
  • Ditching Wearables, Paradoxical Intent, and CBT for Insomnia with Shane Creado, MD

    Ditching Wearables, Paradoxical Intent, and CBT for Insomnia with Shane Creado, MD
    Mar 11 2026

    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 the Society 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.
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    44 m
  • Multi-Location Growth, Referral Pipelines, and Metrics that Matter with Scott Craig

    Multi-Location Growth, Referral Pipelines, and Metrics that Matter with Scott Craig
    Mar 4 2026

    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.
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    35 m
  • Applesauce Pouches, Cognitive Deficits, and Pediatric Airways with Dr. Stacy Becker

    Applesauce Pouches, Cognitive Deficits, and Pediatric Airways with Dr. Stacy Becker
    Feb 25 2026
    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 EpisodeThe 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 MattersThis 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 MentionedHere are the links and references for the resources mentioned in the podcast:Community & DirectoriesASAP Pathway (Airway, Sleep, and Pediatric Pathway): * asappathway.comFind a Provider Map: asappathway.com/map/AAPMD (American Academy of Physiological Medicine & Dentistry):Main Site: aapmd.orgFind a Professional Directory: aapmd.org/find-aapmd-professionalClinical Research & ArticlesThe 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 SyndromeKey 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: profiles.stanford.edu/audrey-yoonResearch 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 - NCT00560859Context: This is the landmark study that evaluated "watchful waiting" vs. surgery for mild-to-moderate pediatric OSA, which Dr. Ron Mitchell helped lead.Expert ViewpointsDr. Stephen Sheldon (Lurie Children’s Hospital):ADHD & Sleep Link: Dr. Sheldon is a pioneer who famously posits that a vast majority of...
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    54 m
  • Basic B**** Cancer, Portal Purgatory, and Waiting Rooms That Fail with Lesia Tierney

    Basic B**** Cancer, Portal Purgatory, and Waiting Rooms That Fail with Lesia Tierney
    Feb 18 2026

    What happens to a patient’s heart when they receive life-altering news alone, staring at a cold computer screen?

    In this deeply moving episode, Lesia Tierney—a 20-year leader in dental sleep medicine—shares the moment her world shifted. After decades of helping convert patients, she found herself on the other side of the consult desk, navigating a breast cancer diagnosis. This isn't just a talk about practice management; it’s a masterclass in human-to-human connection.

    Jason Tierney and Dr. Erin Elliott join Lesia to peel back the layers and look at the raw vulnerability of the patient experience. They explore how a simple hand-hold, a well-timed joke, or a quiet waiting room isn't just "good business"—it’s an act of love that restores a patient's dignity.

    The Heart of the Matter

    • The Loneliness of the Portal: Lesia reflects on the "purgatory" of finding out she had cancer via a portal refresh. We discuss why no patient should ever feel alone in their diagnosis, and how to ensure your office is the guide they desperately need.
    • The 10-Second Intervention: A story of a nurse, an operating table, and a hand-hold. Learn how ten seconds of authentic presence can pull a patient back from the brink of terror and give them the peace to proceed.
    • Humor as a Shield: Why Dr. Liu’s "basic bitch cancer" comment was the most professional thing she could have said. We dive into how laughter lowers the walls of fear and allows a patient to finally exhale.
    • The Waiting Room as a Sanctuary: Your front office is the patient's first "safe space." If it’s loud, messy, or sterile, their nervous system shuts down. Learn how to curate a calm soundscape that whispers, "You are safe here."
    • The Gift of "Personhood": Why the "Bring Your Person" rule is about more than just remembering facts—it’s about honoring the patient’s need for emotional support during a moment of high stakes.

    A Note from Lesia Tierney

    "Our job is to give them hope, give them solutions, and walk them through it. It’s such a blessing and a gift to be able to do that for other people. When you’re on the other side of it, the fact that someone actually cares... that is what stays with you."

    Why This Episode Matters

    This conversation is for every team member who has ever felt like they were just "running a process." Lesia reminds us that beneath every sleep study and oral appliance is a human being looking for a steady voice and a hand to hold. By the end of this episode, you won't just want to improve your conversion rate—you’ll want to improve the way you show up for people.


    • (00:18) - Introduction
    • (02:26) - Lesia’s dental sleep medicine journey and how she got here
    • (07:36) - From being a part-owner of the practice to being a patient herself
    • (13:09) - Why front office should reflect back office
    • (17:27) - Choosing a practitioner who you trust
    • (25:10) - What phone policy has Lesia introduced in her office
    • (30:03) - What other experiences Lesia had that impacted how she runs her office
    • (34:33) - How cancer influenced Lesia’s life
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    41 m
  • The TEDx Stage, Role-Playing, and Physician Relationships with Dr. Suzanne Thai

    The TEDx Stage, Role-Playing, and Physician Relationships with Dr. Suzanne Thai
    Feb 11 2026

    What happens when the life you’ve built no longer fits? Dr. Suzanne Thai, a prominent dental sleep medicine practitioner and TEDx speaker, joins Jason Tierney and Dr. Erin Elliott to discuss her journey from "existential dread" in general dentistry to finding renewed purpose in sleep medicine. This episode dives deep into the power of vulnerability, the necessity of mastering communication, and the specific "soft skills" that separate average practices from elite ones.

    What We Discuss with Dr. Suzanne Thai:

    • The TEDx Journey: The behind-the-scenes reality of preparing for a TEDx talk and why Dr. Thai chose to share her most vulnerable stories.
    • From Dread to Joy: How moving from general dentistry to dental sleep medicine saved Dr. Thai’s career and brought back her "spark."
    • The Power of Vulnerability: Why sharing "stories that hurt" fosters deeper connections with patients and peers.
    • Communication as a Clinical Skill: Why taking a perfect bite registration isn't enough—and how to truly engage a patient in their own treatment.
    • The "Chameleon" Technique: How to read a patient’s energy and adjust your own to build immediate trust.
    • Mastering the Physician Referral: Why getting cell phone numbers and sending "sushi photos" is more effective than traditional professional outreach.
    • Role-Play and Recording: The "cringe-worthy" but essential practice of recording your consults to eliminate filler words and improve conversion rates.

    Episode Summary

    For many clinicians, the daily grind of "millimeter-perfect" dentistry can lead to burnout. Dr. Suzanne Thai reached that breaking point after 15 years, but discovered that dental sleep medicine offered a different kind of fulfillment: the ability to save lives and marriages.

    In this episode, Dr. Thai explains that while the clinical mechanics of making an oral appliance are relatively straightforward, the true challenge—and the key to a successful practice—lies in communication and emotional intelligence. She shares her framework for "staying on the line" during patient consults, the importance of genuine compliments, and why her team is required to role-play scenarios regularly.

    Whether you’re looking for the courage to reinvent your career or simply want to improve your patient "yes" rate, Dr. Thai’s high-energy insights provide a roadmap for professional and personal transformation.

    Resources and References Mentioned

    Featured Presentation: Dr. Suzanne Thai’s TEDx Talk

    • (00:04) - Introduction
    • (00:41) - Dr. Thai's First TED Talk
    • (08:40) - Discovering Dental Sleep Medicine
    • (13:14) - How Has The TED Talk Influenced Dr. Thai's Life
    • (18:58) - Can Anyone Practice Dental Sleep Medicine
    • (28:36) - Using Soft Skills To Develop Referring MD Relationships
    • (36:21) - Actionable Advice To Improve Sleep Practice
    • (41:52) - Final Countdown
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    44 m
  • Dental Sleep Labs, Bite Records, and Why Most Appliances Fail

    Dental Sleep Labs, Bite Records, and Why Most Appliances Fail
    Jan 29 2026

    Why do some oral appliances fail before they ever reach the patient’s mouth? Sonnie Bocala, founder of Apex Dental Sleep Lab, pulls back the curtain on what really happens inside the lab, why bite records matter more than devices, and how dentists can avoid the mistakes that lead to remakes, broken appliances, and poor outcomes.

    What We Discuss with Sonnie Bocala

    • The Bite Problem in Dental Sleep Medicine: Why the bite is the hardest and most important part of oral appliance therapy and why devices are just the delivery mechanism.
    • Why Most Appliances Fail Upstream: How poor bite records, bad workflows, and misaligned expectations lead to remakes and clinical failures.
    • Devices Are Not Widgets: Why dentists obsess over shiny appliances instead of patient-specific biomechanics and airway positioning.
    • The DSM Learning Curve: Why dentists get lost after CE and how to stage your entry into dental sleep medicine without blowing up your practice.
    • Lab as a Clinical Partner: How labs can act as an extension of the practice and why experienced partners see more cases than any clinician ever will.
    • Scanning and AI Pitfalls: How digital impressions can introduce hidden errors and why more data beats faster scans.
    • 3D Printing and In-Office Manufacturing: How to safely print appliances in-house and why FDA-validated workflows matter.
    • The Future of Airway and Orthodontics: Combining aligners and sleep appliances to maintain airway while moving teeth.
    • Choosing the Right Device: How Apex evaluates materials, manufacturing, company ethos, and long-term product viability before recommending devices.
    • And much more.

    Episode Summary

    Dental sleep medicine has never had more devices, more courses, or more technology. Yet outcomes still hinge on one overlooked factor: the bite.

    In this episode, Sonnie Bocala, founder of Apex Dental Sleep Lab, shares 26 years of lab-side insight into what actually makes oral appliance therapy succeed or fail. He explains why dentists get lost after CE, why labs often absorb the blame for upstream clinical errors, and how bite position, patient anatomy, and workflow decisions drive results far more than the appliance itself.


    Sonnie also breaks down the realities of digital scanning, AI-filled impressions, in-office 3D printing, and the coming convergence of orthodontics and airway therapy. If you want fewer remakes, better outcomes, and stronger lab partnerships, this episode is essential listening.


    Resources and References Mentioned

    Apex Dental Sleep Lab
    https://apexsleep.com
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    39 m
  • GLP-1, Sleep Apnea, and Why Patients Struggle With Long-Term Weight Loss With Dr. Jonathan Lown

    GLP-1, Sleep Apnea, and Why Patients Struggle With Long-Term Weight Loss With Dr. Jonathan Lown
    Jan 29 2026

    Why are GLP-1 drugs exploding in sleep medicine, yet most patients still struggle to lose and keep off weight? Dr. Jonathan Lown breaks down why obesity is not a willpower problem, how GLP-1s change sleep apnea outcomes, and why dentists need to rethink how they talk about weight, airway, and treatment options.

    What We Discuss with Dr. Jonathan Lown:

    • GLP-1s in Sleep Medicine: Why tirzepatide and other GLP-1 drugs are a major shift in treating obstructive sleep apnea, not just obesity.
    • Why Weight Loss Fails Most Patients: The biology of weight regain, the SURMOUNT-4 data, and why maintenance is the real battle.
    • The Food Noise Problem: How appetite, reward systems, and evolution work against long-term dieting success.
    • CPAP, Oral Appliances, and Weight Loss: When patients lose weight, how treatment strategies shift and why oral appliances may become more viable.
    • The Uncomfortable Weight Conversation: How clinicians can discuss weight without shaming, while still being honest about health risks.
    • Muscle Loss, Protein, and Exercise: What actually happens to muscle during rapid weight loss and how to mitigate it.
    • Practical GLP-1 Tips: Bowel regularity, hydration, reflux timing, and why late-night eating matters more than people think.
    • The Future of Sleep Therapy: How GLP-1s may reshape Inspire, CPAP adherence, and dental sleep referrals.
    • And much more.

    Episode Summary

    For decades, sleep medicine has treated airway collapse while ignoring the weight conversation. That is no longer sustainable.

    In this episode, Dr. Jonathan Lown, internist, sleep physician, and sleep apnea patient, explains why GLP-1 medications represent a turning point for sleep apnea care. He shares his personal 50-pound weight loss journey, the clinical trial data behind tirzepatide, and why most patients fail at weight loss long-term despite multiple attempts.

    The hosts unpack the uncomfortable truth: obesity is biologically defended, weight regain is common, and lifestyle advice alone is often insufficient. They explore how weight loss changes CPAP tolerance, opens doors for oral appliance therapy, and may fundamentally change how dentists and physicians collaborate in airway care.

    If you treat sleep apnea, this conversation will change how you think about weight, compliance, and patient outcomes.

    Resources and References Mentioned

    • Featured Study
      Malhotra A, et al. Tirzepatide for the Treatment of Obstructive Sleep Apnea and Obesity (SURMOUNT-OSA). New England Journal of Medicine, 2024.
    • Weight Maintenance Study
      SURMOUNT-4 Trial: Long-term data showing significant weight regain after stopping GLP-1 therapy.
    • Clinical Practice Guidelines
      2015 AASM/AADSM Joint Guidelines for Oral Appliance Therapy.
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    45 m