Sleep Matters Podcast

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: erinelliottdds.com
• Sleep Apnea Implementation Course (Dr. Elliott's hands-on training, via 3D Dentists): 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: 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.