Sleep Matters Podcast

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...