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.

The Final Countdown: Rapid Fire Round

• The Magic Wand: If money did not matter, Sonnie would be a professional motorcycle racer.
• Cinematic Sins: White Men Can’t Jump earns the title of worst movie of all time.
• The Walk-Up Song: Sonnie enters the ring to “Man! I Feel Like a Woman.”
• Plead the Fifth: On whether he has ever been fired.

Resources and References Mentioned

Apex Dental Sleep Lab
https://apexsleep.com

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.

The Final Countdown: Rapid Fire Round:

• The Magic Wand: If money did not matter, Dr. Lown would keep doing exactly this, while the hosts debated alternate career paths.
• Cinematic Sins: Over the Top and Cobra take the crown for worst movies of all time.
• The Walk-Up Song: Dr. Lown enters the ring to “Adventure of a Lifetime.”
• Uncharacteristic Moment: Falling asleep in a restaurant after a few too many drinks.

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.

Why do thousands of dentists take sleep courses but never treat a single patient? Dr. Erin Elliott explains the "Implementation Gap" and how to bridge the friction between interest and action.

What We Discuss with Dr. Erin Elliott:

• The "So What? Now What?" Framework: Why most continuing education (CE) fails practitioners and how to filter clinical information through the lens of immediate office implementation.
• From Outliers to Mainstream: How the dental sleep medicine landscape has shifted over the last seven years, moving from a niche curiosity to a packed-house necessity.
• The Implementation Gap: More dentists are attending courses than ever before, yet the "rubber meets the road" friction remains. We break down the pitfalls and "pratt-falls" of scaling a sleep practice.
• Beyond Sleep: Why Dr. Elliott is integrating Cone Beam (CBCT) technology with implants and pathology to create a comprehensive surgical and airway-focused practice.
• The "Alford Plea" of Business: The hosts discuss a "guilty plea" in which the defendant maintains their innocence but admits that the prosecution likely has sufficient evidence to convict them. It allows a defendant to take a plea deal while technically never saying "I did it."
• And much more…
  
  

Episode Summary:

You’re sitting in the back of a darkened conference room, pen poised over a fresh notebook, ready to revolutionize your practice. Three days later, you return to the office with twenty pages of notes and zero idea how to bill the first medical insurance claim or talk to a patient about a MAD device. This is the Implementation Gap, and it’s where most dental sleep dreams go to die.

In this inaugural episode, Jason Tierney and Dr. Erin Elliott—returning to the mic together after a seven-year hiatus—tackle the "intellectual self-play" that plagues the industry. They introduce a framework designed to bypass the abstractions and focus on the "So What? Now What?" of clinical life. Dr. Elliott, a national lecturer based in Idaho, shares how she balances general dentistry with a high-level focus on sleep, surgery, and pathology. Whether you're a sleep medicine veteran or just curious about the airway, this conversation will fundamentally reshape how you think about "making it happen" in your practice.

The Final Countdown: Rapid Fire Round

• The Magic Wand: If money didn't matter, Dr. Elliott would be on the pro pickleball circuit, while Jason would be molding minds as a high-school English teacher.
• Cinematic Sins: The hosts agree: the sequels are never as good. Avoid Anchorman 2 and Five Nights at Freddy's 2 at all costs.
• The Walk-Up: Entering the ring? Dr. Elliott pumps up with her original jam "Air Baby," while Jason goes dark with "Shockwave: 5 Faces of Darkness."