At the Highest Levels of Our Government

I am truly thrilled to share the recent efforts of David Gergen, both within the ASBA and on a global scale! He has most recently been working with Dr. Gopal from India, who is the Dean at Manipal College of Dental Sciences. Dave works closely with top-level government officials, including those within the Executive Branch, and has strong, lifelong relationships with influential individuals, such as Mark Brnovich, who are committed to shaping and improving healthcare across our country.

In a truly bipartisan effort, Dave has enlisted my support to communicate with key government leaders, including the President. There is no disagreement among Americans, regardless of political affiliation, that our active-duty soldiers, veterans, and all those who have sacrificed for our freedom deserve the best healthcare possible. They have more than earned that right. One meaningful way to give back is by working together to move healthcare forward for all of them as quickly as we can.

With that in mind, Dave has previously advocated for dental sleep medicine with esteemed professionals such as Dr. Robert Ricketts, Dr. Harry Sugg, Dr. Elliott Alpher, and Dr. Ed Speigel. Thanks to their efforts, the Federal Government now recognizes the effectiveness of customized oral appliance therapy for sleep apnea as a valid and evidence-based treatment option.

Based on this advocacy, the Government did a 6-year study on the effectiveness of Oral Sleep Appliances. It concluded that only 2 labs (Gergen's Orthodontic Lab and Space Maintainer Lab of CA) were up to par to fabricate these appliances. This is fantastic news for all of us in dental sleep medicine, including labs, practitioners, and—most importantly—the millions of patients in need of assistance with their sleep-breathing issues.

It is with this same spirit that I am honored to assist Dave and the ASBA in advancing the future of dental sleep medicine, particularly for our veterans and active-duty military personnel. I am excited to announce that my efforts have caught the attention of the Executive Branch. Following a response to my letter, Dave received a call from the Government. It’s clear that no matter where we stand politically, every American agrees on one thing: we must care for our military.

See letter below:

April 25, 2025

Dear President Trump,

I thank you in advance for your time and willingness to look into the healthcare issues of our veterans and active duty military regarding the treatment of sleep apnea. In mutual admiration for them, we believe our soldiers and veterans deserve the best as they have fought (or are currently fighting) for our freedom. The literature clearly states untreated sleep apnea can cause a myriad of co-morbidities and serious conditions that not only affect combat readiness, alertness, and performance of our active military but also the quality of life and function of our veterans and war heros.

It is with that concern, and with your help Mr. President, that effective attention will be placed to improve sleep apnea treatment for our military. The literature clearly and undeniably states that there are multiple problems with compliance and adherence to CPAP treatment option (see attached Federal Government Studies). Moreover, so many Americans have side effects, CPAP recalls, biogunk- dirty machine issues, and a whole list of other problems that they have to deal with.

So many veterans are on a waitlist to get replacements, and even after 1-3 years of waiting, when they get one, they don’t use it for the proper length of time. As adults, we are supposed to get 7.5–8 hours of quality sleep 7 nights per week. The best averages show that patients use CPAP only 4–5 nights per week and at about 5 hours per at best per night. That is a poor and potentially lethal standard to go by. Some CPAP machines have carcinogens that are blown down people’s airway (and most of them are on recall, thank God) and other CPAP machines interfere with pacemakers and cardiac rhythm.

So, the alternative and there is ample peer reviewed studies to back that up, would be to use FDA cleared oral appliances to treat sleep apnea. The Federal Government (see attachments) years ago did a long and thorough study on customized oral appliances, for example—the Herbst arm appliance, and found that they are extremely effective, so they approved that type of appliance for Medicare with PDAC regulations.

Studies show that with these Herbst appliances, patients have far better compliance / adherence, and they are far more effective at mean disease alleviation (MDA), apnea burden and apnea load when compared to CPAP therapy.

The problem is, however, there are so many VA Hospitals and centers that are not providing these appliances and the ones that are, they use cheap plastic “suck-down” materials and the appliance pieces often stretch and break off during sleep. They also pose a risk of aspiration and other issues and are usually done by dentists who are not trained properly in sleep medicine and don’t have dental sleep medicine board certification. Our military deserves better, and they need your help Mr. President.

Next, there are abundant qualified community care sleep dentists that are available for VA hospitals and centers to refer to. However, these hospitals keep their dental sleep medicine treatment in house and the dentists don’t do titration-calibration and follow up visits, and they don’t even know how to evaluate a sleep study. They also take airway bites that are arbitrary, and they aren’t trained to properly handle potential issues with TMJ, orofacial pain, and trigger points especially if they caused those issues from making poor and cheap appliances to begin with.

They also do improper coding for the treatment because sleep apnea is a medical condition and the VA hospitals would code their treatment as a dental condition. In the civilian world, dentists would lose their license to practice if they did that.

There are many examples where VA hospitals that have ignored community care VA practices, as well as active duty TriCare practices for sleep apnea, have seen so many soldiers and war heros—some even amputated—been given such poor healthcare and attention. They had been CPAP intolerant for years or have been on a waiting list to get replacement or alternative treatment such as dental sleep medicine and custom FDA oral appliances, and felt so neglected and sometimes, even hopeless.

Several have gone outside the VA system expressing frustration and others have been brought to tears. In contrast, Board certified sleep dentists in community care have been providing detailed attention to follow up and comprehensive treatment, which then in turn, have been able to basically fix their sleep breathing problems. They do the necessary post treatment sleep studies to validate the effectiveness of their care. As a community care provider myself, I am ready, able and always willing to provide that best quality and care for our military.

The VA hospitals get hundreds and hundreds of patients per month who end up getting the cheap appliances that break and are ineffective. Many have already come to me on their own for help because the VA hospital would end up neglecting them.

Thank you again for your time and attention to this matter that concerns all of us.

Sincerely,
Dr. Jerry Hu
See attachment studies