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Of course, we cannot expect to have slam dunk cases all the time, we cannot guarantee anything in terms of treatment outcome, and we cannot chase unrealistic expectations; however, if we always aim to take our time, do a thorough follow through, and work hard with our patients, the sheer number of successful cases that we will attain will become reality.
I want to share one of the most rewarding and unbelievable dental sleep medicine cases I’ve been blessed to do in my life. This is one of those cases that seemed so complex and difficult, and I had no idea how much this was going to change the patient’s health and quality of life.
Yep, this is one of those goosebump magnifying and emotionally charged cases. I hope the reader understands that all of us who put our patients as top priority can duplicate this in their own practice. We are not only saving lives, but we are also making life purpose and meaning with what we do in our profession.
(Note: this patient wanted me to share all of his medical history, records, and journey. He knew I’m an educator and wants his story shared and only use his initials to refer to him)
D.P. came to see me early January 2025. He came from the Department of Labor, Nuclear Test site facilities near Area 51 in Southern Nevada. He came in with such a complex medical history and stories that were so intriguing, they can make the listener want to eat popcorn and hear him out for days (better than a movie!)
He is a veteran and worked for the Federal Government with top security access and those very, very interesting accounts of the projects he was involved with (only ones he’s permitted to share of course). Sadly, though, 90% of his colleagues have already passed away, especially working at nuclear weapon testing sites. Most had cancer and unusual pulmonary and other rare systemic diseases due to their work.
D.P. had untreated sleep apnea, polycythemia, silicosis, severe daytime sleepiness, brain fog, memory loss, and several blood panel issues. His quality of life was poor, and he presented almost hopeless feelings about his health conditions.
He had a disturbing experience he shared regarding his PAP therapy journey. He had been diagnosed with sleep apnea by a local sleep physician in Las Vegas years ago. This sleep physician was the only choice given to the Department of Labor.
After so many failed CPAP, BiPAP, etc. trials, the sleep physician lied to him and told him it’s his only choice and that he was doing just fine. On PAP therapy, his oxygen still desaturated to 81%, and he was told by the physician that it was normal. The physician also told him that it’s his fault for not trying hard enough with CPAP and to just do better with using PAP therapy.
D.P. googled about hypoxemia and oxygen desaturation, and he confronted the physician about 81%. The physician double downed and told him he has no other choice and again, he had to try harder with the PAP machine.
In addition to the sleep physician, he had seen a pulmonologist and an ENT for all his breathing problems. The pulmonologist had done several scans and comprehensive tests, like rhinomametry and airflow tests.
With his blood panel issues and polycythemia record due to hypoxia and all his breathing issues, he also had seen an excellent cardiologist at the Department of Labor.
CPAP Intolerance Report: Despite multiple trials, CPAP failed to resolve oxygen desaturation. The sleep study recommends alternative therapy, including oral appliances.
So, with no promises, except that I will do everything I possibly can for him, I told him to please be patient with me and that we will work together through it all. He was emotional when I told him that.
I also spent much time discussing his brain fog and memory issues. I cited studies from Stanford Medical and other universities regarding beta and tau amyloid proteins, alpha-synuclein proteins, and meningeal wash with cerebral spinal fluid in connection with sleep apnea to memory, dementia, and other neurological issues like Parkinson’s.
When I explained the studies to him, his eyes lit up and it was like he had newfound hope.
He said to me, “Doc, my wife has been noticing that I have been deteriorating. She has to send me reminders more often, and I am so tired and getting more forgetful all the time.”
We explained about all the fragmented sleep and oxygen desaturations disrupting the meningeal wash and what the literature says about the proteins that build up in the brain.
We also told him there’s no promises about improving his memory, brain fog, morning headaches, but it sure helps if we can successfully address his sleep apnea and oxygen issues.
Since he already explained he is completely PAP therapy intolerant, and he can’t use it for more than 3–4 hours and only a few nights per week anyway, we recommended he use supplemental oxygen at setting of 2 with his customized PDAC-approved Herbst oral appliance. He made a new appointment with his pulmonologist and was able to obtain that.
The first week after delivery of his Herbst appliance, he and his wife both made a surprise visit to our office. They wanted to share how dramatic of an improvement he had with the following:
Snoring gone
No more gasping
No more choking
Wakes up refreshed
Memory and clarity improved substantially
His wearable (watch with sleep app) all showed dramatic improvements
They couldn’t believe that such a difference was possible.
Fast forward to two months later — I was lecturing at an event held by Cold War Patriots and Veterans, and he came up to me and said:
“Boy, do I have news for you! I am going to send you all the reports and scan results I got with my pulmonologist and cardiologist. They were blown away. I also have lost nearly 20 pounds and I followed all of your sleep hygiene and nutrition tips.”
He reiterated that his pulmonologist and cardiologist were both baffled by all the test results and how incredible his health has improved.
His red blood cells, hematocrit levels, erythrocytes — all normalized as his hypoxia issues completely resolved.
Being overly excited, we wanted him to do an efficacy and titration sleep test before the usual 90-day wait. His results were mind blowing:
Lowest O2: 91.4%
AHI: 0.0
REM Sleep: Improved to 25%
He remembers vividly dreaming
Please note that we also titrated his appliance once, on the third week after delivery — but it was only 1 mm anteriorly. We did so at that point because he reported his wife told him his snoring improved a lot, but still had a tiny little bit.
So, this shows the power of titration.
Final Sleep Summary: AHI dropped to 0.0 events/hour with a minimum SpO₂ of 91.4% and no time spent below 90%. The patient demonstrated ideal oxygenation and respiratory stability overnight
The pearls of this case show the power of titration, the power of Herbst arm appliances, and the power of Rickett’s sibilant phonetic bite.
D.P.’s headaches and TMJ all improved with this appliance, and the added supplemental O₂ made his oxygen levels stay above 91.4% throughout the night.
He had been tracking his sleep on his watch app as well, and the oxygen levels remain consistent on the reports. Also, his heart rate remained calm throughout sleep at night, with the highest being in the upper 70s — allowing him to stay in parasympathetic tone rather than in a sympathetic overload with fight-or-flight response.
(See reports – photos he had brought over to our office – with his name blocked out)
Pulse & SpO₂ Statistics From Home Sleep Test: Nightly average oxygen was 96.2%, with lowest at 91.4%, and 0% of the night spent below 90% saturation — confirming successful treatment.
Oximetry Report With Dental Appliance & Oxygen: At 2600' elevation, patient reached basal SpO₂ of 97.9% using 4.5% oxygen with oral appliance — excellent response.
Blood Panel Improvement: After resolving hypoxia, hemoglobin, hematocrit, and white blood cell counts normalized, reversing signs of polycythemia.
Overnight Sleep Graph: Consistent oxygen saturation and low heart rate indicate restful sleep in parasympathetic tone, confirming efficacy of the oral appliance.
HbA1c and Glucose Trends: HbA1c dropped to 5.5% and fasting glucose stabilized at 83 mg/dL after airway therapy — systemic metabolic health improved.
D.P. and his wife have both become such advocates for dental sleep medicine. He wants me to teach, share, and write about his life-changing story. It is with such pleasure that I am able to do so.
It is also because I have the American Sleep and Breathing Academy (ASBA) — a group of the most talented and brilliant dentists in sleep medicine — working hand in hand with me to get the word out.
I am more than happy to share my recipe at ASBA courses and study club.
There are over 1 billion people worldwide who are underdiagnosed and undertreated for OSA. Let’s make a difference!
Therefore, I hope to see all of you who will join me in that effort at the next study club course I’m teaching in Minnesota — coming up in August, 2025!
I credit David Gergen, the Federal Government for PDAC Herbst studies, and Mark Brnovich.
— Dr. Jerry Hu