How I Built My Sleep Practice

Maria Sokolina

Many years ago, I became so excited about the topic of dental sleep that I lost my own sleep. For me, dental sleep was the answer to many puzzles I tried to solve while working as a general dentist. I was very scared that patients would break my dental restorations, my orthodontic treatments would relapse, and my implants would fail. I kept digging and digging to answer the question: why do people grind their teeth? All of a sudden, I learned through my continuing education courses that the cause was sleep and breathing disorders. I took another Sleep Residency Program in Tufts with Dr. Leopoldo Correa, and after completion, I was ready to start helping my sleep-deprived patients. Although I was helping patients get confident smiles, I felt like I wasn’t making a difference in their lives.

As my course recommended, I started identifying Sleep Apnea patients in my practice and sending them to their primary care physicians for sleep studies. As any good observant dentist, I saw the signs of sleep and breathing disorders in my patients’ mouths very clearly. Besides the fact that I asked my patients questions about their sleep and snoring, I loaded the app Snore Lab on their phones and scheduled follow-up appointments to review the results the app provided. Patients usually inquired about what the results should be. “There is no specific number I can give you. It depends on your sleeping condition, air conditioner, your partner’s snoring...” I usually listen to the results collected from three nights on Snore Lab with the patient.

I can’t say that I have a success rate of convincing all my patients about the necessity of a sleep evaluation. Fifty percent of patients were surprised that a dentist, someone they only see as a tooth doctor, could offer recommendations and suggestions about something other than teeth. But the other fifty percent of my patients listened and went back to their PCP to inquire about a sleep study. I scheduled appointments to review the sleep study results with them after one month, but no one kept that appointment. I felt deeply disappointed. I called some patients myself and was very surprised to learn that patients who went to their PCP had two different outcomes. Some PCPs simply said to them that they were not overweight and did not have sleep apnea, despite the oral signs I showed the patients that raised my suspicion. The other group that went to their PCP was referred to a sleep physician, had a sleep study done, and was offered a CPAP machine. This happened despite the fact that the American Academy of Sleep Medicine recommends Oral Appliance Therapy for patients with mild to moderate sleep apnea.

I realized that if I kept this strategy, my dental sleep practice would never happen. I needed to start building relationships with sleep doctors. I have to admit that this was the beginning of a very frustrating chapter in my life called Cold Calls. Here are the lessons I learned:

LESSON 1: BUILDING RELATIONSHIPS THROUGH COLD CALLS

I spent a lot of time knocking on doors, handing out business cards, and bringing gifts in an attempt to build relationships with administrative staff, sending them holiday and birthday cards. I even offered free dental services, such as whitening and cleanings, to doctors and their staff. While they became familiar with my name, it did not result in referrals. Just like Jason Tierney, guest on my channel and Author of the book “Transform Dental Sleep Medicine” said: “Awareness is the first step, but credibility and trust must follow before any referral partnership can flourish.”

LESSON 2: LUNCH AND LEARN STRATEGY

I organized “Lunch and Learn” events at medical offices. While the lunch portion was popular, the learning part about dental sleep medicine didn’t seem to capture the attention of the office staff or doctors. Doctors were often too busy to engage beyond a few minutes or they’d just wave me from the hallway.

Jason Tierney commented on my experience: “Educational opportunities should match the interests and priorities of your audience. If it’s not engaging or immediately relevant, even a free lunch won’t get you far.”

Providing food opened doors and gave me some face time, but the strategy alone was insufficient for in-depth education or relationship-building.

LESSON 3: PERSONALIZED PLAN

After referring a patient with mild sleep apnea to a sleep doctor, who then received a CPAP machine, I conducted some research. I learned that this doctor was a foodie and loved a particular restaurant. I invited him to dinner, fully prepared with articles, examples of oral appliances, and case studies of patients I had referred to him. I wanted to present myself as a knowledgeable professional. While he enjoyed the dinner and found my information interesting, he said, ‘I really had a wonderful time and the information you presented is very interesting, but I will not refer to you.’ Jason Tierney explained: “Physicians refer based on trust in the practitioner’s expertise, but also based on their comfort with the referral process and treatment outcomes.”

This made me realize I needed to understand how physicians view the referral process.

I decided to seek answers through social media by creating my Facebook, YouTube, and LinkedIn channels titled ‘Sleep Apnea: Breathing-Snoring Help,’ where I interviewed sleep doctors, ENTs, neurologists, and PCPs to understand how to build referral relationships with them.

Here are the key secrets I learned:

Secret 1: WHAT DO MDS LOOK FOR IN A PROVIDER THEY REFER TO?

Personal relationships are important, but credibility takes priority. Physicians prefer to refer patients to providers who demonstrate expertise and use standardized medical language, such as AHI (Apnea-Hypopnea Index), the Epworth Sleepiness Scale, the Fatigue Scale, and the Berlin Scale. Additionally, familiarity with other components of Sleep Medicine is advantageous. A survey indicates that 88% of physicians prioritize a provider’s credibility in their decision-making.

SECRET 2: INSURANCE COVERAGE

Doctors want to ensure their patients’ care will maximize insurance coverage, 50 % of MDs put insurance as an important component of care. While dentists often pride themselves on avoiding dental insurance constraints, medical doctors operate within an insurance-based system, particularly female physicians. It’s important to show a willingness to help patients with insurance matters or offer flexible financial options. As John Nierman, president of Dental Writer, explains: “Dentists can bill medical insurance as out-of-network providers or prepare Superbills for patients to submit.”

SECRET 3: TIMELINESS

Ease of appointment scheduling is crucial for 55% of medical doctors according to a survey. Although gathering necessary information, such as sleep study results and referrals from MDs, can be challenging, this step is essential for maximizing medical insurance coverage. Your team must be trained to streamline this process for patients, ensuring a smooth experience.

SECRET 4: INTERACTION FACTOR

It’s essential for doctors to stay informed about treatment progress. I started sending letters to my dental patients’ sleep physicians and primary care doctors, expressing my concerns about signs of Sleep Disordered Breathing I observed. Many of my patients had prescriptions for CPAP machines that were left unused in closets. I included analyses of sleep studies in my letters, outlining the current situation and offering my assistance in improving their patients’ sleep through Oral Appliance Therapy.

Additionally, I explored the intricacies of medical billing and educated my patients on their medical benefits. By outsourcing to a medical billing company, I was able to gather information about Oral Appliance Therapy coverage, prompting patients to request referrals from their physicians. After the initial consultation regarding Oral Appliance Therapy, I always follow up with letters to keep physicians updated on the treatment status. Once I start the therapy, I refer my patients back to their referring doctors for follow-up sleep studies, typically scheduling these appointments one month later.

A unique challenge I face is that, as dentists, we are trained to expect treatment outcomes within specific parameters—like crowns having no open margins or fillings being decay-free. However, in dental sleep medicine, modern parameters like AHI (Apnea-Hypopnea Index) may not always meet the standard of care below 5. After the active stage of therapy, I feel anxious when reviewing the sleep study results. Even if patients report feeling better and their partners don’t complain about snoring, I might receive disappointing numbers regarding the frequency of breathing troubles at night.

I use letters to build relationships with MDs. If the results aren’t satisfactory, I discuss alternatives with the patient, such as adjunctive treatments like orthodontics, nose breathing therapy, positional therapy, myofunctional therapy, or combined approaches with CPAP machines. Following AADSM standards, I see patients every six months in the first year and annually thereafter, sending letters to their physicians after each long-term visit. Building strong relationships is crucial, and if I notice any health red flags, I reach out directly to the physician to discuss my concerns. I view these collaborations as a team effort, with the medical doctor as my captain.

Every six months, I review my statistics regarding medical providers. These relationships are invaluable to my practice. I encourage my staff to check in with every office to ensure they have enough brochures, referral forms, and business cards. Understanding that the medical team works hard for their patients, we send thank-you notes to every provider we collabo rate with. I also send personalized thank-you gifts to MDs every six months. I highly recommend the book “Giftology” by John Ruhlin, which emphasizes the importance of personalized gifts over promotional items, making it more likely that the recipient will remember you and your services.

Of course, I don’t manage this aspect of my practice alone; I have a dedicated team that assists patients in obtaining necessary documentation and the coordination of medical billing or flexible financial options with insurance. This approach has transformed my practice, rooted in the knowledge I gained from interviews with various professionals.

Building a sleep practice is an art and a science, and it is definitely a very long game. But the internal reward is the satisfaction of helping people live longer, healthier lives, and this is why we chose this profession to begin with.

Dr. Maria Sokolina, founder of Harmony Dental Arts and Diplomat of the AADSM, specializes in Dental Sleep Medicine, using dental appliances, orthodontics, and myofunctional therapy to treat sleep apnea. She educates via her Facebook, YouTube channels “Sleep apnea; breathing, snoring help.” To learn more, visit drmariasokolina.com. You can also take a Self-Assessment on Myofunctional Therapy and Sleep Quality, which will help you determine your level of facial and sleep fitness and provide personalized exercises to improve your overall well-being.