The Future is NOW
OR: How Rebis Gave Form to a Fourteen-Year-Old Dream in Sleep Medicine
By David E McCarty, MD FAASM (but you can call me Dave)
Co-Creator, Empowered Sleep Apnea project | Chief Medical Officer, Rebis Health
12 June 2025
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“If I have seen further, it is by standing on the shoulders of giants.”
—Isaac Newton, in a letter to Robert Hooke (1675)
A beacon of hope from the past shines brightly into our future…
In 2011, the American Academy of Sleep Medicine published a forward-looking position paper titled The Future of Sleep Medicine [1]. For those of us who read it not just as strategy but as story, it felt like a lantern of hope, lifted high in a foggy forest: a visionary call toward integration, collaboration, and patient-centered care. At the time, it felt ambitious, disruptive—perhaps even romantic—especially for those of us practicing within the hidebound confines of academic medicine, where change happens like the glaciers. It outlined six aspirations for how sleep medicine might evolve: from isolated diagnostics toward complexity-literate care teams, from rigid definitions toward precision management, from gatekeeping toward shared agency, and it was right there in our flagship journal SLEEP!
And we all held our collective breath…
And then the years passed. Fourteen years, to be precise. The fog in our forest, as best as I can tell, has not yet lifted.
Today, I’m going to describe why that’s going to change.
Today, I’m writing about the new Rebis Health clinical Sleep Medicine project—a mythic, yet pragmatic response to the very dreams outlined in 2011. A bit of foreshadowing: we didn’t set out to fulfill Strollo 2011’s prophecy about The Future of Sleep Medicine though that’s ultimately what ended up happening. During co-creation, we’ve been simply following the threads of what made most sense, and Rebis is where we found ourselves.
But when I revisited the paper, here, now, in 2025, the overlap was uncanny…and it’s hard to describe how that makes one feel…it’s like building a cathedral and then finding out that someone else had drawn plans for it, years ago. Or like walking into someone else’s house, and finding a picture of your dog, on their mantle.
Uncanny!
But I’m getting ahead of myself, again! 😊
I’ll start with this: Out there, in the “wild blue,” things aren’t going so hot, when it comes to collaboration.
Instead of enhanced cross-pollination, the silos of Sleep Medicine have seemingly deepened…
We see that the AASM and AADSM—who used to have a joint meeting with lots of cross-pollination—no longer play together, meetings separated now by months and thousands of miles. We see Expansive-Orthodontia & Airway-Focused Dentistry off, doing their own thing, trying to avoid persecution at the hands of the establishment. We see mainstream “retractive” orthodontia providers pretending that orthodontia-associated airway issues are a made-up problem, hyped by a fringe element. We’ve seen our language diverge, rather than unite. As the language has diverged, we’ve seen silos stop listening to each other altogether.
For many of our patients, “Sleep Medicine” has become a narrow alley with locked doors, with many barriers to successful holistic integration of care. At the SLEEP meeting in Seattle this week, I had lots of conversations with clinicians in various locales—private practice, academia, the VA—providers who just feel overwhelmed: too many people to see… too many studies to read… too many tasks in the queue. Many had never heard about the exciting narrative of expansive Airway Focused Dentistry.
I heard a lot of talk about burnout, though. I heard a lot of people wondering if they would be able to retire early. I heard a lot of people quietly wondering if hope was still on the table.
So.
This is why I’m writing this essay.
I’m writing about hope, specifically my hope. I’m writing about the real-life manifestation of something that was only a pipe dream in 2011, a real-life dream that I’m living out, in real-time, right now.
My name is Dave McCarty. I’m the Chief Medical Officer of Rebis Health.
And I guess you could say that I care a little bit about patient EMPOWERMENT :)
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Integration: Not Just Interdisciplinary—Interwound
One of the clearest calls in the 2011 paper was for a breakdown of disciplinary silos: a plea for dental sleep medicine options, behavioral sleep medicine interventions, primary care considerations, and traditional “western” sleep medicine options to stop pretending they live on different planets and play nice together. This was aspirational goal #1: to develop a robust integrated care program.
Rebis doesn’t just nod at this. It embodies it.
We operate as a braided model: airway focused dentistry, integrative medicine, behavioral sleep medicine, and sleep medicine, provided by an army of advanced practice providers, all speaking a shared cultural language…not just “collaborating,” but carrying the same maps, with the same tools to deconstruct complexity. This creates the opportunity to experience what US Army General Stanley McChrystal (ret) called a “shared consciousness” of the complexity we confront.
This isn’t integration by referral. This is integration by design.
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Education: Language as Liberation
The Strollo 2011 paper made a simple but profound point: if patients don’t understand what’s happening, then nothing else matters. That’s the foundation of “patient centered care.” The aspirational dream was to place education at the center of care—not as a handout, but as a healing act.
Rebis took that challenge to heart, by integrating a fully realized patient-centered educational initiative into its very DNA: the Empowered Sleep Apnea universe.
If language is how power is distributed, Rebis is using a whole new dictionary. Instead of relying on data packets or generic web pages, we organized the project around a whole narrative cosmology. By integrating the Empowered Sleep Apnea project and its patient-facing complexity deconstruction tools into our clinical protocols, we translated physiology into something a person could feel. Not simplification—but democratization.
The Empowered Sleep Apnea language allows patients to understand Sleep Apnea not just by number, but by nature, not with scary admonishments to “use CPAP”, but with cartoons, storytelling, and poetry so they understand the “WHY”. You might say we don’t just give folks a tri-fold handout--we walk with them into the Bay of Narrative and help them find their way. It’s an unfolding act of co-discovery, and the patient is in the driver’s seat.
We manage complexity at Rebis as a collaborative enterprise, and we use the two five-point mnemonics from the Empowered Sleep Apnea project to promote that collaborative co-discovery: The Five Finger Approach, and the Five Reasons to Treat. I’ll talk about the Five Finger Approach now, and I’ll get to the Five Reasons to Treat in a minute.
The Five Finger Approach allows each discipline to share a common scaffolding for the deconstruction of nonspecific sleep-wake complaints, and it’s a language we share with our patients. The result is that the entire ecosystem supports a shared and supported journey that’s driven by the patient’s narrative.
This is not a checklist.
This is a compass and a map and a set of hiking boots.
The Workforce: Crows Teaching Crows
The AASM Task Force noted that the shortage of sleep physicians would require the inclusion of Advance Practice Providers (APPs) and other non-physician clinicians. But what does it mean to include without tokenizing? To share responsibility without dilution?
Rebis is built around a culture where nurse practitioners and PAs are not assistants—they are authors of care in partnership with their patients. Their depth of understanding is not optional. We don’t hand them a protocol and hope they follow it. We give them collaborative complexity deconstruction tools to co-discover individualized solutions with patients, one by one, in real time, coupled with an ecosystem that can handle these solutions.
This is not task-shifting. It’s epistemic handoff. It’s the polar opposite of “one-size-fits-all” medicine. It’s the recognition that clinical Sleep Medicine is a complex, nonlinear organism, with many bidirectional relationships and emergent characteristics. All of this makes shared decision-making a must. When a medical trajectory is uncertain, a solid provider-patient partnership is a powerful ally.
This is the difference between algorithmic management and management of complexity. The shared collaborative structure of Empowered Sleep Apnea allows providers of all stripes to move confidently through this complexity, with humility and clarity. At Rebis, we’re not training with answers.
We train with frameworks.
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Precision: Without the Pretense
One of the strongest critiques and most future-facing points in Strollo 2011 was that the “CPAP-or-nothing” mindset needs re-thinking. It was clear then—as it is now—that not all sleep-disordered breathing is created equal, and not all patients need the same treatment or the same pressure. The dream was to create personalized care that accounted for nuance.
This has become our central ethic at Rebis.
We resist the flattening of physiology into a binary label, into a “yes” or “no” answer. We do not tell someone they “don’t have sleep apnea,” just because their CMS-AHI is 4.9. We do not say “mild Sleep Apnea doesn’t need treatment” without first exploring the nature of the events, the vulnerability of the person, the architecture of their sleep, and the “moving parts” of Sleep Apnea that might be in play.
Which brings me to our second five-point complexity deconstruction tool!
This—all of this—the discussion about “should we or shouldn’t we?”—is the hot mess that the Five Reasons to Treat (FReTT) co-discovery paradigm was built to hold—it’s a structure for exploring the questions “Why are we doing this?” and “Is it working?”.
FReTT helps us move beyond the diagnosis code and into the reasons that actually matter to the patient:
1. incremental RISK for early demise
2. SNORING and its social and physical trauma,
3. SLEEP disruption, damage, and curtailment,
4. impairment to the WAKE neurobehavioral experience
5. COMORBIDITIES made worse by the nonspecific stress of Sleep Apnea.
Five reasons. Each patient has the opportunity to decide which are important, and whether it all adds up to justify engaging in a treatment strategy.
Or not!
FReTT is an inventory and a curated discussion and a wakeup call to anyone who thinks that our job is just to get our patients “compliant.”
Why are we doing this? Is it working?
For each of the Five Reasons, it’s possible to set individualized treatment goals, following which a treatment strategy is put in motion, and then we follow up to see if our goals have been achieved.
Rinse and repeat until you reach Pleasant Dreams Beach.
FReTT lights the way.
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Story as Strategy
Sleep medicine—when poorly conceived—becomes a robotic metrics game, a conveyor-belt medical mill doling out CPAP machines one after the other, as long as the money is green and the AHI is high enough. But humans do not live in spreadsheets. Strollo 2011 called for an embrace of “quality of life” outcomes—of narrative, experience, and subjectivity.
These elements are the very foundation of Rebis. We did not build a clinic. We built a culture.
We humanize the experience, using the zany language of the Empowered Sleep Apnea project…we teach the biology of DLMO using a shy pilot trying to land a plane…we explain homeostatic sleep pressure with a story about fumes building up in an attic…we teach people not to cross a certain river before they’ve gone to the Coffee Hut for a good long talk about The Five Reasons...
We like to use stories like this to convey complexity because it allows the fear response to fade, leaving curiosity and…hope behind.
There’s that little bubble of a word again: hope.
And you know what? It works.
Patients remember. They feel understood. Providers find language for what was previously ineffable. Culture forms. And out of that culture comes not just “compliance”, but coherence.
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Technology: Tool, Not Tyrant
Finally, Strollo 2011 envisioned a tech rich future, but warned us about technology becoming an end in itself. CPAP is a tool. Apps are tools. Telemedicine is a tool. But if we forget what they are for—or who they are for—we drift into absurdity.
At Rebis, we embrace technology, but we hold it accountable. We ask: is it helping this person reclaim their nights? Is it honoring their biology, their story, their rhythm? Rebis incorporates telehealth and remote patient monitoring into every case. These technologies are intelligently combined with individualized home titration of therapy pathways to identify the most effective and most comfortable strategies to meet a patient’s needs.
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Real World Data are Coming
The mandate for strategic planning for sleep research is loud and clear. The world of “Real World Data” is here, and Rebis is ready. Dr. Ellen Stothard, co-creator of the Empowered Sleep Apnea project is also Chief Medical Officer at Rebis. Research is her jam. And, as she detailed in her recent essay, there’s plenty to do, and it starts by standardizing our outcome measures, and working together to pool our knowledge.
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A Note Across Time
Dr. Strollo and colleagues, if you’re reading this: thank you!! You named the path, you lit your beacon. You saw what was needed. You gave voice to a future you hoped might arrive.
We just wanted to let you know: it’s here!
We found your signal…we are flashing back now, our beacon across time and space: We’re here! We’re here! We’re here!
The future is now!
And guess what?
We brought cartoons! 😊
Kind mojo,
Dave
David McCarty MD FAASM
Boulder, Colorado
Reference:
1. Strollo PJ Jr, Badr MS, Coppola MP, Fleishman SA, Jacobowitz O, Kushida CA. The future of sleep medicine. Sleep. 2011 Dec;34(12):1613–1619.