[00:00:01] Welcome to the Chalk Talk Jim podcast, where we explore insights into healthcare that help uncover new opportunities for growth and success. I'm your host, Jim Jordan.

[00:00:21] Welcome back to the podcast. Today's guest is Kirk Huntsman. He's the co-founder and CEO of Vivos Therapeutics. It's a publicly traded company reshaping the way we diagnose and treat sleep apnea and related disorders. With a decade of leadership, including founding one of the largest corporate dental groups in the United States,

[00:00:39] Kirk brings a unique perspective to solving one of healthcare's most pervasive challenges. In this episode, he discusses how his company is pioneering a non-invasive treatment that addresses the root causes of sleep apnea. He offers his patients alternatives to traditional CPAP machines, and we dive into the connection between sleep apnea and chronic diseases. We talk about the impact of early interventions in children and the role of cutting edge technology in transforming patient care.

[00:01:08] Kirk also shares powerful insights into how better sleep can improve health, relationships, and quality of life. If you're ready to learn how innovation is tackling a billion-person health crisis, this is the episode you must listen to. So, Kirk, tell me in the audience a little bit about yourself.

[00:01:25] Kirk Huntsman, my name is Kirk Huntsman. I am the co-founder and CEO of Vivos Therapeutics. We are a public company that trades on NASDAQ, and we have been public since the latter part of 2020. So, we're about, I guess we're almost five years now, four years. Kirk Huntsman, my name is Kirk Huntsman. We have been public since the last year.

[00:02:16] Treated well over 50,000 patients now. And it's really a fascinating technology in a truly needy market niche. This whole sleep medicine thing has not really had much innovation in the last 45 years.

[00:02:36] I mean, it was about 40 years ago that the first CPAP machines came on the market, and they were brought to market in the mid-80s and first introduced kind of 1980-ish, but it brought to market in the mid-80s.

[00:02:51] And so, we're talking 40 years of basically the same solution for a problem which is growing more and more pervasive. So, our focus is on sleep apnea, but there are so many other breathing and sleep disorders which are associated with that. And then, of course, there's all the things that sleep apnea is comorbid with, which makes it especially pernicious as far as chronic diseases are concerned.

[00:03:17] And so, you know, I think that your viewers might be kind of interested to know a little bit about the sort of the pathogenesis of sleep apnea, because not a lot of people really know that it actually begins in the womb and actually can begin prenatally. Before we draw our first breath here on planet Earth, we see and we find that there are nutritional deficiencies which can predispose an infant.

[00:03:47] There are lack of development issues in the cranium, in the craniofacial area, the maxillofacial region in particular. We have certain developmental deficiencies that don't really manifest, except for one thing that does happen is sometimes a child will be born with a tongue tie, which is the frenulum, the tissue right below your tongue that attaches your tongue to the floor of your mouth.

[00:04:14] And that frenulum may be too short, too tight, and the fascial tissues that are in there oftentimes need to be released or they need to have some therapy to stretch them or whatever. But a lot of times children, little infants, are unable to latch on and nurse because of these short frenulums. The tongue can't get up and create the suction that's necessary to extract milk from the breast. And so you have a very frustrated mother and a very hungry child, let's say.

[00:04:44] But at the end of the day, our doctors out there across the country do thousands and thousands of frenectomies or these tongue tie releases. But that's one of the early things that you notice is that something has not developed properly.

[00:04:57] And in certain genetic phenotypes where you're actually looking at racial profiles such as Asians, African-Americans, they don't have the same developments in their cranium and the cranial base in particular is slightly shorter. And so what happens is that their faces are flattered. Nobody thinks about the fact that what's behind all that compresses their airway.

[00:05:24] And so Asians in particular are predisposed to obstructive sleep apnea at higher rates than other ethnic groups. And a lot of that starts in the early, early, early stages of life. So a couple of things here. First of all, sleep apnea can begin in early, early stages of life. It's manifest sometimes in children where they'll mouth breathe in order to get adequate airway space.

[00:05:52] Mouth breathing leads to the inflammation of the tonsillar tissues of their oral cavity and the adenoid tissues. And so when those things inflame, it compounds the problem. And so when children manifest with signs of obstructive sleep apnea, it typically is in some form of mental disorder such as ADD or ADHD.

[00:06:15] Very common to see patients, pediatric patients with sleep and breathing disorders that are diagnosed as ADD, ADHD kids and put on psychotropic drugs. When in reality, their problem that they have is a breathing disorder that's gone undiagnosed.

[00:06:33] And so we're getting better as a society and as a medical community in our ability to understand what's really happening and intervene early and intervene in ways that today, the standard protocol for a child that has obstructive sleep apnea with the swollen tonsils and adenoids is to do an adenotonsillectomy, which is a radical intervention and it's a traumatic intervention for that child.

[00:07:03] And unfortunately, the relapse rate is quite high, up to 70% of those cases relapse. So what we're attempting to do surgically has a very limited and very short half-life, if you will, for its effectiveness. First of all, I want to do a Pittsburgh plug. So Jerry McGinnis founded Respironics in Pittsburgh and it was Jerry passed in January of this year at 89 years old. And I was fortunate enough to be on a couple boards of directors with him.

[00:07:31] And he was an extremely generous, generous human being, a great philanthropist in the Pittsburgh area. So I just want to put a shout out to him. But that was the first, I believe that was the 45 year ago beginning that you spoke to. And then I think the other piece that we're talking about here is that there's stages of this sleep apnea. And historically, or the past 45 years, has been really focused on the later stages, I think.

[00:07:58] And one of the things that I sense you're bringing to the party is an earlier intervention, which does that stop the ability of it moving to advanced? Well, so interestingly, we have a great deal of success with children intervening as young as age three. We have actual FDA clearances to treat the condition from ages six to 17. So our FDA cleared appliances, which we just got that clearance in the last couple of months.

[00:08:28] So this is all relatively new. So what that represents is a third rail option now available to clinicians who are otherwise the ENT is getting those patients and doing the tonsillectomies, the adenoid removals and all that with limited success. And what we're doing is actually repositioning. We call them guided growth and development appliances.

[00:08:52] So we're actually using oral devices to guide the growth and development of these children to open up that airway. So what we're doing is we're actually bringing the maxilla, the mandible, we're bringing that or those tissues, those structures forward, making them wider. And by doing that, we're opening up the airway. So it strikes me that that's incredibly important.

[00:09:16] I mean, we think of people that have chins that go backwards to the braces or there's the books that have been out. That's a protrusion of the mandible. Yeah. Okay. And a lot of people have been talking about mouth breathing and young kids and adjusting that and the impact of that. So this is sort of in that same, they're growing so you can make that change in their anatomy, I guess, or influence it. So there's two aspects of this.

[00:09:40] So let me make a couple of statements here that I don't think anybody, you know, we talk about it this way at Vivos. I don't think anybody else is really talking about it this way because they don't have the technology that we have available to us. So there's really only three things you can do with obstructive sleep apnea. You can prevent it, which means that you intervene early, pre-puberty. So you got that window between, let's say, birth and 12, roughly, age 12. And you can prevent it.

[00:10:08] If you get in early and you even get some of these children that have already presented with swollen adenoids and tonsils, in many cases, we can reverse that without the surgical intervention. And then we guide their growth and development so that their full genetic potential is reached with, in terms of the size and shape of their oral cavity and the airway behind it. And I can show you a couple of examples of that real quick here.

[00:10:35] But then what happens is, is that that child typically is set for life. One of the things about our technologies is it's typically one and done. A child may wear our devices over a slightly longer period of time because there's so much change going on as they grow and develop. But we're guiding that throughout the process. So the earlier we can get in, the more malleable these children are, the easier the effort is. And compliance is really quite high. So these are removable devices.

[00:11:04] And a child may be in them for three or four years, actually, five years. But the effects are almost immediate. So like, for example, one of the things that you may not be aware of, and some of your listeners may have children that suffer with this, is that a child may not just have ADD, ADHD, but they may have restless leg syndrome. They may wet the bed. Bedwetting is a huge deal. We can fix bedwetting. We've got research that shows that 97% of children who wet the bed,

[00:11:33] we can turn that around and turn that off within two months. Half of those kids within two weeks and the other half within two months. This is where the medical community is beginning to connect the dots between these sleep and breathing disorders and a whole array of childhood health conditions, chronic allergies, these behavioral issues, aggression, academic challenges, lower IQ, stunted growth and development,

[00:12:02] all kinds of things that parents are wrestling with with these children. And the pediatricians are just now coming to realize that it's important that they think about and test these children or screen these children for a sleep and breathing disorder. Because the list of symptoms for ADD, ADHD, and the list of symptoms for a sleep and breathing disorder are almost a mirror image of each other.

[00:12:27] So a lot of times, professionals, they actually did a study one time where they took kids with breathing disorders and kids that were diagnosed ADHD. They put them all in a room, let them play together, then put a bunch of professionals behind a glass, a two-way mirror. The psychologist could not tell the difference between the kids with the breathing and sleep disorder and the kids with diagnosed confirmed ADD, ADHD. It is that compelling.

[00:12:54] So there's a huge amount of kids that are being medicated who don't need medication. They need a sleep study and they need a sleep intervention to fix what they've got going on where the lack of development. You mentioned a retreated mandible, right? The classic sort of bird beak type face with the weak jawline. All of those things, we see more and more of that nowadays. And all of those things behind that tend to compress the airway.

[00:13:22] It strikes me now that I really appreciate your dental strategy because having four kids myself, the dentist is looking in there quite often at a young age compared to maybe the time they spend with the doctor, right? And so it seems to me that there's an intervention opportunity here that has not historically been pushed that way. That's totally true. The challenge that we have is that the dentists have never been taught that and they're formal dental training.

[00:13:51] And so we have to do a lot of, I don't want to call it remedial training, but we have to catch them up to, hey, here's what you should be looking for. These are the signs and symptoms. And here's the way out of jail here for this child. And there's easy solutions, but you got to know what you're looking for. You got to know what you're doing. And it's a little bit of a lift to get all the dentists to think out of the box like that. But yeah, they're coming around. I pulled some numbers. Tell me how close I got.

[00:14:15] Globally, there's 936 million individuals affected by this between mild and severe. In the US alone, it was roughly 30 million, of which 9 million would be mild, 12 million would be moderate, and 9 million severe. Does that sound about right? So the latest figures are over a billion people worldwide. So you were close with the 936 million. I think that's, it doesn't take much to get to a billion after that, right?

[00:14:42] And the latest figures though in the US, which I think you're going to find very interesting, you know, there's a lot of talk nowadays about the GLP-1 drugs, the Ocephic and all that. And when Eli Lilly announced their thing recently, they came out with an updated figure of 80 million people in the United States suffering from sleep and breathing disorders, specifically sleep apnea. And then we have the latest data on children. Those were just adults. Yes.

[00:15:09] On the children's front, it's actually about 20%. The latest data is 20%. Now, that has more than doubled in the last decade. So if you go back to the literature, the scientific literature, just 10 years ago, in 2014, it was 9.4%. Now it's 20.4%. And so you see this more than doubling in a decade of the incidence of sleep apnea among the most vulnerable segment of our population.

[00:15:39] And it's those people, those children that we, I mean, we have products that treat mild, moderate and severe in virtually any age group. But trying to get to the children is where we're trying to prevent the next generation from having quite as much of this condition as our current generation. So we have a special affection for the work that we do with kids. And so... Well, I think for the audience, there's cardiovascular, metabolic, right? There's cognitive issues.

[00:16:09] There's fatigue in adults. Yeah. I remember a 20-year-old story, but a friend of mine was easily 50, 60 pound overweight. Found out he had sleep apnea, got the device and probably lost 80% of that weight within the first year of having it with really doing nothing other than just getting proper sleep. So I think to your point, particularly with children, once you have plaque, once you've got diabetes, I mean, a lot of times it's just no going back, right?

[00:16:37] So the trajectory of the public health impact of what you're doing is absolutely amazing. So what's the cost of this compared to, say, braces or a CPAP machine? Well, so it's a little bit of a different thing. So remember that I said to you that there's only three things that you can do. And I mentioned the first one, which is prevent. And that's what we've been talking about. But after you get to the prevention, if you miss that window and you're an adult with sleep

[00:17:06] apnea, like your buddy, probably, right? Then you have to manage it. And what CPAP really is, is a management device. It's a device that you wear this mask and you wear it every night for the rest of your life. And it's not going to fix your sleep apnea. It's not going to cure your sleep apnea. But every night that you wear it, it gives you another shot at another day of life, let's say. And that's really the intent. It's the management of the disease state over the balance of that patient's lifetime.

[00:17:37] That's the intent. That's the design. That's what it does. Now, what I would like to say to that is, is that the other oral appliances on the market, all the other oral appliances that are out there, there's over 200 different ones, they're doing the same thing. They're basically repositioning that lower jaw forward to bring the tongue out of the airway and to bring all that anatomy forward. So there's a mechanical repositioning. That's what oral devices have done.

[00:18:05] What our oral devices do is allow for a third option. So if we don't intervene in childhood and prevent it, we either manage it using CPAP or an oral appliance for the rest of your life, or the third rail option is unique to Vivo. So I'd like to share my screen if I could. So, okay. So this is a 30-year-old male.

[00:18:31] Now, interestingly enough, this 30-year-old male is not obese, but he has severe obstructive sleep apnea because his jaws failed to develop fully in the earliest stages of life. And so as a normal adult, he was having very serious sleep apnea problems, found a doctor who would treat him. And this is what happened here.

[00:18:58] So what I'm going to show you now is the beginning airway, that colored section, blue, red, all that. And then you see after, this is with no device in the mouth. And this is what happened to him over the course of time. So you can see we've made the pipes bigger. So his airway has doubled in volume and tripled in size. So for the audience, because they will be listening to this verbally, it almost looks like to me,

[00:19:26] when you think of a cardiac vessel narrowing that has plaque, right? So this throat looks like that, obviously bigger. And then the after looks like a wide open pipe, like you put a stent in or something like that. It's exactly right. Exactly. So what our oral devices do is they actually open that airway. Now, here's what a traditional oral device does. And I'm just going to show you this. This is what a mandibular advancement device does. And it takes that lower jaw.

[00:19:56] And you can see this is the exact same patient, just five minutes apart. And it takes that lower jaw and thrusts it forward. You can actually see, if you look closely at the x-ray here, you can see. But you look at the difference in the size of that airway disproportionately enlarged by just a very small movement of the lower jaw forward. And what is a very large enhancement of the airway behind.

[00:20:23] That's a principle that guides a lot of what we do because a lot of what we do is very small changes in the oral cavity lead to very large changes in the mouth. And I'm going to show you here. And we talked about weight situations. This is a 48-year-old female. I realize your audience isn't able to see this for the most part.

[00:20:46] But here you see her going from just in seven months time, you see her already starting to lose some weight. But she's also gone from severe, severe sleep apnea to mild. And then within a few months right after that, because of COVID, we didn't capture her image. But you can see here how much weight she's lost.

[00:21:08] A lot of our patients lose a lot of weight because of the body's ability to metabolize lipids or fats in the body more efficiently during sleep. And the secretion of cortisol is suppressed and the secretion of human growth hormone is enhanced when sleep is improved. And so you see her with no sleep apnea here after a period of just really this was about a 12-month deal for her to get to no sleep apnea.

[00:21:37] But I share those with you because I wanted you to just see the remodeling that takes place here as a patient goes through treatment. It's really a phenomenal thing to see. And we do that with children as well. We just completely bring their oral facial, their maxillofacial, upper, lower jaws. We bring that anatomy forward, make it wider, and the airway just pops open.

[00:22:01] So in addition to these wide pipes for the audience, what's striking to me is it appears to me she got a chin lift. Oh, yeah. Her neck looks fantastic. She looks 10 years younger. Well, about 20% of patients that go into therapy do so for cosmetic purposes. So it's not just our technology does change the look and the anatomy of a face. Much more aesthetically appealing, I think, by most standards.

[00:22:29] And so a lot of people will do it just for the aesthetics. That's interesting. So where are most of these devices put in? Are they mostly found by the dentist today? Well, it does take a dentist to do this today. We're actually working to see if we can't modify that a little bit. In some countries, it's actually done by MDs. But we do have distribution and whatnot all over the world. So in most countries, you'll be able to get this. We're not yet approved in Europe.

[00:22:59] Most of the Middle East, we just did our first in Dubai. We just did our first clinical training. So we've got a whole group of newly minted, trained dentists there in the Middle East. We're excited about that. Australia, we have some providers. So Canada, the U.S., not much in South America yet, but expanding as we go here. But yeah, it's a dental delivery and a dental product because we are changing the oral cavity.

[00:23:27] We're changing the bite registrations of the teeth. We're making the upper palate especially whiter and bringing everything forward. So it does have that. Yeah, there is a need to have somebody who can manage all that. And that's typically a dentist. I listen to you. You know, having three out of four kids having dentist braces, it strikes me that this could be something that is just part of someone's development

[00:23:54] when they're younger, if it could be caught appropriately and have a significant impact. We are so onto that. We are doing everything we can. We're actually working right now behind the scenes. I can't announce which foundations we're talking to, but we are working with some very notable foundations. We've treated some very A-list type celebrities and professional athletes.

[00:24:20] And the ability to breathe is so fundamental, not only to life itself, but especially if you go out and you're trying to do any type of athletics, you need to be able to breathe well. You need to be able to sleep well. You need to be able to have that rejuvenation and healing that takes place from the breakdown that athletic competition requires. And all of that, it comes right back to can a patient breathe properly?

[00:24:47] And through their proper breathing, are they able to then enter into a restful, complete deep sleep that is necessary for complete sort of rejuvenation? So we dive sort of right into this. I usually ask the question, how did you get here? You were, were you running a dental group at some point in your career? I did. I did. I ran a, I ran one of the largest corporate dental groups in the country.

[00:25:11] A lot of the large dental groups today that are multi-billion dollar enterprises, by the way, most of us started back in the early to mid 1990s. And I had a company called Dental One, became Dental One Partners. And we had a series of private equity infusions. And we went through a couple of different transactions and whatnot. But at the end of the day, I mean, we ended up with 165 offices in 15 states.

[00:25:41] And I don't know, it was close to 300 million in revenue. So we had a nice run there with that. And it was after that, that I was introduced to this technology. And I, I really was intrigued by this and I decided, you know what? I don't feel like I'm done yet. I've always been a bit of a serial entrepreneur. So I just said, I'm back in and we launched Vivos and here we are. So what are your biggest challenges as you grow this organization?

[00:26:07] Well, to be quite honest, the biggest challenges are the dentists themselves. We've spent over a hundred million dollars at Vivos trying to get dentists to really embrace the idea and the notion that their patients, that their scenes with such frequency are more than just a set of teeth or gums that have problems, right? Those teeth and gums are attached to a living, breathing human being. And many of those patients are not breathing very well.

[00:26:37] We do about 80,000, 75 to 80,000 home sleep tests a year through our network around the country. And half of the patients, half of all these patients going through these dental offices present with mild, moderate, or severe sleep apnea. And even the mild ones we're finding, because mild sleep apnea, it sounds like it's innocuous. It's just maybe serious snoring or something like that.

[00:27:04] What we're finding is, is that some of the, even the most mild sleep apnea patients, the sleep apnea is actually something that's pointing to a more serious cardiovascular condition, maybe hypertension, maybe all kinds of other things that if you wait, that will eventually become severe sleep apnea. And then it's all hands on deck for heroic medical interventions.

[00:27:31] And we're saying, hey, wait a minute, if we can just screen and identify this condition earlier on when it is mild or moderate, then we can get to it. And now, ironically, our technology works better with severe. In 2022, we published in the Journal of Sleep Medicine that for the very first time that it is possible to actually reverse this disease, that it is no longer required that patients be

[00:27:59] in a device like a CPAP or an oral appliance device for life. And that we can actually reverse it and get their AHI score, which is their apnea hypopnea index, which is how they grade severity of sleep apnea. Get that down below five, which is no sleep apnea. And we've shown that we can do this over and over and over again by simply intervening, remodeling those tissues, getting those pipes bigger, like I showed you, and doing what we did for that young man.

[00:28:28] Now, that young man is now, I think his treatment ended in, where I showed you a few minutes ago, his treatment ended in 2018. He went from severe to no sleep apnea. He's walking around six years, seven years later. He still doesn't have sleep apnea and no further intervention in the interim, right? So it's kind of a one and done. And there's some social things here that think about for people that I know that have had it, it's caused husbands and wives to sleep in separate bedrooms. Oh, yeah. It's changed their vacations.

[00:28:57] They don't have one hotel room now. They have to get two. It's had a lot of other sort of impacts. And the friend I was telling you about is his wife is quite attractive. And I remember saying at the time, you need to put this thing on because you go to bed and you roll over and sound like Darth Vader to kiss your wife. I mean, it was a joke, but he was like, this is a real issue. And after about two years, he was able to get off it. And it really meant a lot to him.

[00:29:22] So there's other aspects here to your point that have relationship issues and social issues. Oh, so true. So true. It affects the trajectory of a person's life. It affects their most intimate relations. One of the side effects of chronic sleep apnea is erectile dysfunction. So it messes with males. It messes with females. Females who are at a stage of menopause or even premenopausal in those time period right

[00:29:51] before menopause initiates, then you have a much higher incidence of obstructive sleep apnea. And so these things tend to go together and it tends to make a lot of things in life worse. And so I had a cardiologist just recently. He's a very big supporter of the company. He's out of Chicago. This guy runs the cardiology departments at nine hospitals. And he said to me, he said, Kirk, you need to get the message out.

[00:30:19] Sleep apnea is cardiovascular disease. Full stop. It is cardiovascular disease. And if we don't start treating it as such, we're going to lose people that we would be able to otherwise help and save. And so get the word out at every opportunity that sleep apnea is cardiovascular disease. And he said, I think it should be one of the fundamental, a sleep screening or a sleep

[00:30:45] test should be one of the fundamental things that we do check vital signs of a human being. Yeah. So how are the insurance companies and the payers handling this? Are they reimbursing for it yet or they still need the proof? Well, they're sort of reluctantly coming around, right? I think they're a little bit afraid. What's happening is, is that it used to be that they would throw up a lot of roadblocks

[00:31:11] and they could do it very successfully to prevent too many people being diagnosed. Because the problem is, is that if you just kind of put it out there and just, and you have an in-lab polysomnogram is the gold standard. Well, to get to that level, to qualify for that and to be reimbursed on that, a one night, overnight polysomnogram in lab can be as much as four or $6,000 for that night.

[00:31:42] Today's technology has driven, we use a technology right here in Colorado called sleep image. And we use this technology. It's a ring that goes on your finger and the ring gives you a clinical grade overnight sleep test. You put the ring on, it automatically starts up. It syncs with your cell phone. And then what happens is, is that you wake up the next morning and the algorithms kick

[00:32:06] in and within 30 minutes, there's a sleep test in the inbox of your provider for you for that night. So, and so the technology is now at home, clinical grade, medical quality, get a full diagnosis without having to go to a sleep lab. There are cases and times where sleep, a full polysomnogram is indicated, but these home sleep tests are really, they're driving the cost of care and the cost of diagnosis so low.

[00:32:36] I mean, you're talking about really the cost when you talk about the actual cost to the provider for conducting the test, you're talking about $20, $30 as opposed to, you know, like I said, several thousand dollars for the in-lab overnight. So I imagine that when I go to my dentist once a year, they do a full head scan. Yeah. And I know with the kids, when they were getting their braces, they were measuring how their mouth was shifting.

[00:33:03] And being a nerd, I look at those images and you can see the back and the opening of the throat. And I imagine that we're, if those companies had a little bit of insight, there would be a measurement there that you see in all sorts of technology, whether it's heart surgery or any cardiovascular surgery there, they're able to measure on the screen. And I would think that it could be part of the annual test. Oh, absolutely. Absolutely.

[00:33:29] That technology is called cone beam computerized tomography or CBCT. And you're exactly right. There are measurements now that can actually look at the size and shape of the airway and at least give you an indication that there might be a problem. And then you can ask further questions and do further screenings and whatnot and determine the course of treatment that might be useful for that patient. So I would normally ask a lot of more diverse questions, but this was such an interesting

[00:33:59] topic. I just wanted to go deep. Is there anything else you'd like to offer the audience? Well, I think it's important for people to understand because 95% of patients, even today, who are diagnosed with sleep apnea are being given a CPAP. And I think the single most important thing for people to understand is that they do not have to spend a lifetime in that CPAP device. Your friend who got off of his CPAP in two years was fortunate.

[00:34:27] Most people get tired of wearing it and they stop wearing it in a matter of months anyway. But for those who actually need it to live, they have to wear it every night to survive. And what we're saying is, hey, would you like to get off of that CPAP? There's a pathway for you to do that that's non-invasive, reasonably priced, reasonably cost. You asked me about the price. I don't know if I answered that or not, but it's typically between $8,000 and $10,000. Most of that's being covered nowadays by insurance, not all of it.

[00:34:56] So it works out to be similar to the cost of an orthodontic case, right? So it's not much more than an orthodontic case. And it's one and done. So 12 months in treatment, nine months in treatment, and you're done. And you're probably done for life. So we want people to know there's an alternative. We want people to know there's an escape route for you to get out of this. You don't have to live with sleep apnea and you don't have to die with sleep apnea. Very good. Well, thank you very much for being a guest. This has been most interesting.

[00:35:26] And I think that what's the most exciting thing is you're moving upstream. And if this can become something that's widely used, it could save millions of dollars. I think one of the differences between working with the European insurance agency is they tend to have a one-payer or two-payer system and they see you as a patient for life. So anything that shows any sort of benefit, they're more interested.

[00:35:54] In the U.S., the average patient's around for five years or less in the insurance company, and you're not going to see the long-term implications sometimes. So I think that's part of the difference. You're right. Well, thank you very much. Jim, thank you so much. I really enjoyed it. Yeah, thank you. Thanks for tuning into the Chalk Talk Jim podcast.

[00:36:17] For resources, show notes, and ways to get in touch, visit us at chalktalkgym.com.