Dr. Dan Tache, DMD

06/19/2026

If you take one thing from everything I've been sharing this week, let it be this.

Ask for the RDI.

Not the AHI. The RDI.

The apnea hypopnea index counts apneic events and oxygen desaturations. It is the dominant metric in sleep medicine. It is also an incomplete picture for a significant portion of the patients you are seeing.

Upper airway resistance syndrome patients don't have apneic events. Their oxygen doesn't drop. Their AHI can be two or three and every sleep specialist in the room will tell you they're fine.

But add the respiratory effort related arousals, the RERAs, and you get the RDI. The respiratory disturbance index. That is the true measure of sleep fragmentation. That is the number that tells you how many times per hour the body was under enough stress to activate the sympathetic nervous system, release cortisol and adrenaline, and pull the person out of restorative sleep.

An AHI of three and an RDI of thirty is not a mild sleep problem. It is a significant one. That patient is releasing cortisol thirty times an hour. Their pancreas is suppressed. Their blood sugar is rising. Their blood pressure is climbing. They are craving carbohydrates because ghrelin is being released every time they arouse. They cannot lose weight. They grind their teeth. Their TMJ is loaded. They are depressed and exhausted and no one can explain why.

You can.

When a patient brings you a sleep study and the AHI is low, don't stop there. Ask what the RDI is. Ask if RERAs were measured. Ask whether the study was attended and whether nasal cannula data was captured for flow form analysis.

If the answer is no to most of those, and your clinical exam shows a scalloped tongue, retrognathia, forward head posture, a narrow airway, bruxism, and TMJ symptoms, push for a full polysomnogram.

Trust what you're seeing in the chair. You see these patients every day.

I'm spending two full days in Fort Lauderdale on July 10-11 going deep on all of this. Diagnosis. Appliance design. Pharyngometry. The TMD airway connection. Real cases. Real protocols.

My son told me that before I retire, I owe it to people to share what I know.

Course details in the comments.

06/19/2026

If you take one thing from everything I've been sharing this week, let it be this.

Ask for the RDI.

Not the AHI. The RDI.

The apnea hypopnea index counts apneic events and oxygen desaturations. It is the dominant metric in sleep medicine. It is also an incomplete picture for a significant portion of the patients you are seeing.

Upper airway resistance syndrome patients don't have apneic events. Their oxygen doesn't drop. Their AHI can be two or three and every sleep specialist in the room will tell you they're fine.

But add the respiratory effort related arousals, the RERAs, and you get the RDI. The respiratory disturbance index. That is the true measure of sleep fragmentation. That is the number that tells you how many times per hour the body was under enough stress to activate the sympathetic nervous system, release cortisol and adrenaline, and pull the person out of restorative sleep.

An AHI of three and an RDI of thirty is not a mild sleep problem. It is a significant one. That patient is releasing cortisol thirty times an hour. Their pancreas is suppressed. Their blood sugar is rising. Their blood pressure is climbing. They are craving carbohydrates because ghrelin is being released every time they arouse. They cannot lose weight. They grind their teeth. Their TMJ is loaded. They are depressed and exhausted and no one
can explain why.

You can.

When a patient brings you a sleep study and the AHI is low, don't stop there. Ask what the RDI is. Ask if RERAs were measured. Ask whether the study was attended and whether nasal cannula data was captured for flow form analysis.

If the answer is no to most of those, and your clinical exam shows a scalloped tongue, retrognathia, forward head posture, a narrow airway, bruxism, and TMJ symptoms, push for a full polysomnogram.

Trust what you're seeing in the chair. You see these patients every day.

I'm spending two full days in Fort Lauderdale on July 10 and 11 going deep on all of this. Diagnosis. Appliance design. Pharyngometry. The TMD airway connection. Real cases. Real protocols.

My son told me that before I retire I owe it to people to share what I know.

06/15/2026

My brother was not obese. He didn't snore much. His sleep study came back negative.

He was 42 when he died in bed.

Upper airway resistance syndrome. UARS. It's real, it's common, and it is almost never caught. Not because it's rare. Because the tools most doctors are using to find it aren't sensitive enough to detect it.

Here's what happens. The airway doesn't collapse. It just narrows. Breathing becomes effortful. The body senses the struggle and sends an alarm. Adrenaline. Cortisol. A micro arousal pulls the person out of deep sleep. Heart rate spikes. They settle. They fall back. It happens again. 40, 50 times an hour. All night long.

No oxygen drop. No obvious snoring. So the report comes back clean.

The patient is told they're fine.

They are not fine.

They're exhausted. Their blood pressure is creeping up. Their blood sugar is rising. They're grinding their teeth down to nothing. They're depressed. They can't focus. They feel like they're dying on the vine.

Because they are.

The standard metric in sleep medicine is the AHI. Apnea hypopnea index. It counts apneic events and oxygen desaturations. If yours is low, most doctors send you home.

But UARS patients don't have apneic events. They have RERAs. Respiratory effort related arousals. Effort without collapse. Stress without saturation drop.

The number that actually matters is the RDI. Respiratory disturbance index. It adds the RERAs to the AHI and gives you the full picture of how fragmented someone's sleep truly is.

I've seen patients with an AHI of 3 and an RDI of 30. 3 times per hour they're having apneic events. 30 times per hour their body is under stress. 30 times per hour they're releasing cortisol and adrenaline and never reaching deep sleep.

That patient is miserable. And almost every provider they've seen has told them they're okay.

We can do better. Dentists especially. We look in their mouth every single appointment. We see the scalloped tongue. The dry mouth. We hear about the morning headaches and the jaw pain and the fatigue.

We just haven't been trained to connect the dots.

That's what I'm going to teach in Fort Lauderdale this July.

Course details & registration in the comments.

06/11/2026

Dentists are in a unique position to play a bigger role in the screening of patients for sleep apnea. It is up to us to make a difference.

Need more information on how to do this? DM me.

06/10/2026

The overlooked key in airway advancement: vertical dimension

When we think about fixing sleep apnea with oral appliances, we often focus solely on how far we can move the jaw forward. But that’s only part of the story.

Most clinicians aim to open the airway by pushing the jaw forward, setting it at a certain percentage of maximum protrusion. Still, here’s the crucial insight: vertical dimension matters just as much, if not more.

Advancing the jaw without considering vertical height can actually worsen breathing. Why? The muscles that keep the airway open run vertically, and increasing vertical dimension stiffens these muscles, helping maintain a clear airway through the night.

In fact, studies show that adding about 8 millimeters vertically can reduce the need for excessive forward advancement by up to 70%. Less forward movement means fewer side effects and a better, more stable outcome.

It’s simple, but often overlooked, vertical control can be the difference between an effective and a problematic appliance.

06/10/2026

One month out!!

July 10-11. Fort Lauderdale. The TMJ-Dental Sleep Connection course.

If you've got patients who aren't responding to treatment—grinding more, not less, headaches worse, bite feels off—this is where we fix that.

Two days. 16 CE credits.

We'll cover the stuff that isn't taught in dental school. Permissive vs directive splint design. Vertical dimension protocols. The restless leg–bruxism connection. How to recognize UARS when the sleep study says "mild." And what to do when advancement alone isn't working.

You don't need to be a sleep dentist. If you're making night guards for patients who grind, this is for you.

One month. Limited seats.

Course details & registration => https://shorturl.at/BWYPh

Two-day clinical intensive on the TMJ-Dental Sleep connection. Learn to identify TMJ risk factors in sleep patients, prevent appliance failure, and manage non-responsive cases. Taught by Dr. Dan Tache—board-certified in dental sleep medicine with 25+ years experience. July 10-11, Fort Lauderdale. ...

06/09/2026

"My doctor gave me a mouthpiece so I wouldn't grind my teeth."

I hear this all day long. Most of my patients come from physicians and dentists. And this is the story every time.

Here's what I tell them.

People grind their teeth because they're having sleep problems. That's a separate but related issue. There's more to it than just a mouthpiece.

But what do they get? An NTI. A little one that goes up front. Flat. Or a maxillary or mandibular piece of plastic made on a biostar. Flat. Maybe some cuspid rise.

What's emphasized in dental school is a little misguided. They're taught to give something that enables the jaw to move infinitely forward, back, side to side.

Then the patient falls asleep. Loses consciousness. And that jaw automatically slides back on the glassy plastic.

Now it's harder to breathe. Maybe just increased resistance. But that's enough to cause more grinding. More clenching. Worse headaches in the morning.

And when the jaw slides back far enough, it jams the joints. The retrodiscal tissue gets compressed. The disc pops out. The patient wakes up locked.

The splint they were given to stop the grinding is making everything worse.

It's not the patient's fault. It's not even the clinician's fault. It's what we were taught.

But now you know. And you can do it differently.

✅ Follow for more TMJ-Dental Sleep insights.

06/08/2026

A lot of times when you go to a CE course, it's supported by a manufacturer.

You're learning about the appliance, the appliance, the appliance. But not what goes into making that appliance more effective.

The clinical nuances. The vertical dimension considerations. The screening for sleep apnea before you deliver a night guard. The palpation techniques. The questions you should be asking.

That's the gap.

It's not a failure of intelligence. It's a failure of information.

If you'd sat next to me through the courses I've taken, had the conversations I've had, you'd be saying the same things. It's context. It's clinical expertise combined with the academic foundation.

We're not getting this in dental school. We're not getting it in most CE courses either.

This is exactly why I'm doing the July course. Not to sell you on an appliance. But to teach what goes into making your appliances actually work.

July 10-11. Fort Lauderdale. 16 CE credits.

Course details & registration in the comments.


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✅ Follow for more TMJ - dental sleep insights.