Meet new CEO Neil Verdal-Austin, who concedes missteps with Renew Sleep Solutions and pivots toward a technology-driven future.

At the end of 2018, SomnoMed was stumbling. The oral appliance maker was in the process of shuttering its direct-to-consumer subsidiary Renew Sleep Solutions as well as changing its chief executive. Its CEO since fall of 2016, Derek Smith, stepped down, and long-time chief financial officer Neil Verdal-Austin stepped up.

New CEO Verdal-Austin had been SomnoMed’s CFO for the past decade, a role he characterizes as not just number-crunching but “highly operational and strategic.” He says, “It was implementing the strategy that the board and the CEO at the time had embarked on.”

At SLEEP 2019, Verdal-Austin spoke with Sleep Review about how his vision differs from his predecessor’s, including how good intentions went awry, digital initiatives, and an upcoming device launch.

Renew Sleep Solutions Closure

There were several factors behind Renew Sleep Solutions’ failure, including patient volume missing expectations, high advertising costs, lower than expected third party payor reimbursement, and ill-will from dentists who utilized SomnoMed oral appliances in their practices and perceived the direct-to-consumer centers as competition.

Verdal-Austin says the execution and implementation of the subsidiary was fraught with difficulties the company didn’t anticipate. “Looking at the Renew Sleep Solutions’ experience, our intention was never what we experienced, unfortunately. And that’s our fault. It’s not anybody else’s fault. There’s no doubt about that.

“Our intention, as bold and courageous as it was, was to reach patients who had been previously diagnosed, treated with CPAP, and failed CPAP, if they remain at home untreated and are still sick. Our intention was to try and reach those patients and bring them back into the system…and treat them with an oral appliance that they probably were unaware of, unfortunately, because the physicians tend to not talk about oral appliances.”

The company “misread” several circumstances, Verdal-Austin concedes, including that it didn’t see the centers as in conflict with existing dental sleep medicine practices and it didn’t predict the changing health insurance landscape.

Former patients of Renew Sleep Solutions can get their medical records by emailing treatment[at] with their name, birthdate, and mailing address. The patient portal is available to message the billing team, view and print clinical summaries, and make payments. SomnoMed’s list of recommended dentists for patients to continue treatment is available at in a chart format organized by previous center location.

According to Verdal-Austin, “At every single center, we contacted the patients and let them know which dentist they can go to for help. We did not abandon or leave anybody at all.”

Driven by Technology

In terms of his vision for SomnoMed, Verdal-Austin says, “Our business will be technology driven in the future.” He says that technological systems, platforms, and partnerships are being put in place around the product line and will be unveiled as early as this fall. “And then we can start communicating in a stronger way,” he says, for now only saying that technology will “enable the facilitation of use of our device in more areas than we’ve seen before.”

Neil Verdal-Austin

Neil Verdal-Austin

“Digital Done Right”

Verdal-Austin went into more depth about a new SomnoMed oral appliance that has been FDA cleared and will be unveiled to the sleep medicine community this fall. The device is part of SomnoMed’s “digital done right” initiative, which also includes promotion of the company’s digital workflow.

The new milled device can be created using digitally scanned impressions and ordered online via the SOMaccount e-commerce portal for an end-to-end digital workflow.

It also represents a new design concept from SomnoMed: a feature that limits patients’ ability to open their mouths during sleep. A pilot study detailing apnea-hypopnea index (AHI) changes with the device was presented at the American Academy of Dental Sleep Medicine 2019 annual meeting (Poster #009: Short-Term Results on a Novel Duo-Block Custom-Made Titratable Mandibular Advancement Device Using A Flexible Counter-Balancing Titration Mechanism: A Pilot Study).

“Gravity and muscle relaxation might cause the mouth to open during sleep, decreasing the amount of protrusion during mandibular advancement (MAD) treatment. Applying a connection mechanism that could maintain protrusion should be advantageous in such circumstances,” the investigators wrote. “The present study investigates the effect of such a MAD using a flexible counter-balancing titration mechanism, on reduction in apnea-hypopnea index.” It found statistically significant improvement in overall AHI, as well as AHI when participants slept in supine and non-supine positions. “Especially in the supine sleeping position, it can be expected that mouth opening during sleep increases, thereby counteracting therapeutic efficacy. The tested MAD effectively alleviates such supine effects, showing even a statistically significant higher improvement in terms of decrease in AHI_supine as compared to the improvement in AHI_non-supine,” they wrote.

Dentists aren’t required to have intraoral scanner access to order the new device; Verdal-Austin says SomnoMed can convert traditional impressions into a format useable in its digital workflow. “But more and more dentists are starting to see [intraoral scanning] as viable—it’s efficient; it’s time saving; it’s accurate. And for us, it’s the future,” he says.

More SomnoMed devices will be added to the company’s digital workflow to reap benefits such as shorter turnaround times, Verdal-Austin predicts.

Final Thoughts

Though Renew Sleep Solutions is no more, Verdal-Austin expresses some of the same sentiments behind that initiative today: “As an oral appliance company, we are really determined to try and reach more and more patients with what we believe to be the patient choice, and that’s an oral appliance.”

He says that means increasing awareness about overall patient health outcomes—that is, adherence (where oral appliances shine over CPAP therapy) and efficacy together. “Our battle is not with other oral appliance companies,” he says. “Our battle is trying to reach, advise, make aware, and drive adoption and acceptance of oral appliances and lift the water table level for all boats in the industry, so that patients are aware that CPAP is not the end, or the only option.”

Sree Roy is editor of Sleep Review.