Breathe better.
Sleep healthier.
Live longer.
The technology and integration architecture behind Sleep Cycle Center, The Longevity Institute, and a national network of sleep-apnea-led longevity practices.
What you've described is not a clinic chain. It's a longevity platform with sleep apnea as the front door.
Your View from 30,000 Feet document defines four key pieces of the puzzle: sleep apnea treatments, wearable devices, AI, and a referral plus treatment ecosystem. The first is yours. The next three are where every competitor will get stuck. That's where this document begins.
3× top, 10× bottom in 2026. Operationalized, documented, instrumented, so it can be cloned.
Continuous monitoring, contextual interpretation, daily action. Not a wellness gimmick. A reimbursable clinical signal stream.
MSO above the network. Owns brand, technology, data, and patient relationships. Investor-grade structure from day one.
A bespoke six-layer architecture, built for this. Not adapted from someone else's MSO.
Every existing sleep-medicine SaaS treats the patient as a row in a database. Ours treats the patient as a longitudinal physiological signal, and the franchisee as the operator of a high-yield clinical product, not the manager of an EMR.
Multi-tenant from day one. New franchisee equals new tenant ID. Branding, pricing, payor mix, comms templates configurable per location.
HIPAA, SOC 2 path, FDA 21 CFR 820 awareness for any SaMD claim. Data segregation per state for CPOM and anti-kickback boundaries.
Every external dependency, payor, device, model, EMR, sits behind a TTC interface so vendor lock-in stays under our control, not theirs.
What the platform does, and what it does not.
- •The platform does not diagnose sleep apnea from wearable data.
- •Wearables support patient engagement, trend monitoring, adherence coaching, and clinician review.
- •Diagnostic claims remain tied to approved testing pathways, clinician interpretation, and applicable regulatory standards.
- •AI outputs are decision-support and patient-education tools unless and until separately validated and cleared.
Eight integration plays most sleep-medicine platforms are not built to operationalize.
Sleep-medicine software today connects to one CPAP cloud and one billing clearinghouse. We're going to connect to the entire physiological surface of the patient, then translate that into the kind of clinical signal that justifies the longevity-platform thesis you're raising on.
Apple AirPods as one of many
future clinical signal layers.
Apple is steadily turning AirPods into a health interface. AirPods Pro 2 already support regulated hearing-health features, including Apple's FDA-authorized OTC Hearing Aid Feature, Hearing Test, Hearing Protection, and Live Listen. AirPods Pro 3 extends the platform further with in-ear heart-rate sensing for workouts. Together, these moves point to a clear direction: ear-worn devices are becoming a mainstream channel for health data.
Apple's public patent filings go further. The company has filed applications describing earbud-based biosignal sensing using in-ear and around-ear electrodes, including EEG-style neural signal measurement. These filings do not mean Apple has shipped EEG AirPods, and they do not guarantee Apple will expose neural data to developers. But they strongly support the strategic thesis that the ear is becoming a high-value sensing location for hearing, cardiac, motion, and potentially neural signals.
TLI's opportunity is to build the sleep-medicine interpretation layer ahead of the hardware curve. We can begin today with public Apple frameworks: HealthKit, audiogram data, heart-rate data where available, motion data, and audio / hearing-health workflows. As Apple and other ear-worn platforms expose richer biosignals, TLI is positioned to become the clinical destination for interpreting that data in the context of sleep health.
This is not a bet that AirPods are a clinical EEG device today. It is a bet that the world's most widely adopted ear-worn platform is moving toward clinical-grade sensing, and that sleep medicine needs a trusted interpretation layer when those signals become available. We are equally open to non-Apple device manufacturers, niche clinical sensors, and combinations of small purpose-built devices that together cover the patient 24 hours a day. The platform integrates with whatever ships, from whichever vendor, with the cleanest signal.
Oura Ring · Whoop · Garmin
HRV, recovery, body temperature, sleep architecture cross-validation. Three rings is better than one. Agreement-vs-disagreement signals improve confidence intervals on AHI estimation.
Dexcom G7 · Libre 3 · Levels
CGM as a sleep-quality biomarker. Apnea events drive overnight glucose excursions. Correlating the two is a powerful patient-education moment and a publishable signal.
Withings ScanWatch · Omron · KardiaMobile
Continuous BP and ECG. Untreated apnea drives nocturnal hypertension. Objective BP normalization post-treatment is the clinical proof point that justifies premium pricing.
Eight Sleep Pod 4
Bed-level temperature, HRV, sleep-stage data. The only ecosystem that can act on a recommendation overnight by adjusting bed temperature in response to apnea-related arousal.
ResMed AirView · Philips Care Orchestrator · React Health
Compliance and AHI streaming directly into the franchisee dashboard. 90-day adherence drives reimbursement. Auto-flagged non-compliant patients get a coach call within 24h.
Availity · Change Healthcare · Eligible
Real-time benefits verification, prior auth tracking, claims posting. The "we'll handle insurance" promise to dentist franchisees becomes a real, measurable workflow. Not a sales-deck line.
The Marwan Sabbagh / Alzheimer's correlation lane
Dr. Marwan Sabbagh is one of the most cited Alzheimer's researchers in the world, the national voice on the topic, and a personal childhood friend of Ernie's. He is reachable.
Sleep apnea is now established in the literature as a major contributor to amyloid clearance dysfunction and Alzheimer's progression. A formal advisory relationship with Sabbagh, appointed to the TLI Scientific Advisory Board, gives the platform a clinical research narrative no competitor can match: "the sleep-medicine network that publishes Alzheimer's-prevention data."
Ernie will not initiate outreach until you green-light.
The wearable problem, answered.
The Doctor's vision is a single device that does ten jobs at once. No device on the market does all ten. Waiting for one to exist is the wrong bet.
The wearable is one sensor. The platform is the product. We build the platform now and feed it from a small set of best in class sensors that already ship.
Clinical, SCC supplied
Overnight pulse ox is the signal SCC owns and consumer wearables do not deliver. One clinical device under the patient's pillow or on the finger every night.
- • Wesper Lab (longitudinal patches)
- • Masimo MightySat (best-in-class SpO2)
- • Withings Sleep Analyzer (mat, AHI cleared)
- • Sleepiz One+ (bedside radar, white label)
- • CMI NightOwl (HSAT, OEM friendly)
Consumer, patient owned
The patient brings their own device. We integrate at the platform layer through one healthcare-grade aggregator, not a dozen brittle direct integrations.
- • Vital (primary, also covers labs)
- • Terra API (breadth coverage)
- • Apple HealthKit (iOS companion)
- • Google Health Connect (Android)
- • Oura, Whoop, Garmin, Apple Watch, Withings
Cohort specific
Optional sensors tied to therapy lanes. SCC supplies for active trials. Patients keep or return when the cohort closes.
- • Dexcom Stelo, Abbott Lingo (GLP-1 lane)
- • Oura Gen 4 / Ultrahuman (trial enrollees)
- • ResMed AirView, Philips Care Orchestrator (CPAP cloud)
- • KardiaMobile 6L (AFib subset)
- • Withings BPM Connect (hypertension lane)
The platform itself
The moat is not the device. It is the unified longitudinal record with quarterly labs, EMR, AI coach with physician review, and a consented research pool.
- • Rupa Health for lab ingest
- • Lexicomp + First Databank interactions
- • Thin EMR with FHIR out (Mahler aligned)
- • AI clinical coach, physician approved
- • Data Use Committee for research licensing
Live in SCC Austin. Five patients. Three months. The flywheel starts.
We do not need a hardware bet to start, and we do not wait for one device to do everything. We start in SCC Austin with five enrolled patients, one clinical pulse ox, one consumer aggregator, one lab partner, and a combination of small purpose-built devices that together cover the patient 24 hours a day. From day ninety forward, every additional patient deepens the moat.
- 1Clinical pulse ox partner. Wesper, Masimo, or white-label OEM.
- 2Consumer aggregator. Vital + Terra + HealthKit (recommended).
- 3EMR posture. Thin platform-native with FHIR out, or full Mahler integration.
- 4Lab vendor. Rupa, Vibrant, or direct Quest / LabCorp.
- 5Research governance. DUC chair, consent flow, patient revenue share.
Polypharmacy, deprescribing, and supplement safety. The medication review nobody else runs.
The average TLI member over 65 is on 5 prescription medications and 4 to 7 supplements. Their prescribing physicians often do not see each other's notes. Their pharmacy sees the prescription stack but not the supplements. Their cardiologist doesn't know what their dentist put them on. Nobody owns the whole picture.
TLI does. Every member has one complete medication and supplement record, screened continuously, deprescribed where appropriate against established geriatric criteria, dose-adjusted for age, and reviewed by both a credentialed physician and a clinical pharmacist before any recommendation reaches the member.
"This alone is worth membership for the older patients we treat."
Dr. Chad Denman, SCC's primary sleep clinician, has flagged this as one of the highest-impact services TLI can offer the older member.
The literature backs him up. Adverse drug events drive an estimated 1.3 million ER visits per year in the US, concentrated in patients over 65, most preventable with a single integrated medication review. A 2026 narrative review of 79 polypharmacy studies (Rambam Maimonides Medical Journal) concluded that multidisciplinary medication review and deprescribing improves outcomes and quality of life. TLI's offering operationalizes exactly that, continuously, at scale, inside one record.
No PCP, pharmacy, or longevity app in the market does all six end to end.
Three databases, continuous scan.
Lexicomp, First Databank, and NIH RxNorm plus DDInter run on every change to the record. Covers prescription, supplement, food, alcohol, and CYP450 genetic interactions.
Beers and STOPP / START.
American Geriatrics Society Beers Criteria and the European STOPP / START tools applied automatically. Surfaces medications the member may no longer need, in priority order, for physician review.
Cognitive risk, scored.
Cumulative anticholinergic load (diphenhydramine, oxybutynin, certain antidepressants, many OTC sleep aids) is one of the most under-recognized cognitive-decline drivers in older adults. We score it on every member, weekly.
Pharmacokinetics catch up.
eGFR decline, slower hepatic metabolism, and body composition shifts mean older adults often need lower doses than the label assumes. Most prescribers don't dose-adjust. Our engine flags the gap to the prescribing physician.
Not just drug-to-drug.
NSAIDs in CKD. Beta-blockers in asthma. ACE-inhibitors with hyperkalemia risk. Anticoagulants with high fall risk. The platform sees diseases, labs, and medications, so it can run the screen no single-source system can.
Annual, structured, billable.
CGA is the geriatric standard: medications, cognition, function, mood, nutrition, social, and falls risk in one structured review. Annual for members 65+. Billable to Medicare Advantage. Drives quality-of-life outcomes.
Proton pump inhibitors (PPIs)
Prilosec, Nexium, and similar. Roughly two-thirds of older adults on a PPI lack a valid GI diagnosis. Long-term use is associated with dementia, hip fractures, C. difficile infection, pneumonia, and cardiovascular events. The platform flags any member on a PPI longer than 8 weeks without documented indication and routes a deprescribing protocol to the physician.
Psychotropics in older adults
Benzodiazepines (Ativan, Xanax, Valium), antipsychotics, certain antidepressants. Beers Criteria explicitly flags this class for the 65+ population. Drives falls, confusion, hospitalization, and is overrepresented in institutional settings. The platform flags chronic use and surfaces evidence-based tapering protocols for physician review.
Clinical pharmacist added to the review chain.
The polypharmacy literature is unanimous on one point: pharmacist involvement is the single highest-impact intervention. TLI embeds a centralized clinical pharmacist (PharmD) in the MSO review chain. Every flagged stack lands in a queue the PharmD triages, annotates, and forwards to the prescribing physician with a recommendation.
- 1Engine screens record on every change, surfaces flags.
- 2Clinical pharmacist (MSO) triages the queue, adds notes, drafts a deprescribing or interaction recommendation.
- 3Prescribing physician approves, edits, or rejects.
- 4Member sees the result as a clear next step, never raw model output, never unreviewed.
- 5Audit log captures every prompt, output, edit, and signer. Reviewed quarterly by the advisory board.
"Fewer pills. Sharper thinking. Caught before the ER."
The honest member pitch isn't a hospitalization stat. It is a quality-of-life pitch: lighter pill burden, fewer side effects, clearer cognition, more energy, and the reassurance that someone is finally watching the full stack. For members 65+, this is one of the most marketable, most provable, and most differentiated promises in the entire TLI offering. PCPs don't run it. Pharmacies don't run it. Longevity apps don't run it. TLI does.
- ● AGS Beers Criteria (2023)
- ● STOPP / START v3 (2023)
- ● Medication Appropriateness Index
- ● Anticholinergic Cognitive Burden scale
- ● Lexicomp + First Databank
- ● NIH RxNorm + DDInter
- ● Comprehensive Geriatric Assessment
Phase 1 is the slow one. Phases 2 to 4 sprint.
Planning, hardware partner selection, EMR architecture, advisory board sign-off, and the SCC Austin v1 deployment all happen in Phase 1. It is deliberate work. Everything after is built on top of it and moves faster by an order of magnitude.
Dentists can sign Letters of Intent in Phase 2. We onboard them in waves through Phases 3 and 4 as marketing proves out and as the operating system absorbs more locations without breaking.
Foundation
- • Sign the five Decision Card items
- • Vendor contracts (Wesper, Vital, Rupa, Lexicomp, EMR)
- • Advisory board to 4 of 4 confirmed
- • Working session with Mahler on EMR posture
- • Platform build with five SCC Austin patients
- • AI coach guardrails reviewed and signed by advisory
- • Series A data room and audited unit economics
LOI wave
- • Open LOI program to qualified dentists
- • 200 to 400 LOI targets, 50 to 150 signed
- • Marketing channel matrix in execution
- • Cohort #2 in SCC Austin (25 patients) proves the AI guardrails at scale
- • Two additional SCC-style anchor sites stood up
- • Series A closed
Onboarding waves
- • Convert LOIs to live franchises in waves of 20 to 30
- • Marketing channels that worked in Phase 2 scale
- • Marketing channels that didn't are cut
- • Franchise operating system absorbs the volume without breaking
- • Research arm crosses 2,500 consented patients
- • First peer-reviewed publication submitted
Network effect
- • Vetted-network marketplace opens (MD-VIP, Med Spas, Longevity Centers)
- • Research licensing revenue is material
- • International franchise inquiries qualified and prioritized
- • Strategic partnerships with sleep labs and large PCP groups
- • Series B or strategic buyer conversations on TLI's timeline, not theirs
Sign hundreds of dentists in Phase 2. Onboard them in waves through Phases 3 and 4.
A signed LOI is a soft commitment that lets us forecast, prioritize, and sequence onboarding by market, by readiness, and by which marketing channels we have actually proven. It avoids the trap of signing more franchises than the operating system can absorb in any given quarter, while still locking in the demand we know is there.
- ●Wave size capped at the franchise team's ability to deliver a clean opening (initially ~25 per wave, ramps as the OS absorbs volume).
- ●Priority based on market density (referring sleep labs nearby, PCP networks, payer mix).
- ●Marketing channel evidence drives sequencing. Channels that prove out in early waves get more spend in later ones. Channels that don't are dropped.
- ●LOI signers receive prelaunch training, branding materials, and a confirmed wave slot.
Three working prototypes built in one weekend. Imagine what's next.
We built clickable prototypes of the three primary surfaces of the TLI platform. They are live in your browser, click in and navigate.
Morning AI Report
The 30-second readout the patient sees on waking. Telemetry, interpretation, tomorrow's recommendation, quarterly labs, medication and supplement interactions, FHIR record sharing, and research consent. The full longitudinal record in one view.
Practice Operating System
The day-one workspace for a dentist who's never run a sleep-apnea practice. Pipeline, billing, marketing, training. Turnkey.
Network Command Center
Multi-location rollups, cohort analytics, compliance audit, the AI coach physician-in-the-loop queue, the research arm dashboard, and Series A investor reporting. The surface FORBventures leadership runs the network from.
The franchise architecture isn't theoretical. We've already built one.
Franchise systems are not built in strategy documents. They are built in the tension between brand standards, local operator reality, unit economics, training, compliance, and cash flow. TTC brings the rare combination of brand-building, software-building, and real franchise operating experience.
Ernest Koury · selected operator track
Largest franchisee in the territory. Multi-unit P&L. Hiring, training, vendor management, real estate, marketing. Operated as principal for years.
2013 to 2019. Built a country's franchise system from zero. 16 stores in Sydney. Site selection, build-out, training systems, supply chain, multi-state regulatory navigation, multi-currency, expat ops.
Largest sign manufacturer in the Southwest US. Vertical integration into the brand-standardization layer that every franchise system relies on.
Operated in parallel with the franchise stores. TTC turned Callaway from #4 to #1 in two years and held it for 13. Currently servicing the LPGA Tour, Mark Wahlberg's Municipal, and Lab Golf.
Population density, payor mix per ZIP, dentist-density saturation, drive-time isochrones, competitor mapping.
Unit-economics worksheet, $20K/mo bottom-line target reverse-engineered to patient throughput, payor mix, treatment plan.
Brand non-negotiables vs. operational latitude. The line that separates franchise integrity from franchisee revolt. We've drawn it before.