REBIS RISING! A New Compass for Sleep Medicine in the Age of Complexity
The following article was originally published in Empowered Sleep Apnea on May 20, 2025. Content is lightly edited for clarity and length.
By: Dave McCarty, MD, FAASM (but you can still call me Dave)
“The only true voyage of discovery, the only fountain of Eternal Youth, would be not to visit strange lands but to possess other eyes, to behold the universe through the eyes of another, of a hundred others, to behold the hundred universes that each of them beholds…”
--Marcel Proust, In Search of Lost Time
~ ~ ~ ~ ~
Sleep Medicine and The Limits of the Linear
Modern sleep medicine, for all its brilliance and nano-wizardry, is built mainly on a framework inherited from the industrial age: precision in, precision out; diagnose, prescribe, repeat. In this model, control, standardization, and hierarchy define success. It's a universe where expertise (which is to say: complexity) is centralized, and deviations are minimal. This model has served us well for some playing fields—for sepsis, for trauma, for surgical specialties. But it begins to fray at the seams when applied to conditions that are not singular diseases but emergent syndromes.
Sleep Apnea sits squarely in that frayed margin, as does “sleep medicine” at large.
For decades, the prevailing model has sought to collapse the complexities of sleep-disordered breathing into a single label (for example: OSA) and a single solution (for example: CPAP). But as the field matures, so too does our awareness: this is no longer sustainable.
Sleep Apnea is not a hammer-and-nail condition. It is a complex adaptive system.
This is no longer a discussion about how best to manage a medical problem.
This is a discussion about how best to manage complexity.
And to do that, like Proust’s narrator, we’re going to have to learn to look through the eyes of others.
The Complexity Frame: Sense-Making, Not Control
Enter Dave Snowden, a Welsh knowledge management theorist who, through his Cynefin Framework, offers a radically different way of understanding the terrain we’re navigating.
In Snowden’s map of reality, not all problems are created equal. Some are obvious, some are complicated, some are complex, and some are chaotic. Each type of problem demands a different strategy, a different operational toolkit. In Snowden’s world, handling a “complex” situation with a “complicated” operational toolkit is like skiing in jeans. You may get someplace, but you’ll look silly, and everyone will make fun of you.
Here's where this essay gets good: “Sleep Medicine”—including the management of the leviathan we all walk around calling “Sleep Apnea”—clearly falls into the complex domain, where:
“Cause and effect are only clear in hindsight.
Interventions have nonlinear, emergent effects.
Solutions must be discovered, not imposed.”
In this domain, traditional “top-down” clinical reasoning based on rigid algorithms fails to produce durable success. The belief that more pressure, more adherence, or tighter Apnea-Hypopnea Index (AHI) control must result in better outcomes is not a law—it’s a leftover from the “complicated” domain’s playbook. And it doesn’t hold.
For Snowden, complex problems require a different approach:
Probe → Sense → Respond
Act experimentally, observe patterns, and adapt iteratively.
Co-create meaning with the system, rather than trying to engineer it into submission.
This is not the world of “doctor knows best” anymore! It’s the world of the gardener, the listener, the story-weaver.
And it is the world Rebis Health was born to inhabit.
The Myth of Rebis: Union at the Eclipse
The name Rebis comes from alchemical mythology—a being born during an eclipse, when the sun and moon occupy the same sky. Rebis is the union of Divine Masculine and Divine Feminine—the archetypes of action and receptivity, assertion and presence, order and emergence.
This myth is not ornamental. It is foundational to our vision.
Modern medicine has leaned heavily—almost exclusively—on the “masculine” energy of management: protocols, diagnostics, categorization, and control. What’s lost is the feminine energy of attunement: listening, pattern recognition, narrative, curiosity, intuition, and collaboration.
Rebis is the synthesis, representing a new strategy for care, where:
Diagnostic expertise meets narrative medicine.
Protocol meets presence.
Structure meets space.
The eclipse symbolizes a rare moment of cosmic balance—and in our clinical work, that balance becomes the fertile soil for a regenerative approach to care.
~ ~ ~ ~ ~
Scaling Complexity: The Role of Advanced Practice Providers
Questions arise: How can we scale such nuance? Isn’t complexity the enemy of scalability?
Not necessarily. It depends on whom we empower.
Traditionally, physicians have been the sole stewards of complexity. But in the Rebis model, we recognize that Advanced Practice Providers (APPs)—physician assistants and nurse practitioners—are highly skilled navigators of complex systems when provided with the correct language, scaffolding, and mentorship.
This is where Empowered Sleep Apnea comes into play.
Rather than burying our care prctitioners in a sea of guidelines, we invite them into a map of meaning. We teach them to:
Identify the “moving parts” in a case of sleep-disordered breathing (like loop gain, arousal threshold, airway collapsibility).
Use narrative as a clinical tool, allowing the patient’s story to illuminate which levers are relevant to start pulling.
Explore treatments with humility, using safe-to-fail experimentation rather than rigid protocols.
In other words, we give them a compass, not a rulebook.
“DIAGNOSTIC DILEMMA” originally appeared in Sleep Review magazine in May 2025.
When “Sleep Apnea” could be part of any syndrome, it helps to have a method for managing the complexity!
~ ~ ~ ~ ~
Listening as Clinical Method
Rebis is not about what we treat, but how we relate.
In traditional care models, the patient sits at the base of a pyramid. Expertise trickles downward. The physician tells. The patient complies.
In our model, the triangle is inverted.
We listen first. We consider what Snowden calls the “narrative fragments” that emerge in a system—the stories, metaphors, and emotional cues that patients offer freely, if we are trained to hear them. These fragments are not noise. They are data—rich, often nonlinear, and far more predictive of future adherence and therapeutic fit than an AHI ever will be.
To listen deeply is not a weakness. It is diagnostic sophistication of the highest order.
Being treated like a “label” can make you want to change the subject!
~ ~ ~ ~ ~
Complexity Is the Strategy
I keep telling folks on my team: “Welcome to the future!” Why is REBIS a future-looking model?
The old model is breaking down:
AHI is increasingly understood as an insufficient biomarker.
CPAP adherence remains stubbornly poor.
The risk-benefit ratio of CPAP therapy has become harder to discuss.
Patients crave agency, not an algorithm.
Meanwhile, the complexity model offers:
Resilience, because it adapts.
Scalability, because it invites distributed sense-making.
Empowerment, because it honors context and intuition.
The Rebis strategy is not new—it is necessary.
As AI encroaches on the simpler tasks of medicine (pattern recognition, image analysis, protocol automation), the human clinician’s value will rise in relational intelligence, complexity sense-making, and narrative integration. These are precisely the muscles Rebis trains.
A New Kind of Leadership in Sleep Medicine
Leadership in the Rebis model doesn’t come from command-and-control. It comes from curation of context.
As Chief Medical Officer, my task is not to dictate what happens minute by minute at the bedside, but to cultivate the conditions where insight can emerge—through stories, through training, using shared language (hello, Empowered Sleep Apnea!), and through trust in our Advanced Practice Providers. Prioritizing the patient is not an abdication of clinical rigor—it’s a reimagining of how clinical excellence propagates.
~ ~ ~ ~ ~
The Path Forward
Rebis is not just another sleep clinic. It’s a myth made manifest—a story about what happens when medicine rebalances its energies and begins to listen to itself again.
We live in a time of great medical disillusionment. Systems are burning out. Patients feel alienated. Clinicians are drowning in algorithms that miss the soul of care.
And yet, something beautiful is emerging.
A new generation of integrative and functional medicine clinicians—fierce, intuitive, multidisciplinary—is rising. They’re not afraid of ambiguity. They’re willing to experiment. They want to build maps that breathe.
Rebis Health is for them.
We are the eclipse-born, the boundary-walkers, the ones who believe that in the very tangle of complexity lies the way forward.
Let’s not simplify the world. Let’s get better at navigating it.
~ ~ ~ ~ ~
Recommended Reading:
