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Sulis Sleep Service

Why have I been referred to a sleep service?

You have been referred for a sleep test because your symptoms suggest you may have Obstructive Sleep Apnoea (OSA) or another sleep related condition affecting your quality of life.

OSA is a common condition affecting about 1 in 20 adults during their sleep.

What is OSA?

When we sleep, the muscles in our throat relax. In some people, this can cause the airway to narrow or close, making breathing difficult.

This can lead to snoring, pauses in breathing, and disturbed sleep. 

You can stop and start breathing like this hundreds of times each night. 

It is more likely to happen in the deepest part of your sleep (REM – Rapid Eye Movement).

Most people are not aware of this happening.

OSA makes it difficult to get good sleep.

  • Loud snoring.
  • Pauses in breathing during sleep.
  • Waking up gasping or choking.
  • Poor or unrefreshing sleep.
  • Headaches on waking.
  • Daytime tiredness or sleepiness.
  • Poor concentration or low mood.

If left untreated, OSA can increase the risk of:

  • High blood pressure.
  • Heart disease and stroke.
  • Diabetes.

There are several factors that can increase the chance of developing OSA. 

  • Weight – Individuals who are obese are at greater risk (BMI ≥ 30 kg/m2).
  • Large Neck size - ≥ 40.6cm or ≥ 16 inches.
  • Large tonsils.
  • Pregnancy.
  • Drinking alcohol – alcohol can make the muscles of the mouth and throat relax, which may close upper airway leading to snoring. 
  • Smoking – smoking can cause inflammation in upper airway, which affects breathing.

LIFESTYLE FACTORS: Making lifestyle changes can lower the risk of OSA and, in some cases, can even reverse the condition.

While you are waiting for your sleep study (usually 4–6 weeks), there are a few steps you can try. Any positive change, no matter how small, can help improve sleep and overall health. 

  • If possible, work towards or maintain a healthy weight.
  • Cut down on alcohol, especially in the evening.
  • If you smoke, stopping can improve breathing.
  • Try some regular physical activity, at a level that feels right for you.
  • Sleeping on your side rather than your back may help.
  • Aim for a regular bedtime routine where you can.

Your sleep team can support you with advice and guidance.

No evidence of sleep apnoea or mild sleep apnoea without significant sleepiness (Mild OSA):

  • Discharge back to your GP with conservative advice as detailed below.
  • Elevation of the head of the bed by 15 to 30 degrees.
  • Use of saline nasal spray or nasal douche morning and night.
  • Please use steroid nasal spray to improve nasal patency e.g. Beconase, Flixonase, Avamys.
  • Please avoid Sudafed, Vicks and Otrivine nasal spray.
  • To consider use of mandibular advancement device (British Snoring & Sleep Apnoea website - britishsnoring.co.uk).
  • Please consider a position modifier cushion to ensure you sleep on your side.
  • Please consider weight loss if BMI greater than 25.

Moderate to severe or mild sleep apnoea syndrome (Sleep apnoea changes with significant symptom burden) - Mild, Moderate or Severe OSAS:

  • If moderate or severe OSA is confirmed, you may be offered CPAP (Continuous Positive Airway Pressure).
  • CPAP is a small machine and mask worn at night whilst you are asleep.
  • CPAP entrains air from the environment, cleans it through a filter and passes it back down a tube which links the mask and machine. In doing so it allows a constant flow of air through the upper airway to prevent intermittent closure and prevents heart rate rises, blood pressure surges and micro arousals thus improving your nighttime quality of sleep.
  • CPAP therapy is not provided by Sulis Hospital or the Royal United Hospital Bath, as such, if required, you would be referred to your local provider, The Bristol Sleep and Ventilation Unit, who will invite you to a group CPAP set up class.

Please note: ALL patients at risk of excessive sleepiness when driving have a duty to stop driving now. For further details on how these rules are applied with specific reference to Class 1 and 2 driving licenses please see The Gov.UK page on Excessive Sleepiness and Driving Please abstain from driving if symptoms of excessive daytime sleepiness are experienced.

  • You will complete a sleep study and specific sleep related blood tests completed.
  • Your results will be reviewed by the sleep team.
  • A letter will follow which will outline the treatment option you have been recommended.
  • If your sleep study changes are indeterminate or indicate an alternative diagnosis you may receive a letter detailing alternative treatment options or if more information is required, you will be referred to the Royal United Hospital Bath for further assessment. Your letter will explain if this has been arranged.

If you have any questions, please speak to your Sleep or Respiratory Practitioner.