Sleep and Home Ventilation Service

Sleep Clinics

The Royal Surrey provides diagnostic, treatment, and ongoing monitoring services for people with sleep disorders, and those that have breathing disorders during sleep.

Insomnia

Our insomnia team provide services for people with chronic insomnia. More about this service can be found out on the Insomnia Clinic page here.

Home Ventilation Clinics

We offer assessment, monitoring, and treatment for people who require assistance with their breathing due to long term conditions such as:

• Chronic Obstructive Pulmonary Disease (COPD). 
• Motor Neurone Disease and other neuromuscular disorders. 
• Chest wall problems (Kyphoscoliosis). 
• Obesity Hypoventilation Syndrome. 
• Weak cough due to neuromuscular disorders. 

This service is for people who live within Guildford and Waverley. We recommend referral to a local service or to a service who can offer home visits, for people who live outside Guildford and Waverley.

Long Term Oxygen Therapy 

Assessment for long term oxygen therapy is provided for people who live within Guildford and Waverley by the Integrated respiratory team.

Ambulatory Oxygen Therapy

Ambulatory oxygen therapy is the use of supplemental oxygen during exercise and exertion (activities of daily living). It is suitable for people who remain active but whose oxygen saturation levels drop on exertion provided that their oxygen saturations improve with oxygen and that it allows them to walk further.

• Patients with sleep breathing disorders. (e.g.Obstructive sleep apnoea (https://www.blf.org.uk/support-for-you/obstructive-sleep-apnoea-osa/what-is-it)
• Patients with chronic lung disease or neuromuscular weakness who have difficulty breathing due to muscle weakness or lung disease.
• Patients who have a weak cough and are unable to cough or expectorate.

Q: How do I get referred

A: We accept referral from GPs via Choose and Book, hospital consultants and other healthcare professional in the Hospitals and community services.

Q: What are the indications for referral?

A: Daytime sleepiness
History of snoring and witnessed apnoeas (where you are witnessed to stop breathing during your sleep)
Nocturnal symptoms such as waking gasping or choking

Q: Do you see children?

A: We only see patients over 16 years of age.

Q:What will happen at the first appointment

 A: You will be seen by a member of the sleep  and home ventilation team who will make full assessment. 

They will listen to you and ask you to describe

• Current sleep/breathing problem and how it is affecting you
• Medical history (previous operations and conditions managed by your GP)
• List of medication
• Your sleep pattern
• Anything unusual that happens to you at night

They may perform or arrange various tests including:

• Blood pressure check
• Height, weight and BMI
• Spirometry (breathing tests)
• Blood gases (to measure oxygen and carbon dioxide levels)
• Chest xray (if required)

They will review the questionnaires sent out to you in the post

• Epworth sleepiness score (Please add link to Epworth sleepiness score here)
• Sleep diary

Overnight Sleep study

• Most patients will have a sleep study at their first appointment

Q: What should I bring with me to my appointment

• Your diary so we can book further visits and tests (where necessary) at a convenient time for you
• Your current medication list including any alternative or herbal remedies and anything you have bought over the counter.

Q: Should I bring someone with me to my appointment?

A: For initial consultations it is helpful if your bed partner or a relative comes with you as they may be able to give a better account of what's going on during your sleep than you can. 

Q What does the sleep study entail?

A: You will be provided with a device to take home and wear overnight which will monitor your breathing, heart rate and oxygen levels. 

Q: Will I been shown how to put the equipment on?

A: Yes during you appointment we will put the equipment on you to make sure that it fits and to demonstrate how to put it on. You will also be given a diagram to help remind you.

Q When do I need to return the equipment?

A: We will ask you to return the equipment the next day.

Q: When will I get the results?

A: We will aim to see again as quickly as possible. This will depend which hospital you are seen at.

For clinics at Cranleigh and Haslemere followup will be the following morning.

For clinics at Royal Surrey-We will see you as quickly as possible (usually within 2 weeks). We may arrange a telephone consultation to give you your results if appropriate

Q: What information do we get from the sleep study?

A: The sleep study measures snoring, breathing, breath holds, oxygen levels, pulse rate, body position in bed, chest movement and chest movement. When required we also measure leg movements with additional leg leads.

Q: What is the treatment for Obstructive sleep apnoea?

A: This will depend upon the severity and your symptoms. Find out more on: https://www.blf.org.uk/support-for-you/obstructive-sleep-apnoea-osa/symptoms

Treatment Options

Lifestyle changes including:

• Weight reduction
• Exercise
• Alcohol intake
• Stopping smoking

CPAP: https://www.blf.org.uk/support-for-you/obstructive-sleep-apnoea-osa/cpap-machines

An auto titrating CPAP machine and a mask is provided for a trial period of 4-6 weeks to assess your response to treatment. CPAP machines control snoring and sleep apnoea; they are not a cure. If the trial period is a success and the treatment is beneficial you will be provided with a CPAP machine and other equipment. You will be asked to use the machine and mask every night for at least four hours and preferably all night. We will review you on a yearly basis.

Q: What happens if I have questions or problems using the CPAP?

A: Our team are available on email or via the telephone if you have any problems or questions. We can often advise you over the telephone or email. If you need to see us in clinic we can arrange an appointment for you to come in and see us.

Q: Will a diagnosis of sleep apnoea affect my driving license?

A: If you have a diagnosis of sleep apnoea syndrome

Information about driving: https://www.blf.org.uk/support-for-you/obstructive-sleep-apnoea-osa/driving

We provide:

• Outpatient assessment with home sleep studies including breathing tests (Spirometry), blood gases when required.
• Home assessment for people who are too unwell to leave home. (Guildford and Waverley). 
• Ongoing wireless monitoring and support for patients on CPAP and home ventilators. 
• People with sleep breathing disorders. (e.g. Obstructive sleep apnoea). 
• People with chronic lung disease or neuromuscular weakness who have difficulty breathing due to muscle weakness or lung disease.
• People who have a weak cough and are unable to cough or expectorate.

Q: Who do you accept referrals from?

A: Our referrals usually come from hospital consultants, pulmonary rehabilitation, or respiratory nurses. It is important that our patients have already been seen by respiratory specialists who will have optimised treatment.

Q: Can oxygen be supplied if I am a smoker? 

A: No oxygen cannot be provided if you smoke. 

Q: What does the assessment involve?

A: You will be given a full consultation, which, in some instances, may be on the telephone before you attend the hospital. At the hospital appointment you will undergo waking tests to assess your oxygen saturations at rest and during exercise. The test will also establish whether you would benefit from supplementary oxygen.

Q: I am very breathless does that mean my oxygen saturations are low and that I need oxygen?

A: No, breathlessness is not actually an indication that your oxygen saturations are low. Some people are very breathless but have normal oxygen saturations and in that case additional oxygen is not recommended.

Referral 

Q: How do I get referred? 

A: We accept referrals from GPs via Choose and Book, hospital consultants and other healthcare professionals in the hospital and community services.

Q: What are the indications for referral?

A:

• Daytime sleepiness. 
• History of snoring and witnessed apnoeas (where you are witnessed to stop breathing during your sleep). 
• Nocturnal symptoms (such as: waking gasping or choking).

Q: Do you accept referrals from anywhere?

A: We accept referrals for our sleep clinic from anywhere as long as it is possible for people to travel to one of our sites for assessment. Unfortunately, we cannot accept referral for the home ventilation clinic for people who live out of the Guildford and Waverley area because people requiring assessment in this clinic will benefit from referral to a service who can also see them at home if required at a later stage.

Q. Do you see children?

A: No, we only see adult patients over 18 years of age.

First appointment

Q: What will happen at the first appointment?

A: You will be seen by a member of the sleep and home ventilation team who will make a full assessment. They will listen to your concerns and ask you to describe your:

• Current sleep/breathing problem and how it is affecting you. 
• Medical history (previous operations and conditions managed by your GP). 
• List of medication. 
• Your sleep pattern. 
• Anything unusual that happens to you at night. 
• Comments from anyone who has witnessed your sleeping. 

They may perform or arrange various tests including:

• Blood pressure check. 
• Height, weight and BMI. 
• Spirometry (breathing tests). 
• Blood gases (to measure oxygen and carbon dioxide levels).
• Chest xray (if required). 

They will review the questionnaires sent out to you in the post: 

• Epworth sleepiness score (link to Epworth sleepiness score). 
• Sleep diary. 
• Overnight Sleep study (Most people will have a sleep study at their first appointment).

Q: What should I bring with me to my appointment

A:

• Your diary so we can book further visits and tests (where necessary) at a convenient time for you. 
• Your current medication list including any alternative or herbal remedies and anything you have bought over the counter.

Q: Should I bring someone with me to my appointment?

A: For initial consultations it is helpful if your bed partner or a relative comes with you as they may be able to give a better account of what's going on during your sleep than you can.

Q: What does the sleep study entail?

A: You will be provided with a device to take home and wear overnight which will monitor your breathing, heart rate and oxygen levels.

Q: Will I been shown how to put the equipment on?

A: Yes, during you appointment we show you the sleep study equipment and will describe how to put the equipment on at home. You will also be given a diagram to help remind you.

Q: When do I need to return the equipment?

A: We will ask you to return the equipment the next day. We will explain where we would like you to hand it in.

Q: When will I get the results?

A: We will aim to see again as quickly as possible. This will depend which hospital you are seen at. 

For clinics at Cranleigh and Haslemere followup will be the following morning. You will be given an appointment and asked to return the equipment and wait so that we can report your study and give you your results immediately.

For clinics at Royal Surrey we will see you as quickly as possible (usually within two weeks). We may arrange a telephone consultation to give you your results if appropriate.

Q: What information do we get from the sleep study?

A: The sleep study measures snoring, breathing, breath holds, oxygen levels, pulse rate, body position in bed, chest movement and chest movement. When required we also measure leg movements with additional leg leads.

Q: What is the treatment for obstructive sleep apnoea?

A: This will depend upon the severity and your symptoms. You can learn more about obstructive sleep apnoea symptoms here. 

Treatment Options:

Lifestyle changes including:

• Weight reduction. 
• Increasing exercise. 
• Reduction in alcohol intake. 
• Stopping smoking. 
• Change in sleeping position. 

CPAP:

An auto titrating CPAP machine and mask will be provided for a trial period of four - six weeks to assess your response to treatment. CPAP machines control snoring and sleep apnoea; the CPAP is not a cure. If the trial period is a success and the treatment is beneficial you will be asked to continue with the CPAP machine. We will provide you with the equipment you need. You will be asked to use the machine and mask every night for at least four hours and preferably all night. We will review you on a yearly basis.

Q : Will I be shown how to use the CPAP?

A: Yes. We are very keen to give you all the help you need. There are several options and we will discuss which will be best for you:

1. Pick up the CPAP in a clinic where you will be shown how to use it. 
2. Pick up the CPAP from the hospital reception with information from the Website to describe how to use it.
3. Pick up the CPAP and attend our attend anywhere video clinic where we will demonstrate how to use the CPAP and mask.

Q: What happens if I have questions or problems using the CPAP?

A: Our team are available on email if you have any problems or questions. We can often advise you over the telephone or email. If you need to see us in clinic we can arrange an appointment for you to come in and see us. If you do not have access to email we have a telephone message system.

Q: Will a diagnosis of sleep apnoea affect my driving license?

A: If you have a diagnosis of sleep apnoea syndrome (sleep apnoea with daytime sleepiness), you must inform the DVLA of your diagnosis. Your license will not be affected provided that you use the CPAP machine and your sleepiness is controlled. You can get further information on the DVLA website. You can find information about driving here. 

Q: Is CPAP treatment for life?

A: Many of our patients continue to use CPAP machines long term. Some people make lifestyle changes which can reduce the severity of sleep apnoea. We can arrange repeat sleep studies if we think that the severity of your sleep apnoea has reduced.

Q: How often will I be followed up?

A: Once you are established on your CPAP machine you are reviewed yearly. We are able to review the data from your CPAP machine wirelessly and if you are happy with this we can offer telephone followup rather than attending the hospital for your appointment. You are welcome to contact us at any time if you have problems or questions concerning your CPAP.

 

 

 

 

 

 

 

Telephone: 01483 571 122 Ext 2662

Email rsc-tr.sleepteam@nhs.net

The Sleep Office is located on level B at the Royal Surrey County Hospital. 

We provide services across our sites at Royal Surrey Hospital in Guildford, Cranleigh village hospital  and Haslemere Hospital.

Home visits may be offered to patients who are too unwell to travel to a clinic.

 

Denise Daley MCSP,MSc, Consultant Physiotherapist/Head of Sleep, Home Ventilation and Ambulatory Oxygen Service:

Trained in Bristol she specialised in neurology and subsequently in respiratory medicine before starting the sleep service at the Royal Surrey County Hospital some 15 years ago. She completed her MSc in advanced clinical practice in 2005. She has lectured at national clinical meetings and received national awards for her service developments. The service has flourished and expended under her leadership and offers hospital and community service across Guildford and Waverley with clinics at Royal Surrey Count Hospital, Cranleigh Village hospital and Haslemere hospital.

Dawn Gamble, Specialist Sleep and Home ventilation Nurse:

Dawn qualified from the University of Derby with a Bachelor Degree of Science in Adult Nursing. She then worked on the Respiratory ward as a staff nurse before joining the sleep team. She has been working with the sleep team now for four years and has recently assisted in the expansion of the sleep service at Cranleigh Hospital.

Katherine Marshall, Specialist Respiratory Physiotherapist:

Katherine completed her MSc at Glasgow Caledonian University and qualified as a physiotherapist in 1999. She then specialised in respiratory medicine having worked in a number of hospitals in London and Surrey. Having worked on the respiratory ward as the physiotherapy team lead for 5 years and leading the acute non-invasive ventilation service she joined the Sleep team in 2010.

Laura Manning, Specialist Sleep and Home ventilation Nurse:

Laura qualified from the University of Surrey with a Diploma in Adult Nursing in 2006. She then worked on the Respiratory ward as a staff nurse before becoming Junior Sister in 2008. She has been working with the sleep team now for six years and has recently assisted in the expansion of the sleep service at Haslemere Hospital.

Anna Furniss, Specialist Respiratory Physiotherapist

Donna Parsons, Specialist Nurse Sleep and Home Ventilation:

Donna qualified from the University of Surrey in 2006 as an adult nurse. Her first role was in the Day Surgery Unit at the Royal Surrey County Hospital where she was a Staff Nurse for 12 years. She then decided on a new role and joined the Sleep Team as a Specialist Nurse in 2018.

Nicola Ross, Specialist Respiratory Physiotherapist

Elaine Durbridge, Specialist Nurse Sleep and Home Ventilation:

Elaine qualified with a Bachelor Degree of Science in Adult Nursing from Surrey University in 2017. She then worked in an acute setting on a respiratory ward where she championed care for patients with learning disabilities. Elaine moved to the sleep team in 2019.

Laura Brockway, Clinical Specialist Physiotherapist Sleep and NIV:

Laura completed her training at Kings College University London and qualified as a Physiotherapist in 2007. She specialised in respiratory physiotherapy, working in acute respiratory medicine and intensive care. She was subsequently involved in the development and set up of a local home ventilation and oxygen assessment service before joining the sleep team at the Royal Surrey County Hospital in 2014.

Phil White, Sleep Technician

Abigail Sheppard, Sleep Technician