If you’re experiencing persistent tiredness, loud snoring, or your partner reports you stop breathing during sleep, you might be wondering about Obstructive Sleep Apnea (OSA) and how to get help. The good news is that the NHS provides a clear pathway from suspicion to diagnosis and, if needed, the provision of a Continuous Positive Airway Pressure (CPAP) machine, a highly effective treatment.
This article will walk you through the typical NHS process, including the crucial role of a sleep study, to help you understand what to expect on your journey to better sleep and improved health.
Step 1: Your First Port of Call – The GP
The journey usually begins with a visit to your General Practitioner (GP). It’s helpful to go prepared, perhaps with a list of your symptoms and, if possible, observations from a partner or family member about your sleep. Common symptoms your GP will look for include:
- Loud and regular snoring
- Witnessed pauses in breathing during sleep
- Gasping or choking during sleep
- Excessive daytime sleepiness (even after a full night’s sleep)
- Morning headaches
- Difficulty concentrating or memory issues
- Irritability or mood changes
Your GP may use screening questionnaires, such as the Epworth Sleepiness Scale, to assess your daytime sleepiness and the STOP-BANG questionnaire to evaluate your risk of OSA. They might also rule out other potential causes for your symptoms, such as thyroid issues or vitamin deficiencies.
Step 2: Referral to a Sleep Clinic
If your GP suspects sleep apnea, they will refer you to a specialist NHS sleep clinic or a hospital respiratory department. Due to demand, some clinics may triage patients directly to a sleep study based on the referral information.
Step 3: The Sleep Study – Unveiling Your Sleep Patterns
This is a critical step in diagnosing sleep apnea and determining its severity. Most often, the sleep study is conducted in the comfort of your own home, though in some complex cases, an overnight stay at a sleep centre (polysomnography) might be required.
What is a Sleep Study?
A sleep study, often referred to as a “sleep polygraphy” or “oximetry” if it’s a simpler home test, involves monitoring your breathing and other vital signs while you sleep. You’ll typically be given equipment to take home, which may include:
- Finger Probe (Oximeter): Measures your blood oxygen levels and heart rate. Drops in oxygen are a key indicator of apnea events.
- Nasal Cannula: A small tube placed under your nose to measure airflow, detecting when breathing stops or becomes shallow.
- Chest and Abdominal Belts: These measure your breathing effort and movements.
You’ll receive clear instructions on how to set up and wear the equipment. The device is usually pre-programmed to record throughout your typical sleep hours. The following morning, you return the equipment to the clinic for analysis.
What Happens After the Sleep Study?
Specialist physiologists or sleep clinicians will download and analyse the data from your sleep study. They will determine your Apnea-Hypopnea Index (AHI), which is the average number of times your breathing stops (apnea) or significantly reduces (hypopnea) per hour of sleep. The AHI score determines the severity of your OSA:
- Mild OSA: AHI of 5 to 14 events per hour
- Moderate OSA: AHI of 15 to 30 events per hour
- Severe OSA: AHI of over 30 events per hour
The clinic will then communicate the results to you, often via a letter. Depending on the results and your symptoms, you may be invited for a clinic appointment to discuss the findings further or, if CPAP is indicated, proceed directly to the CPAP initiation stage.
Step 4: CPAP Initiation and Follow-Up
For individuals diagnosed with moderate to severe OSA, Continuous Positive Airway Pressure (CPAP) therapy is the most common and effective treatment offered by the NHS.
What is CPAP?
A CPAP machine gently pumps a continuous flow of pressurised air through a mask you wear over your nose or mouth while you sleep. This constant air pressure acts as a “pneumatic splint,” preventing your airway from collapsing and ensuring uninterrupted breathing.
Getting Your CPAP Machine:
Once CPAP is recommended, you’ll typically receive an appointment (often within 2-4 weeks of diagnosis) at the CPAP clinic. During this appointment:
- A specialist will explain how the CPAP machine works and its benefits.
- You’ll be fitted with a suitable mask. There are various types of masks (nasal pillows, nasal masks, full-face masks), and finding the right fit for comfort and effectiveness is crucial.
- You’ll receive all the necessary information, including manuals and contact details for ongoing support.
- In some cases, the machine and mask may be delivered to you directly after your diagnosis is confirmed and your mask size is determined.
Adjusting to CPAP:
It’s common to find CPAP therapy a little strange or awkward at first. Perseverance is key, as most people who stick with it experience significant improvements in their symptoms, including reduced daytime tiredness, improved concentration, and better overall quality of life.
The NHS sleep service will provide ongoing support, including:
- Initial Review: Often a telephone review after a few weeks to assess how you’re adjusting and if the treatment is effective.
- Regular Servicing: CPAP machines are typically serviced every few years to ensure they are functioning correctly.
- Mask and Filter Replacements: You’ll usually be provided with replacement masks and filters annually or as needed due to wear and tear.
- Patient-Initiated Follow-Up (PIFU): Many services offer PIFU, allowing you to contact the clinic for an appointment whenever you have concerns or issues with your therapy or equipment.
The Benefits of Adhering to CPAP Therapy
Untreated sleep apnea can lead to serious health problems, including high blood pressure, increased risk of stroke, type 2 diabetes, heart disease, and a higher chance of accidents due to fatigue. By following the NHS pathway and adhering to CPAP therapy, you can significantly mitigate these risks and dramatically improve your quality of life.
Remember, the NHS is there to support you every step of the way. If you suspect you have sleep apnea, don’t hesitate to speak to your GP and begin your journey towards a healthier, more rested you.