Sleep studies and snoring clinic

What is the sleep clinic?

The sleep clinic offers specialist tests and treatments to people with sleep disorders. 

Snoring

A common sleep disorder we provide treatment for is snoring. Snoring is caused by turbulence inside the airway during inspiration, which is caused by a partial blockage anywhere from the tip of the nose to the vocal chords. During sleep our muscle tone is reduced and there may be insufficient muscle tone to prevent the airway tissue vibrating.

The following may help you reduce your snoring:

• Losing weight if you are overweight
• Not drinking alcohol
• Giving up smoking
• Not sleeping on your back if the snoring is worse in that position.

Obstructive sleep apnoea (OSA)

If you snore loudly and are sleepy during the day you may have OSA. The throat relaxes too much during sleep so that it flops shut, stopping breathing (apnoea). After a few seconds your brain detects what is happening and wakes you up so that your throat opens and breathing restarts. Sleep usually quickly returns but then further apnoeas can occur. You may also wake up choking, suffer from morning headaches, memory and concentration problems.

Treatment for OSA

Simple measures may be all that is needed:

• Losing weight if you are overweight
• Not drinking alcohol
• Stopping smoking
• Not sleeping on your back if the snoring is worse in that position
• More severe cases require specific treatment, such as CPAP therapy. A CPAP machine sends air under pressure through a tube into a mask fitted over the nose, where it gives positive pressure to the upper airways
• You may be given a device to wear in your mouth during sleep, which keeps your throat open.

REM sleep behaviour disorders

There is a combination of vivid dreams with an aggressive content, associated with often violent physical movements related to the content of the dream or nightmares. The condition is usually seen in men over 50, but can be brought on by drugs or alcohol in younger people.

Treatment for REM sleep behaviour disorders 

Specific types of hypnotics are usually effective. Drugs such as Melatonin and Gabapentin may also be useful.

Nocturnal epilepsy

Some specific types of epilepsy occur particularly at night, such as frontal lobe epilepsy. This is often invisible on tests such as MRI or CT scans, but may cause episodes in which the person screams, makes wild movements and may walk out of bed. The episode subsides quickly and the person may feel scared.

Treatment for nocturnal epliepsy 

Anticonvulsant drugs may be prescribed.

Restless leg syndrome (RLS)

With RLS you experience the following:

• You need to move your legs, which may feel painful or burning
• This happens or is worse when you’re resting, lying down or sitting
• Walking or stretching helps
• It’s worse or happens only at night.

Treatment for restless leg syndrome 

• Good sleep hygiene
• Medication given for another condition may induce RLS and an alternative may need to be found
• If RLS is due to another medical condition such as iron deficiency or kidney failure these should be treated
• Anticonvulsants may be given.

Sleep paralysis

Sleep paralysis is the inability to move the body before falling asleep or just after waking up. Almost half the population have experienced this on occasions. If it occurs often it may be part of a sleep disorder such as narcolepsy and requires further investigation.

Narcolepsy

The main symptoms of narcolepsy are:

• Excessive daytime sleepiness (EDS)
• Cataplexy (sudden muscle weakness brought on by emotion)
• Hypnagogic and hypnopompic hallucinations (dreams invading wakefulness)
• Sleep paralysis.

Tests for narcolepsy 

If you regularly experience some or all of these symptoms then you may have a polysomnogram and multiple sleep latency test (MSLT).

Treatment for narcolepsy 

Some people with narcolepsy have only mild symptoms and are able to use regular naps during the day to avoid falling asleep when they need to stay awake. Medicines may be prescribed to increase alertness during the day.

Excessive daytime sleepiness (EDS)

Symptoms of EDS, despite getting enough sleep are not uncommon, yet EDS is often under recognised or considered untreatable. EDS is a feature of several sleep conditions: OSA, narcolepsy, RLS and idiopathic hypersomnolence, which are easily treated.

Tests

If you have symptoms of OSA then you may have a simple home sleep study first. If the result is normal or OSA is not suspected then you will be admitted for a polysomnogram and a multiple sleep latency test (MSLT).

Treatment for excessive daytime sleepiness 

Medicines may be prescribed to increase alertness during the day.

Sleep phase delay syndrome

Some people who cannot get to sleep at night find that they can sleep for a normal amount of time from the small hours of the morning into the next day. This is particularly common in the later teenage years and in older people.

Treatment for sleep phase delay syndrome 

Behavioural techniques may help. Ask the clinic for more information.

Primary insomnia

People suffering from primary insomnia find they continue to struggle to establish or maintain sleep at night when all of the other possible causes have been addressed.

Treatment for primary insomnia 

The clinic offers support. Ask for more information.

Vivid dreams and nightmares

Nightmares may be related to anxiety, stress or are a result of sleep deprivation. Depression and schizophrenia may also cause nightmares. Many drugs can increase the frequency and intensity of dreams, including dopaminergic drugs, beta blockers and antidepressants.

Treatment for vivid dreams and nightmares

Relaxation techniques and imagery rehearsal therapy help encourage the dreamer to have more pleasant visions.

For more information, and if you have any queries about any of the disorders or treatments, ask your consultant.

These are not definitive lists and symptoms will vary with each patient.

Good sleep hygiene  

The following are important for any sleep disorder or problem:

• Giving up smoking
• Losing weight if you are overweight
• Waking up at the same time each day and going to bed at the same time
• Doing enough exercise each day, but not close to bedtime
• Drinking less caffeine
• Avoiding alcohol
• Not eating too much food or drinking too much fluid after 8.30pm
• Setting aside enough time each day to deal with stress, for example making a to-do list
• Not engaging in any stimulating activity before sleep, eg watching TV, arguments
• Giving yourself enough time to wind down before bedtime
• Making sure your bedroom is quiet, dark and cool enough.