Sleep and Home Ventilation Service

We review adults with:

• Sleep breathing disorders, for example obstructive sleep apnoea and insomnia.
• Chronic lung disease or neuromuscular weakness who have difficulty breathing due to muscle weakness or lung disease.
• A weak cough and are unable to cough or expectorate.
• Requiring assessments for ambulatory oxygen therapy.

Indications for referral to our sleep services:

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

Sleep Clinics

These provide diagnostic, treatment, and ongoing monitoring services for people with sleep disorders, and those that have breathing disorders during sleep.

Insomnia

Our insomnia team provides services for people with chronic insomnia. You can find out about this service on the Insomnia Clinic page.

Home Ventilation Clinics (Guildford and Waverley only)

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. 

For people who live outside Guildford and Waverley, we recommend referral to a local service or to a service that can offer home visits.

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.

Sleep services

We accept referrals from GPs via Choose and Book, hospital consultants and other healthcare professional in the hospitals and community services.

We provide services across our sites at Royal Surrey Hospital in Guildford, Carleigh village hospital and Haslemere Hospital. Home visits may be offered to patients who are too unwell to travel to a clinic.

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 referrals 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.

Ambulatory Oxygen Therapy

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.

The sleep office is located on Level B at Royal Surrey County Hospital, Guildford. 

Telephone: 01483 571 122 ext 2662.

Email: rsc-tr.sleepteam@nhs.net.

Katherine Marshall, Specialist Respiratory Physiotherapist and Sleep Clinic Lead

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. She worked on the respiratory ward as the physiotherapy team lead for five years and lead the acute non-invasive ventilation service before joining the sleep team in 2010.

Nicole Ross, Consultant Physiotherapist and Sleep Clinic Lead

Nicole completed her degree at the University of Plymouth in 2007. She has specialised in respiratory medicine and non-invasive ventilation, leading a number of services in Surrey hospitals. She joined the sleep team in 2019.

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.

Elizabeth Wakeham, Specialist Sleep and Home Ventilation Physiotherapist

Lizzie graduated as a physiotherapist from the University of Nottingham in 2013. She specialised in respiratory physiotherapy at Guy’s and St Thomas’s Hospital, working across a variety of areas, but particularly focused on COPD and asthma management and oxygen prescription. She joined the sleep team at Royal Surrey Hospital in 2023.

Jo Saunders, Specialist Sleep and Home Ventilation Physiotherapist

Jo completed her bachelor of science degree in physiotherapy at the University of Brighton in 2004. She has specialised in respiratory medicine since 2006, working across a variety of London and Surrey hospitals. She joined the sleep and home ventilation team in July 2023

Anna Furniss, Specialist Ambulatory Oxygen and Home Ventilation Physiotherapist

Anna is the lead of the ambulatory oxygen service and is a specialist in the team assessing and prescribing ambulatory oxygen for patients to use at home. 

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 our Day Surgery Unit as a Staff Nurse. After 12 years, she then decided on a new role and joined the Sleep Team as a Specialist Nurse in 2018.

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.

Phil White, Sleep Technician

Phil works within the team managing the department stock, orders and posting equipment to patients.

Rizwana Ahmad, Sleep Technician

Riz works within the team managing the department stock, orders and posting equipment to patients. She also helps set sleep patients up with their new CPAP devices.

What will happen at the first appointment?

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).

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.

Should I bring someone with me to my appointment?

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.

What does the sleep study entail?

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

Will I be shown how to put the equipment on?

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

When do I need to return the equipment?

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

When will I get the results?

For clinics at Cranleigh and Haslemere, follow up 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.

What information do we get from the sleep study?

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

What is the treatment for obstructive sleep apnoea?

This will depend upon the severity and your symptoms. 

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 four-six weeks trial 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 and show you how to use it. 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. The team are available to help with any questions you have about using the CPAP.

Will a diagnosis of sleep apnoea affect my driving license?

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. 

Is CPAP treatment for life?

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.

Who do you accept referrals from?

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.

Can oxygen be supplied if I am a smoker? 

No oxygen cannot be provided if you smoke. 

What does the assessment involve?

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.

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

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.