Spotlight on our sleep apnoea service at Yeovil District Hospital

Many of us will be familiar with difficult sleeping patterns, waking up in the middle of the night, or that age-old nemesis known as snoring – most annoying!

This could simply mean we need a bit of time to rest and repair ourselves, but for some people they may have a condition known as obstructive sleep apnoea.

At Yeovil District Hospital we have a team of five colleagues who’re here to help people with this condition to finally get a good night's sleep.

Last Friday (15th March) marked the international World Sleep Day and Dr Phil Raines, our respiratory medicine consultant and clinical lead for our sleep apnoea service at YDH, took to the airwaves as he joined BBC Radio Somerset’s Simon Parkin for a chat about all things ‘sleep’ – you can listen back here (1:08:25 into programme). Dr Raines was accidentally introduced by Simon as "from MPH"...but he's very much part of the YDH team!

Dr Raines explains: “Obstructive sleep apnoea is a fairly common condition where a person temporarily stops breathing when they go to sleep at night.

“It’s more common in men, particularly as they get older, as well as those who are overweight – which is something that’s increasing in the UK.

“The upper airway closes during sleep as the muscles relax, so the person stops breathing and that wakes them up, causing disturbed sleep, and therefore tiredness and poor concentration in the daytime.

“It also probably leads to them needing the toilet more in the night as it has a diuretic effect, and sadly impacts on their quality of life in general.

“To be honest it can be quite debilitating in some people, resulting in low energy and leading to them putting on more weight, making the problem even worse.

“One of the side effects of undiagnosed obstructive sleep apnoea includes heart problems, as it raises the body’s stress levels.

“Thankfully obstructive sleep apnoea is very easy to treat using a device called continuous positive airway pressure (CPAP), which is a small pump that sits by a person’s bedside at night, attached to a mask worn over the nose or mouth. It works by applying pressure, which keeps the upper airway open.

“By using this device, people find that they sleep through the night and feel much better in the daytime, and in general.

“It can be remotely monitored, and the manufacturer has developed an app so that patients can upload their data, where we can see day-by-day how they’re getting on with it.

“It’s one of the few things that we do in respiratory medicine that actually changes people’s lives for the better and that’s why we really enjoy this work!”

The service tends to receive around two thirds of its referrals from the patient’s GP, with our pre-operation assessment clinics and cardiology clinicians tending to make up the rest.

Fran Holbrook, the service’s clinical nurse specialist lead, explains: “When a patient is referred to us, they get a telephone assessment from either myself or my colleague Julie Mills, where we ask some general questions about their symptoms, such as whether they’re feeling tired in the morning, do they wake up with a headache, has their short term memory or concentration changed, has their mood changed recently, or whether they’re waking up to go to the toilet.

"We also ask them, where applicable, whether their partner tells them that they snore, or have been heard to gasp or cough in their sleep, and then we take some measurements, including their collar size.

“The patient collects a little monitor, that’s a bit like a watch, that they wear for two nights, which produces a sleep report that goes to our consultant, Dr Raines.

“At this point, Dr Raines reviews the patient’s sleep report for the typical patterns of obstructive sleep apnoea, which can be mild, moderate or severe.

“There are also cases where we’re just not sure, and on those occasions we may either repeat the test, or there may not be enough for us to treat, so we’d advise some lifestyle changes and for the patient to come back to us if their symptoms worsen.”

The service has received some fantastic feedback from patients, some of who’ve called the intervention, “life-saving” and” life-changing”.

“It’s fair to say that our service can be life-changing for many people and some patients have even said that it has saved their life, in the respect that they weren’t able to function before in their job, or it was affecting relationships.” Fran continues.

“Our Friends and Family Test results and other feedback tends to be really positive, and people often tell us that they wouldn’t be without their CPAP…and we’ve saved a few marriages!

“Not everyone gets on with it of course and some people don’t like having a diagnosis of obstructive sleep apnoea, and that’s just the way it is, but the vast majority feel the benefit.

“We’re a very hands-on service so we don’t leave the patient once they’re assigned treatment, we follow them up regularly and very often patients will stay under our care for many years as normally CPAP is a lifelong treatment.”

Having a diagnosis, and then treatment, for obstructive sleep apnoea can also ensure people can continue with much of their daily life feeling more energised and refreshed on waking unlike previously.”

“If obstructive sleep apnoea goes undiagnosed and makes someone tired and sleepy then it can affect their ability to drive,” Dr Raines continues.

“Actually, people aren’t legally allowed to drive if they have excessive daytime tiredness, so we get a number of referrals from people who need to drive for work.

“Occasionally we can see people who’ve had an accident because they’ve fallen asleep, so we prioritise those cases urgently.

“We also find that a lot of women on our CPAP machines tend to be over 40 and going through the menopause, so we’ve worked closely with colleagues in the menopause group that we run in the trust.

“In total we have about 2,500 people who are currently on a CPAP, which in most cases is for life, so the number keeps getting bigger as we get more referrals.

“We see a lot of patients from outside Somerset too, not only neighbouring Dorset, but also quite a long way away, like Salisbury or Cornwall, because our service has a really good reputation, and they may not have a local service in their area.”

Fran adds: “We’re so proud of our service and passionate about the care we offer to our patients, especially how we’re able to take such a personal approach to our patients.

“We even have a Facebook support group, as well as support evenings three times a year, which will restart, following a hiatus during the pandemic, later this month – these are open to anyone who’s interested or curious about what we do.”