The importance of sleep
What is obstructive sleep apnoea (OSA)?
There is an excellent BBC review of this at I snore - but didn’t know I stop breathing 10 times an hour in my sleep - BBC News
Obstructive sleep apnoea occurs when your upper airway (the part between your nose and Adam’s apple), narrows and shuts during sleep.
This can result in apnoeas - when the airway closes completely, and hypopnoeas – when the airway partially closes.
Apnoeas and hypopnoeas can last as long as 45 seconds at a time and happen many times during the night resulting in very disturbed sleep.
People usually ask for medical help because of a partner’s concern or because they feel very sleepy at inappropriate times (for example when driving the car or during a meal).
The DVLA has published a very helpful leaflet ‘Tiredness can kill’ and there is more information about when to contact the DVLA below. Please read this information very carefully.
What are the symptoms of OSA?
Loud snoring.
Pauses in breathing (confirmed by partner).
Restless sleep.
Feeling unrefreshed on awakening, headaches, loss of concentration.
Excessive daytime sleepiness.
Could I have sleep apnoea?
Do an Epworth Sleepiness Scale test below.
What causes OSA?
In approximately 50% (about half) of people with OSA weight is a factor.
OSA is considered to be more common in men and in those over 50.
For women, the risk increases after the menopause.
Occasionally, it may be due to a problem with the upper airway, such as enlarged tonsils.
How do I get a sleep study?
There are a couple of options, either via Albyn or you can use a charity called Hope2sleep.com.
OPTION 1 - ALBYN (£250)
If you are not insured, i.e. self-paying, then my advice is to go straight to Option 2 (see below).
The key points regarding an Albyn study are:
Most insurers will cover the cost (although you should check first). This is paid to Albyn.
The nursing team arrange an appointment with you, shows you the kit, and you take this home for an overnight study. A YouTube video below shows the kit used at Albyn.
You return the kit to the nurses at Albyn the following day.
Your sleep data is analysed by a computer program. This generates an automated report (essentially seeing where on the spectrum you are, ranging from “no evidence of sleep apnoea” all the way through to “severe sleep apnoea.”
I see you at clinic (or a telephone appointment if you prefer) thereafter to discuss the results.
The Albyn sleep kit is a“2-channel study.” Whilst this is adequate for many patients, it is not as detailed as a “4-channel” study (see Option 2 below to find out more about these kinds of studies).
A 2-channel study cannot distinguish between different types of apnoea (obstructive vs central), and it may underestimate the severity of obstructive sleep apnoea by 25-30%.
It is nonetheless useful for screening patients with a very high probability of moderate-to-severe sleep study who have no other health issues.
If more data is needed or there is doubt about the accuracy of your Albyn sleep study, then I will always recommend a more detailed 4-channel study (most insurers, unfortunately, do not cover this cost).
Note that if you do have sleep apnoea, buying a CPAP machine can be expensive, around £1000 and usually not covered by Insurers (see section on CPAP therapy below). Using an Albyn sleep study, if showing obstructive sleep apnoea, I can refer you to ResMed who can set you up with a machine.
NHS colleagues at the Sleep Service in Aberdeen Royal Infirmary do not accept Albyn 2-channel studies. I therefore cannot refer you for a NHS CPAP machine using this data.
OPTION 2 - YOU SELF-REFER TO ‘HOPE2SLEEP’ CHARITY (£189)
If you are self-funding, I recommend this excellent charity. You can easily self-refer for a sleep study at Home Sleep Study for Diagnosing Sleep Apnoea - Hope2Sleep Charity.
The key-points are:
More detailed (4-channel rather than 2-channel) study.
2 nights of data recorded (rather than just 1).
Your sleep data is ‘scored’ by a clinician, and they provide a bespoke summary for you with advice around diagnosis and treatment.
They send your results to you in PDF format (handy if you want to send them on to me).
They also, on their website, have offered a CPAP rental service for 3 months (although my understanding on checking in April 2026 is that this is temporarily suspended since it has proven so popular CPAP Rental Care Package for Sleep Apnoea - Hope2Sleep Charity)
With a 4-channel study such as this, some NHS Sleep clinics may be willing to accept it, in order to then progress to CPAP therapy. This is at the discretion of the NHS service, and therefore not guaranteed.
The other option is that, if your sleep study is consistent with sleep apnoea sydrome, I can refer you a company called ResMed Resmed Shop UK | CPAP Devices, Masks and Accessories and they can remotely set you up with CPAP therapy. This typically costs around £1000 (give or take, depending on the kit used). They can monitor your sleep apnoea remotely and provide reports of how well you are getting on with using the CPAP machine.
What does the jargon in my sleep study report mean?
We classify the degree of sleep apnoea according to the Apnoea Hypopnoea Index (AHI).
AHI 0-5 per hour is normal (we all stop breathing in our sleep occasionally).
AHI 6-15 per hour is mild sleep apnoea
AHI 16-30 per hour is moderate sleep apnoea
AHI 31 and above is severe OSA.
What are the treatment options for
mild sleep apnoea and snoring?
Lifestyle measures may be all that is needed - weight loss, where appropriate, is by far the best option.
Have a look at YouTube videos by Mr Vik Veer. He is an ENT surgeon with a channel that has great content, including describing exercises that help improve the tone of the throat muscles Throat Exercises for Snoring and Sleep Apnoea (myofunctional therapy). These can reduce snoring and help mild sleep apnoea.
A mandibular advancement splint can help, if you have adequate dentition i.e. 8 solid teeth in upper and lower dental arch. This is a device which helps pull your lower jaw forward and take the tongue away from the back of your mouth. It is fitted over your teeth.
CPAP (continuous positive airways pressure). This is not always needed for mild sleep apnoea and snoring, but is sometimes necessary. In all cases of troublesome snoring or sleep apnoea, the throat must be examined either by a doctor or dentist to exclude large tonsils or other masses as a cause.
What is CPAP therapy?
Continuous Positive Airway Pressure (CPAP), involves using a small air pump and a mask, and is the most effective way to treat OSA.
CPAP works by delivering pressure to your upper airway, which pushes the airway open to prevent it collapsing.
It’s the best treatment for moderate to severe sleep apnoea.
If I need treatment what happens next?
If you choose an Albyn sleep study we contact a company called ResMed and CPAP therapy is provided by them directly to you. A machine is sent to you and training provided to you how to use it. Using technology they can remotely assess how well the treatment is working. They have an excellent website which you can link to here explaining more. It costs around £1000 for a full package including kit and teaching from ResMed.
If you choose to self-refer to ‘Hope2sleep’ charity then you can choose to trial a CPAP machine via them for a few months (only £45 and allows you to test out kit!) OR buy a CPAP machine via them.
What does CPAP therapy feel like?
When you use CPAP for the first time you will notice the pressure when breathing in and out and may feel you need to consciously push the air out. This is normal and as you get used to the therapy it will subside.
Tip: When you are just starting CPAP, try using it when you are distracted by something such as a TV programme. In this way you will gradually become used to the feeling of having a mask on your face with some pressure.
Modern CPAP machines are designed to adjust the pressure automatically so you get just the right amount to keep your airway open at any time.
Ramp - This is used to keep the pressure at minimum for a short period after you turn the machine on to give you time to fall asleep.
Humidification - Some people find CPAP makes their mouth and throat very dry. If it doesn’t settle down a humidifier can be added to the CPAP machine that puts some moisture into air before you breathe it in.
What are the UK guidelines around driving and the DVLA?
The latest DLVA guidelines discuss what to do - the key point is that anyone with excessive sleepiness, having or likely to have an adverse effect on driving, whatever the cause, must not drive. It is your legal responsibility to let them know if you have excessive sleepiness (given the increased risk of road traffic accidents).
Please also read their leaflet ‘Tiredness can kill’, which provides more useful information.
The updated guidance is absolutely clear that it is only obstructive sleep apnoea (OSA) with ‘excessive sleepiness having, or likely to have, an adverse effect on driving’ that concerns the DVLA.
The guidance, therefore, does not apply to people who do not have excessive sleepiness affecting driving, thus recognising the widespread phenomenon of asymptomatic or minimally symptomatic OSA.
There is now no longer the suggestion that symptomless patients with OSA need to be treated before they can drive.
Those with diagnosed moderate or severe OSA and sleepiness affecting driving must not drive and must notify the DVLA. Their continuing licensing requires control of the condition, improved sleepiness and treatment adherence. There is also a requirement for a three-yearly review of these factors, although the details of this are not yet known.
Furthermore, there is no need for a patient to notify the DVLA when there is only a suspicion that they might have OSA with sleepiness adversely affecting driving (but they must, of course, stop driving). This applies to people referred and awaiting sleep studies and assessment.
Such sleepiness may turn out to be something different, such as nights disturbed by pain or depression or sedative medication, the symptoms of which should resolve within three months to allow safe driving again.
Even if due to mild OSA with AHI <15, then this too may be relatively easily treated within three months, with changes in lifestyle for example. The three-month rule brings sleepiness in line with other medical conditions, which may resolve within three months.
Whilst the differentiation between those patients with mild OSA and moderate to severe OSA is arbitrary, and based on sleep study definitions, the importance of control of the condition with improved sleepiness is emphasised for both categories.
At present, this symptom control is more likely to be achieved with CPAP for those people with moderate and severe OSA and thus be delivered via the Sleep clinic.
For mild OSA, symptoms may respond to non-CPAP therapies such as weight loss, sleeping position, and dental devices for mandibular positioning therapy. In reality, significant sleepiness (particularly if adversely affecting driving) in people with mild OSA is likely to prompt a trial of CPAP if first-line therapies fail.
This guidance applies to both Group 1 and Group 2 drivers. For Group 2 drivers, compliance with treatment and ongoing symptom control must be assessed on an annual basis.
The Sleep Apnoea Trust Association recommends patients write to the DVLA rather than communicating by phone or online, to ensure a consistent assessment.
The table below is taken from the DVLA guidelines. If you want a very detailed read about driving and sleep apnoea, then have a look at the British Thoracic Society's “position statement” on sleep apnoea, found at Position Statements | British Thoracic Society.
