Sleep apnoea testing in the UK: NHS and private routes compared

Typical features include loud snoring, witnessed pauses in breathing, waking gasping, unrefreshing sleep, morning headaches and daytime sleepiness. Risk factors include obesity, large neck size, older age, male sex, alcohol, sedatives and anatomical features of the airway. Not everyone with sleep apnoea feels sleepy, and some are diagnosed because of resistant high blood pressure, atrial fibrillation or a partner's concern.

A clinician takes a history, checks weight, neck size and blood pressure, examines the airway and uses the Epworth Sleepiness Scale or similar questionnaire. NICE recommends referring to a sleep service if sleep apnoea is suspected, and prioritising people with safety-critical jobs, those at risk of driving accidents or with severe symptoms. Other causes of sleepiness, such as thyroid disease, anaemia, depression, medicines and other sleep disorders, are considered.

The apnoea-hypopnoea index counts the number of breathing pauses or reductions per hour of sleep. NICE uses it to grade severity as mild, moderate or severe, but treatment decisions also depend on symptoms, cardiovascular risk and quality of life. Someone with mild sleep apnoea and marked sleepiness may need treatment, while someone with moderate disease and no symptoms may be managed differently.

On the NHS, a GP refers to a sleep or respiratory service, which arranges tests and treatment. Waiting times vary widely. Private services offer home or in-clinic sleep studies and consultations, often with faster access. If you choose a private test, check that a qualified clinician interprets the results and that there is a route to treatment, including equipment and follow-up. Consumer wearables and apps can flag possible problems but are not diagnostic.

Follow device instructions, sleep as you normally would and avoid alcohol or sedatives unless advised otherwise. Tell the clinician about your medicines and any difficulty wearing the equipment. If the test is inconclusive because of poor signal or limited sleep, it may be repeated.

Ask who interprets the study and what their qualifications are, which type of test is used, how long results take and what happens if sleep apnoea is found, including how treatment equipment is supplied and who monitors it. Ask whether you will receive a written report suitable for your GP and, if relevant, the DVLA. Ask about the total cost including follow-up. Be wary of services that sell equipment without a proper diagnosis, or that diagnose from a wearable alone.