Physiological Sciences

Main Contact Number: 024 7686 5128

Service Manager: Joanna Purvis

Email: CRURECEPTION@geh.nhs.uk

Associated Consultants:-

Respiratory: 

• Dr Edward Nash
• Dr Clare Williams 
• Dr Carol Min
• Dr Rahul Bhat ​​​​​​​

Cardiology: 

• Dr Asok Venkataraman
• Dr Mahdi Halim 
• Dr Ahmad Tahir
• Dr Suresh Krishnamoorthy

Gastroenterology: 

• Dr Edmond Sung

Physiological Sciences is located both in the Community Diagnostic Centre and the Main Hospital, it is important you take note as to which department your appointment is located in.

For appointments in Cardio Respiratory Unit (CRU):

CRU is located on the first floor, apposite the AMU department. See map HERE 

For appointment in Community Diagnostic Centre: 

Our new Community Diagnostic Cenre is located almost opposite the Maternity Deparment and is easily accessible from the B4112. 

For Parking, please see HERE.

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Ten small sticky pads called electrodes are  put on your arms, legs  and  chest. These are connected to wires to an ECG machine which picks up the eletrical signal that makes your heart beat. The test records both the rate and rhythm of your heart beat. The whole test takes a few minutes and is completely painless . You will need to remove clothing from above the waist and lie still. 

What is an echocardiogram?

An echocardiogram is a non-invasive scan of the heart. Ultrasound waves are used to create a moving picture of the heart.

The size and shape of the heart can be seen and  measured; the valves within the heart can be seen moving. The patient will hear noises during the scan as part of the valvular and blood flow assessment; this is normal.

Preparation for the test

There is no special prepartion necessary for this procedure.

Finding the department

From the main entrance walk by the teabar and shop and then take a right at the crossroads just before you reach the XRay and pathology departments there is a lift or a set of stairs, go up to the first floor, we are on the right if you use the lift and left if you use the stairs.

The procedure

The patient will be offered a gown and asked to strip to the waist and lie on a couch. ECG electrodes are placed on the chest and ultrasound gel is put at various points on the chest where the scanning probe is held.

An echocardiogram or ‘echo’ is a scan that uses ultrasound to produce pictures of the heart. It does not use radioactivity. You may hear noises during the scan. This is normal.

The pharmacological medication used is usually a drug called dobutamine. During a pharmacological stress echocardiogram, or stress echo, you be given some medicine (dobutamine) to make the heart beat faster whilst pictures are taken of your heart.

A stress echo is performed as it allows your doctor to understand how the heart copes when it is made to work harder. A stress echo is useful to diagnose whether you have angina (chest pain caused by an issue with blood supply to your heart) or not, and it can help your doctor to decide whether your heart function will improve after a by-pass operation. A stress echo can also provide your doctor with information about your heart valves.

A bubble echocardiogram is a special type of heart ultrasound test. It helps your doctor see how blood flows through your heart and check for any abnormal openings or leaks between the heart chambers. During this test, tiny bubbles made from a harmless saline solution are injected into a vein. These bubbles travel through your bloodstream and help create clearer images of your heart.Your doctor may recommend a bubble echocardiogram if you have symptoms like:

Unexplained stroke or transient ischemic attack (TIA)

Suspected heart defects (such as a patent foramen ovale or atrial septal defect)

Unexplained low oxygen levels

Other heart-related issues that need detailed assessment

An echocardiogram or ‘echo’ is a scan that uses ultrasound to produce pictures of the heart. It does not use radioactivity. You may hear noises during the scan. This is normal.
During a contrast echocardiogram, a contrast agent is injected which improves the quality of the images being recorded. If your doctor has decided that you need an echocardiogram, but the picture quality is not very clear, a contrast agent can be used to help improve the image quality. There is no special preparation needed for this test. You can take your medications as normal. You can eat and drink as normal. You may bring an adult friend/relative with you. We have no facilities to care for dependents so please make suitable arrangements as appropriate. If you require a chaperone, please inform the staff in the department prior to your test where one will be provided. If a suitable chaperone cannot be provided at the time of your test, your test can be rearranged.

This is an ECG that is recorded while you are walking on a treadmill . The aim of this test is to see how your heart is working when you are more active.        

For the test wear suitable clothing and footwear for walking . Avoid a heavy meal 2-3 hours prior to the test . You may be asked to stop taking certain medications before the test , this will be explained to you. 

You may have an exercise ECG if you have symptoms of chest pain, heart palpitations,dizziness or shortness of breath.               An exercise ECG the test usually lasts about 15minutes.

Sticky pads will be attached to your shoulders and chest. You will be asked to walk on a treadmill   starting off at slow comfotable pace.The test will gradually get harder as the speed increases as does the incline.You will be carefully monitored through out the test and told when to stop.

You can go home once  your heart rate and breathing has recovered. Save

Ambulatory blood pressure  monitoring                            

This involves wearing a blood pressure cuff  for 24 hours. The monitor will inflate the blood pressure cuff at various intervals during the 24 hours. You will  also wear a small portable recorder , whist wearing the monitor you can do everything you would normally do except have a bath ,shower, go swimming . when the test is finished you return the monitor to the hospital so the results can be analysed

Pacemaker implantation is a common procedure, typically done under local anaesthetic with sedation to help the patient relax. A small incision is made in the chest, near the collarbone, usually on the left side, and the pacemaker is placed in a pocket created under the skin and chest muscle. The leads are inserted into a vein and guided to the heart, where they are positioned to stimulate the heart muscle. The procedure usually takes about 1 hour. The incision is closed with stitches or glue

Cardiac Resynchronisation therapy pacemaker implantation ( CRTP) also known as a biventricular pacemaker, is a device implanted to help manage heart failure by improving the heart's pumping efficiency. It works by sending electrical impulses to both ventricles of the heart (left and right) to synchronise their contractions, allowing the heart to pump blood more effectively. This can reduce symptoms like shortness of breath and fatigue and potentially improve overall heart function. Typically done under local anaesthetic with sedation to help the patient relax. A small incision is made in the chest, near the collarbone, usually on the left side, and the pacemaker is placed in a pocket created under the skin and chest muscle. The leads are inserted into a vein and guided to the heart, where they are positioned to stimulate the heart muscle. The procedure usually takes about 1.5-3 hours. The incision is closed with stitches or glue

Implantable Cardiac Defibrillator ( ICD) implantation   
An ICD is an implantable device in the chest near the collarbone ,usually on the left side and monitors heart rhythm and delivers electrical shocks or pacing to restore a normal heart rhythm if a dangerous arrhythmia is detected. It is slightly larger than a pacemaker, ICDs are designed to treat and prevent life-threatening heart rhythms like ventricular tachycardia and ventricular fibrillation.  This procedure is done under local anaesthetic with sedation to help the patient relax. A small incision is made in the chest, usually on the left side, and the ICD is placed in a pocket created under the skin and chest muscle. The leads are inserted into a vein and guided to the heart, where they are positioned to stimulate the heart muscle. The procedure usually takes about 1 hour.  The incision is closed with stitches or glue.

Cardiac Resynchronisation Therapy Defibrillator (CRTD)   is a combination device that incorporates both Cardiac Resynchronization Therapy (CRTP) and an Implantable Cardioverter-Defibrillator (ICD). CRT helps improve heart function in patients with heart failure by resynchronising the heart's pumping action, while an ICD delivers electrical shocks to correct life-threatening fast heart rhythms. The device is implanted in the chest near the collarbone This device is slightly larger than a pacemaker and the procedure is done under local anaesthetic with sedation to help the patient relax. A small incision is made in the chest, usually on the left side, and the ICD is placed in a pocket created under the skin and chest muscle. The leads are inserted into a vein and guided to the heart, where they are positioned to stimulate the heart muscle. The procedure usually takes about 1.5-3 hours.  The incision is closed with stitches or glue

Pacemaker checks are regular appointments to ensure a pacemaker is functioning correctly and to monitor its battery life. These checks are typically scheduled every 3 to 12 months, depending on the type of pacemaker and its performance. During the check, a cardiac physiologist will use a programmer to assess the device's settings, battery status, and lead function. This is a painless, non-invasive procedure based in the cardiac device clinic and takes about 20-30 minutes . Some patients may also be eligible for remote monitoring, which allows for checks from home

Implantable Cardiac Defibrillator ( ICD/CRTD) checks are regular appointments to ensure a pacemaker is functioning correctly and to monitor its battery life. These checks are typically scheduled every 3 to 6 months, depending on the type of device and its performance. During the check, a cardiac physiologist will use a programmer to assess the device's settings, battery status, and lead function. This is a painless, non-invasive procedure based in the cardiac device clinic and takes about 20-30 minutes . Some patients may also be eligible for remote monitoring, which allows for checks from home

What is Cardiopulmonary Exercise Test?
Cardiopulmonary Exercise Testing (CPET) is a non-invasive method used to assess the performance of the heart, lungs and muscles at rest and during exercise. It 

Who might need a CPET test?
The test is commonly used in, patients scheduled for major surgery and to aid diagnosis of heart and lung disease, when all other tests have come back normal.

What does the test involve?
During the CPET test the patient will be required to perform a maximal exercise test on an upright bicycle whilst breathing through a mouthpiece. Each breath will be measured to assess how the body is performing. The capacity and strength of the lungs is measured before and during exercise. An ECG (heart tracing) will also be recorded prior to, during and post exercise.

The CPET test will lasts for a total of 45 minutes; however, the patient will only be required to exercise for approximately 10 minutes. The test requires your maximum effort to ensure the most reliable diagnostic information is obtained.

Are there any risks?
The risk for CPET is the same as for mild - moderate exercise. The number of patients who develop symptoms is low (2:1000). The patient will be monitoring closely during the test, with continuous ECG, blood pressure and oxygen measurements. If they develop significant symptoms, the trained staff will stop the testing.

Who will be performing the test?
The test will be performed at the Community Diagnostic Centre (CDC) by a Specialist Respiratory Physiologist and a Specialist Cardiac Physiologist. On occasions a doctor might be present.

What should I wear for the test? 
Wear lightweight, comfortable clothing and flat shoes which will not slip off the pedals. 

Before the test
Before attending for a CPET, please:
Do not eat a heavy meal for 2 hours before
Do not take alcohol for 4 hours before
Do not take vigorous exercise for 30 minutes
Do not take smoke for 1 hours before
Take all medications that have been prescribed as normal, (including inhalers, sprays and tablets), unless your appointment letter states differently.  

If the patient has experienced any of the following they should contact the department:
Current or recent chest infection (within the last 4 weeks)
Recent eye, stomach or chest surgery
Heart attack or stroke within the last month
Attended Accident & Emergency in the last 2 to 3 days
Chest Pain on the Day of the test

How to get the results of the test?
The results will go to the patient's consultant or referring healthcare provider who will discuss them at the next clinic visit.

What are Lung Function Tests?
Lung Function Test (LFT), measures how well the lungs and airways are working. We compare the results with the average results of someone of the same age, gender and height.

Why do I need to have LFT’s?
Healthcare professionals commonly request these tests to:
Diagnose for lung disease
Measure severity of lung disease
To determine a treatment plan or monitor how successful a current treatment plan is
To test lung function before an operation

What is a LFT?
A LFT comprises of 3 different tests, Spirometry, Gas Transfer and Lung Volumes 
Spirometry
This test gives us information about how much air and how fast you can move the air in and out of your lungs. 
We will ask you firstly to breathe in fully and to perform a relaxed blow out, into a mouthpiece, for as long as you possibly can. This will be done in a seated position with a nose peg on. 
We will then ask you to breathe in fully and to blow out as hard and as fast as possible, until you are completely empty.
We will repeat the test several times to get reproducibility.
We might also give you an inhaler and perform reversibility studies, where you will be asked to repeat spirometry again 20minutes after being given the inhaler.

Single Breath Gas Transfer
This test measures how efficiently oxygen exchange takes place across your lungs and into your blood stream. We will ask you to breathe in a harmless, tasteless mixture of gases through a mouthpiece, hold your breath for around 10 seconds and breathe out until you are empty. 

Lung Volumes
This test helps us to measure the total size and all the subdivisions of your lungs. There are a few methods to measure lung volumes, the 2 common ways are where you will be asked to breathe normally through a mouthpiece for 2 to 10 minutes, followed by a full breath in and exhalation until you are fully empty. The other method involves making breathing efforts through a mouthpiece, whilst seated in a large glass box.

How do I prepare for the test?
Before attending for your lung function tests, please:
Do not eat a heavy meal for 2 hours
Do not take alcohol for 4 hours
Do not take vigorous exercise for 30 minutes
Do not wear any tight clothing that may restrict breathing
Do not smoke for at least 6 hour
You will be given an information leaflet with your appointment letter which will give you instruction on the length of time you will be asked to withhold any inhalers for and which other medications you will need to stop taking for the test, these include antihistamines and many anti-inflammatory drugs. (LINK TO LEAFLET)
Please bring with you a list of your current medications.

Please contact the department if they have experienced any of the following:
Current or recent chest infection (within the last 4 weeks)
Recent eye, stomach or chest surgery
Heart attack or stroke within the last month
Attended Accident & Emergency in the last 2 to 3 days
Chest Pain on the Day of your test

How long will the tests last?
LFT’s should last between 45mins – 1hr, however if a reversibility test is needed it could be up to 1.5hrs. So please allow enough time.

Are there any side effects or risks to LFT’s?
Due to the nature of the tests and the full exertion required some patients may feel some chest pain, dizziness or faint during the test. Completing the tests can be tiring but you will be given time to recover between tests. Serious complications are rare, and risks will be kept to a minimum by the physiologist.

How to get the results of the test?
The results will go to the patient's consultant or referring healthcare provider who will discuss them at the next clinic visit.
 

• Measurement of how well oxygen travels from the lungs into the blood.  For this the patient will breathe in until full and then hold their breath for 6 seconds.

• Measurement of the size or volume of air in the lungs.

Preparing for the test
Before attending for your lung function tests, please:

• Do not eat a heavy meal for 2 hours

• Do not take alcohol for 4 hours

• Do not take vigorous exercise for 30 minutes

• Do not wear any tight clothing that may restrict breathing

• Do not smoke for at least 1 hour

• Continue to take all prescribed medication as normal. Please bring a list of current medication.

Allow 30-60minutes for the appointment.

Finding the department
From the main entrance walk by the teabar and shop and then take a right at the crossroads just before you reach the XRay and pathology departments there is a lift or a set of stairs, go up to the first floor, we are on the right if you use the lift and left if you use the stairs.

The patient should contact the department if they have experienced any of the following

• Current or recent chest infection (within the last 3 weeks)

• Recent eye, stomach or chest surgery

• Heart attack or stroke within the last month

• Attended Accident & Emergency in the last 2 to 3 days

• Chest Pain on the Day of your test

Results
The results will go the patient's consultant who will explain them at their next clinic visit. Please note that patients will not be given test results on the day of the test unless they have a clinic appointment directly after testing, in which case they will be able to take a copy to clinic with you.

Useful links

• Patient leaflet

What is Home Oxygen Assessment or Long Term Oxygen Therapy (LTOT)

The air we breathe contains 21% oxygen - a gas vital to every cell in our bodies. Some people with lung or heart problems may have difficulty obtaining all the oxygen they need. This means they have less oxygen in their blood - low oxygen levels. This could be at rest, during activity, during sleep, or all of these.

For these people, giving additional oxygen may help to increase the amount of oxygen in their blood, which may help them to carry out normal daily activities with less difficulty and improve quality of life.

Oxygen is not helpful for everyone; it can be harmful and therefore we need to assess whether or not it may be of benefit to you. If it is found that oxygen would be beneficial to you, then we would need to assess the right amount of oxygen. Oxygen does not always help with breathlessness and is not given just to reduced breathlessness.

What does the assessment involve?

In order to measure your oxygen levels at rest, we need to take a small sample of blood from your earlobe, called a capillary blood gas. Firstly, your ear will be warmed up, using a heat rub cream.

Once warmed adequately, often for 10minutes, we will use a lancet to produce blood flow from the earlobe. The blood will then be collected in a small tube. As your earlobe is often less sensitive that other areas of the body, the test may feel a little uncomfortable, but the pain is minimal.

If during your first visit the blood sample show you require oxygen therapy, we will invite you back for a second assessment in 3/4 weeks time. If your oxygen levels are normal during this visit we might refer you for a walk test, however this depends on your condition.

At this second visit we will again take a blood sample to see if you still require oxygen therapy. If you still require oxygen we will give you extra oxygen to breath and then take a further blood sample after 20minutes. We will adjust the amount of oxygen you breath until it is right for you. Also during this visit we will ask a series of health and safety questions and get you to sign a consent forms. We will also give you some safety advise.

If you smoke, you will not be given oxygen.

What happens after the assessment is competed, how to I get oxygen?

If you need extra oxygen, we will order it for you from a company called Baywater Healthcare and we will let you know what your oxygen prescription is. They will deliver your oxygen to your home address, usually within 3 days. Baywater will contact you before they arrive and explain how to use all the equipment. They will also given you an information pack.

We will also review you again in 6/8 weeks to review your therapy.

How do I prepare for the assessment?

Please continue to take any prescribed medication as normal.
Please remove any nail varnish from fingernails as we might place an oximeter probe onto the finger.
Please contact the department if you have a current or recent chest infection (within the last 4 weeks)

How long will the assessment last?

The assessment can last between 30 minutes to 3hrs depending on what has to be done during the assessment.

Are there any side effects to oxygen?

Problems with oxygen are rare if you use the prescription you are given. The assessment carried out will highlight any potential risks and ensure that home oxygen is safe.

If you wake regularly with headaches after using oxygen, please contact your home oxygen team on the number they provided.

If your nose and/or skin becomes sore or dry whilst using oxygen you can use water-based creams such as KY Jelly. Please do not use any alcohol-based creams.  LINK WITH LEAFLET FOR SAFETY INFORMATION. 

The test
The test is usually performed to assess whether you need extra oxygen during the day and night.

First appointment
The test is performed in the hospital’s Cardio Respiratory Unit. After being seated for about 5—10 minutes, the physiologist will take a recording (Oximeter) that records the patient’s oxygen level and heart rate. 

If the resting oxygen levels are 95% or above, then the physiologist will send the patient home and inform the consultant that they do not require LTOT at this time.

If the resting oxygen levels are 94% or less, then we will put some warming cream (transvasin) onto the earlobe and leave it to warm up for approximately 15 minutes. Once warm we will the take a small amount of blood from the ear lobe and measure accurately how much oxygen is in the blood. 

If the levels are below a certain limit then the physiologist will make another appointment for three weeks later.

Second appointment
On the next appointment (if required), again cream will be applied to both ears. Again we will take some blood from the earlobe—if it is still below our limit then the patient will be given oxygen for 30 minutes and have another blood sample take.  If that result is still too low then we will give higher level of oxygen for 30 minutes and repeat the blood sampling. This will continue until the blood oxygen reaches above the set level.

Once the test is completed we will ask the patient to sign a consent form so that if the Consultant wants them to have oxygen it can be ordered for them.

During the appointment, we may also measure height and weight and ask the patient to complete a simple breathing test.

Useful links

• Patient leaflet

What is a Six Minute Walk Test?

A Six Minute Walk Test (6MWT) is a test designed to assess your functional exercise capacity by walking at a self-paced speed for 6 minutes that reflects your daily activities at home.

As part of the 6 minutes your heart rate and oxygen levels will be measured using a finger or ear probe.

What does the 6MWT involve?

The test involves you walking around 2 cones set 10m apart at your own pace. Chairs are placed along the corridor to allow you to rest if needed. You are able to stop and start walking throughout the 6 minutes, but the time does not stop. The aim is to complete as many laps of the course as possible within the six minutes.

Before, during and after the walk test your heart rate and oxygen saturations will be measured using a finger or ear probe.

Before and after the test you will be asked to describe how breathless you feel using the Borg scale (between 0 to10).

How do I prepare for the test?

Before attending for your 6MWT, please:

Do not eat a heavy meal for 2 hours
Do not take alcohol for 4 hours
Do not take vigorous exercise for 30 minutes
Do not smoke for at least 6 hour
Do not wear nail polish or fail nails
Do not wear any tight clothing that may restrict breathing and make sure you wear comfortable shoes

Please bring any walking aids with you, that you would normally use at home

Please take all your prescribed medication on the day of testing.

Please contact the department if they have experienced any of the following:

Current or recent chest infection (within the last 4 weeks)
Any Musculoskeletal problems or injuries preventing you from exercising
Heart attack or stroke within the last month or chest Pain on the Day of your test
Uncontrolled blood pressure.

How long will the tests last?

Although the test itself only lasts 6 minutes, we may have to repeat the test several times to look at treatments and therapy options. The appointment time is approximately 45minutes. So please allow enough time

Are there any risks to the test?

Due to the nature of the test and that exertion is required some patients might feel dizzy or faint during the test, you might feel out of breath, however you are being monitored closely. Serious complications are rare, and risks will be kept to a minimum by your physiologist.

How to get the results of the test?

The results will go to the patient's consultant or referring healthcare provider who will discuss them at the next clinic visit.
 

What is a Mannitol challenge test

A Mannitol challenge test is a specialist test that will identify if your airways are hypersensitive and easily irritated. The test measures the “reactivity” of the airways.
Assessing the sensitivity of your airways can help your doctor or healthcare professional to understand the type of conditions that may be affecting your lungs and help diagnose Asthma.

What does a Mannitol Challenge test involve?

The mannitol challenge test firstly involves performing a spirometry breathing test to assess your baseline lung function. 
The next step will involve inhaling an amount of dry powdered sugar before repeating the breathing test. This will then be repeated a number of times with increasing doses of the dry powdered sugar. 
If your airways are sensitive, there may be a decline in your lung function, which may cause you to cough and/or feel tight chested. 
The test will be stopped if you have a decline of more than 15% from baseline. 
The physiologist will give you an inhaler and then repeat the breathing test to ensure that you leave the department in the same condition as you arrived. 

How do I prepare for the test?

Before attending for your mannitol challenge, please:

• Do not eat a heavy meal for 2 hours
• Do not take alcohol for 4 hours
• Do not take vigorous exercise for 30 minutes
• Do not wear any tight clothing that may restrict breathing
• Do not smoke for at least 6 hour

You will be given an information leaflet with your appointment letter which will give you instruction on the length of time you will be asked to withhold any inhalers for and which other medications you will need to stop taking for the test, these include antihistamines and many anti-inflammatory drugs. (LINK TO LEAFLET)
Please bring with you a list of your current medications.

Please contact the department if they have experienced any of the following:

Current or recent chest infection (within the last 4 weeks)
Recent eye, stomach or chest surgery
Heart attack or stroke within the last month
Have an aortic aneurysm (a swollen or weakened blood vessel around your heart or brain)
Attended Accident & Emergency in the last 2 to 3 days
Chest Pain on the Day of your test
Or are breast feeding

How long will the tests last?

Typically, the test will last 1 – 1.5hrs. So please allow enough time.

Are there any side effects?

As the test progresses it might cause a cough, a slight wheeze and/or feel a little tight-chested. These symptoms can easily be reversed by using a different type of inhaler at the end of the test. You may also experience some light-headedness, headache, or hoarse voice, which will go away by themselves. Please tell the staff performing the test when any symptoms appear.

How to get the results of the test?

The results will go to the patient's consultant or referring healthcare provider who will discuss them at the next clinic visit.

This test is most commonly used to investigate the presence of Obstructive Sleep Apnoea (OSA). 

Following a referral into the sleep service, the patient will be invited into the department to collect their sleep study device. This will be issued by a member of the sleep team who will demonstrate how the equipment works and how it should be operated. The equipment consists of the following: 

1.  A small box that sits in the centre of your chest to measure which position you are sleeping in. This additionally records audio to measure snoring and movement
2. One or two stretchy bands that fit around your chest and abdomen to measure the effort of your breathing
3. A watch with a soft probe on one of your fingers to measure your heart rate and oxygen levels (Oximeter)
4. Two small tubes in your nose (nasal cannula) to measure any changes in your breathing

  
If Periodic Limb Movement Disorder (PLMD) is being investigated, it may be necessary to attach to small electrodes to each shin to measure muscle activity (EMG). 

During the appointment several simple measurements will be taken including height, weight, oxygen levels and collar size. A sleep questionnaire will also be issued along side the equipment to be completed at home. This will provide the healthcare scientist more information when analysing the test results enabling a more accurate diagnosis. The equipment and question will need to be returned the morning after the test is performed. This can be returned by a friend or relative if necessary.

Pre test instructions

• Please continue to take any medication as normal, unless instructed not too.
• Please must remove any nail varnish or false nails before attending as this can affect the ability of the equipment to record your oxygen levels and appointment may need to be rescheduled. 
• Ensure you are able to return the equipment the morning following the test
• For the study, please try and follow a normal sleep routine.
• Please allow 30 minutes for the appointment.

What are the possible Outcomes?
After analysing your sleep test and putting it together with your sleep questionnaire, the Sleep Healthcare Scientist will make recommendations for the next step. This is likely to be a follow up appointment to discuss the results, gain a greater understanding for the problems you are suffering and discuss a management plan.

If we make a diagnosis of OSA, you will offered either Continuous Positive Airway Pressure (CPAP) therapy or positional therapy depending on your results. Alongside this, lifestyle changes such as weight loss, smoking cessation and abstaining from alcohol would be recommended.

If you have a history of other sleep disorders, we may be able to investigate these within the Sleep Service however others may required referral onto Specialist Sleep Centres for further investigation.

We may be able to provide advice and guidance on matters such as sleep hygiene and the impact of your medication or diagnoses on the quality of your sleep

What is a Skin Prick Allergy Test (SPT)?
Skin prick testing is used to investigate any allergic responses to specific triggers.
These triggers, also known as allergens, may be particles in the air such as grasses, tree pollen, house dust mites and moulds. They may also be in food products such as milk, eggs and nuts.
The test is used for conditions such as hay fever or food allergy. 

What does a SPT involve
The test involves putting small amounts of allergen solutions onto the skin of your forearm then pricking the skin through the drop of allergen with a lancet. This allows a small amount of allergen into the skin. 
After a wait of 20 minutes, we can measure the reaction to each of the allergens (if any). A visual response will be seen in the form of a small lump or weal. This will be measure by a ruler

There should be a positive control which should always have a lump/weal, which everyone will react to. 

Following the end of the test an antihistamine cream will be applied to the test site to reduce the response.

How do I prepare for the test?

Before attending for your SPT tests please do not wear any tight clothing that may restrict you form arms.
 
You will be given an information leaflet with your appointment letter which will give you instruction on the length of time you will be asked to withhold certain medications, these include antihistamines and many anti-inflammatory drugs. (LINK TO LEAFLET)

Please bring with you a list of your current medications.

Does the SPT hurt?

No, the test does not hurt. The procedure is similar to a very tiny pin prick, which is not deep enough to draw blood. 

Are there any side effects?

Skin prick allergy tests are very safe. The only real side effect is an itchy arm. The itchy bumps usually settle down within a few hours. Occasionally very strong positive results last for longer, but the antihistamine cream will help with this.
In an extremely rare circumstance anaphylaxis (significant allergic reaction) is possible. In the unlikely event that this does occur, medical professionals are available and on hand to provide the appropriate treatment.

How long will the tests last?

A SPT should last around 30mins.

How to get the results of the test?

The results will go to the patient's consultant or referring healthcare provider who will discuss them at the next clinic visit.

The Sleep Service at George Eliot Hospital investigates and deals with a number of different sleep disorders. This predominantly involves Sleep Disordered Breathing (SDB) which is an umbrella terms for disorders such as Obstructive Sleep Apnoea (OSA) and Obesity Hypoventilation Syndrome (OHS). 

We see patients from 16 years and over

There are a number of sleep disorders that the GEH sleep service is able to investigate and treat however others require referral to a specialist centre for further investigation.

Why do we sleep?
Sleep is a fundamental component of human life which naturally changes as we get older. The exact reasons for sleep are not completely understood but there is evidence that it is vital for growth, repair and for memory consolidation.
Sleep is driven by natural brain activity and consists of different stages that occur in cycles:

Stage    Description    % of the night
NREM 1    Quite light with brain activity still quite high    1 – 5%
NREM 2    Deeper sleep with brain activity reducing    45 – 50%
NREM 3    Deepest sleep with reduced brain activity    20 – 25%
REM    High brain activity and capable of dreaming    20 – 25%

It is primarily our Stage 3, deep sleep that is important to ensuring we wake feeling refreshed the next day.
This however decreases with age both because of natural changes to brain activity but also due to increased disturbances during the night. 

Most people will naturally sleep between 7 – 9 hours however it may be entirely normal to fall outside of this range. 
What affects sleep?

Sleep naturally change as we grow and get older. This is particularly evident in children where babies generally require more REM sleep and children more Stage 3 sleep. Other common things that impact our sleep are:
•    Mental and physical health
•    Alcohol and Caffeine
•    Lifestyle
•    Environment 
•    Medication

How is sleep measured?
You will be invited into the department to be set up with a test known as a Multi-Channel Sleep Test. This measures a number of parameters and is commonly used to investigate the presence of Obstructive Sleep Apnoea (OSA). The test includes:
•    Nasal cannuala to measure airflow 
•    Stretchy belts placed around the chest and/or abdomen to measure the effort of your breathing
•    Oximeter on a finger to measure Oxygen and Heart Rate
•    Audio to listen for snoring

If there is a history of repeated leg kicking during the night you may also be set up with:
•    Electrodes on your shin to measure muscle activity (EMG)
When you attend the department, you will shown show to operate the equipment so it can be attached before bedtime and used at home. This is usually only performed for a single night and the equipment will need to be returned to the department the following morning for analysis by one of the Sleep Healthcare Scientists. 
To help us interpret the results and ensure you are placed on the correct pathway, you will also be asked to complete a questionnaire all about you and your sleep. 

What are the possible Outcomes?
After analysing your sleep test and putting it together with your sleep questionnaire, the Sleep Healthcare Scientist will make recommendations for the next step. This is likely to be a follow up appointment to discuss the results, gain a greater understanding for the problems you are suffering and discuss a management plan.

If we make a diagnosis of OSA, you will offered either Continuous Positive Airway Pressure (CPAP) therapy or positional therapy depending on your results. Alongside this, lifestyle changes such as weight loss, smoking cessation and abstaining from alcohol would be recommended.

If you have a history of other sleep disorders, we may be able to investigate these within the Sleep Service however others may required referral onto Specialist Sleep Centres for further investigation.
We may be able to provide advice and guidance on matters such as sleep hygiene and the impact of your medication or diagnoses on the quality of your sleep.

What is OSA?
OSA is a common condition that causes the soft tissue at the back of the throat to repeatedly collapse during the night resulting in breath holding known as Apnoeas. This may be a complete collapse of the airways or a partial collapse that prevents sufficient oxygen getting to the lungs.  Once this apnoea is detected, the brain sends signals to wake the body up and increase muscle tone in the throat in order to re-open the collapsed airway. You are not always aware of the brief moments of waking however it is sufficient to disturb your sleep and can cause increased daytime sleepiness.

Whilst anyone can be at risk of OSA, you are more likely to develop it if:

•    You are overweight or have a large neck size
•    You are Male
•    You are a Female and gone through menopause
•    You have a small or narrowed or narrowed throat – Large tonsils, large tongue, recessed jaw
•    You are in the later stages of pregnancy
•    You are taking certain medications such as opiates or sleeping tablets

Breath-holding during sleep itself is entirely normal depending on how often you are doing it per hour:
Classification    Breath-holds per hours
Normal    0 – 5
Mild OSA    5 – 15
Moderate OSA    15 – 30
Severe OSA    30 +

This number is often referred to as an Apnoea-Hypopnea Index (AHI). For many patients, Osa can be cured however for some, depending on the cause, it is a lifelong condition that often worsens with age.
As well as disturbed sleep, untreated moderate or severe OSA can lead to increased heath risks including heart attacks, strokes, high blood pressure and diabetes.

What are the symptoms of OSA?
Episodes of interrupted breathing are often visible in someone with obstructive sleep apnoea (OSA) who is asleep. OSA can also cause other symptoms, often due to tiredness resulting from lack of deep sleep.
These symptoms may include:
•    Loud snoring
•    Stopping breathing
•    Making gasping or choking noises
•    Waking up regularly
•    Excessive daytime sleepiness
•    Difficulty concentrating or memory problems
•    Morning headaches
•    Mood swings

What is the treatment?
There are a number of ways of treating OSA and these will be discussed with you during your consultation.

Lifestyle Changes
For the majority of patients, OSA is caused by excess weight around the neck in particular. This means that weight-loss is advisable if this is felt to be a contributing factor. There is no way of predicting how much weight-loss is required to make a difference to your condition however tracking symptoms such as snoring and sleepiness can be useful. Avoiding smoking and alcohol can also help.
Positional Therapy
For some patients, OSA only occurs when you are sleeping on your back (supine). If that is the case, positional therapy may be an option. As a department, we do not recommend one product over another however we can sign-post you to the various types of devices that can be purchased. These include cushions, belts and electronic devices. 

Mandibular advancement Devices (MADs)
These are gum-shields designed to prevent the mandible (lower jaw) from moving backwards as you go to sleep therefore helping to keep the airways open. These are most commonly used in the milder cases to help with snoring and range from items that can be bought over the counter to specially designed devices bought from an orthodontist.

Continuous Positive Airways Pressure (CPAP)
The gold standard for treating significant OSA is CPAP. This consists of a device, connected to a face mask that generates pressurised air which can support the airways during sleep. This prevents the airways collapsing and the subsequent awakening. It will also improve your sleep quality, prevent snoring and reduce the long term health risks associated with OSA

Using Continuous Positive Airways Pressure (CPAP)
CPAP therapy largely consists of 3 elements:

•    The equipment itself that generates the pressurised air                               
•    The hose that connects the equipment and the face mask   
•    The face mask
           

OSA and Driving
It is the responsibility of every driver to ensure the are safe and alert when driving. This includes sleepiness which studies have found is as dangerous as driving under the influence of alcohol.
If your OSA causes excessive daytime sleepiness that impacts on your ability to drive safely, we may recommend that you stop driving and inform the DVLA of your diagnosis. If this is recommended, you can usually recommence driving once your treatment is established and symptoms controlled. The DVLA may contact the sleep team to confirm your OSA is well controlled and you are adhering to treatment.
If you fail to notify the DVLA about a medical condition, you can be fined up to £1,000.
Further information can be found on the DLVA website.

 What if it’s not OSA?
There are a number of other conditions that may be affecting your sleep. Some can be investigated with the GEH Sleep service.
Hypoventilation
It is normal for breathing to reduce whilst asleep however with certain conditions this can reduced too much resulting in reduced oxygen levels and increased carbon dioxide levels. Carbon Dioxide levels are our waste gas and if they accumulate in the blood it can turn it slightly acidic. This is most common with central obesity, spinal deformities, muscle weakness or certain lung diseases. 
Carbon Dioxide levels are measured via a blood test. This is usually performed by pricking the earlobe and collecting a small amount of blood; much like a diabetes finger prick test. If you Carbon Dioxide is too high, you may benefit from Non Invasive Ventilation (NIV).

 Non Invasive Ventilation
NIV looks a lot like CPAP and uses the same masks and tubing. The main difference however is that it alternates between two set pressures. This ensures that breathing does not decrease during the night which allows the Carbon Dioxide to be exhaled more efficiently. Like CPAP, there will be regular follow ups to ensure treatment is optimised. 
Sleep Hygiene

Sleep Hygiene means having good sleeping habits and behaviours in an environment that is compatible with good quality sleep. Everyone has different requirements regarding sleep hygiene however there are a number of common pieces of advice:
•    Have a regular bedtime routine to help wind down and relax
•    Have a fixed pattern of when to sleep and when to wake
•    Avoid electronic devices for at least 60 minutes prior to bed – this prevents Melatonin production which prepares us for sleep
•    Ensure your bedroom is quiet and dark. A cool room is usually better than a warm one. Quiet ambient or white noise may be preferrable for some
•    Do not remain in bed if you are unable to sleep as this can often make it harder to doze off and create a negative association with the bedroom.
•    If you can’t sleep, get our of bed and perform a quiet activity such as reading and only return to bed when you feel sleepy again
•    Maintain a healthy diet and undertake regular exercise.
•    Avoid caffeine, alcohol or nicotine in the evening.

Most other sleep disorders can be improved by keeping good sleep hygiene.

Restless Leg Syndrome (RLS)
This is an uncomfortable feeling in the legs that is often described as tingling, water running over the legs or ants crawling on them. This feeling can only be alleviated by movement and can often inhibit sleep. There is no definitive test to diagnose RLS however there are several things that can help:
•    Maintain good sleep hygiene and treat any other sleep disorders as RLS is more likely to occur alongside poor sleep quality and daytime sleepiness
•    If you Ferritin levels (a blood protein that stores iron) are below 75ng/mL you may benefit from iron supplements
•    There are some medications that can help treat the symptoms such as Ropinirole and Pramipexole

Periodic Limb Movement Disorder (PLMD)
This usually involves leg movements however can sometimes affect the arms. It consists of regularly kicking out during sleep. This can occur up to every 5 seconds at times and can cause sleep disturbances resulting in reduced deep sleep. This can be investigated and diagnosed by performing a sleep study at home monitoring your breathing, oxygen levels, HR and the leg muscle activity using two small electrodes (EMG).

 Treating other sleep disorders and improving sleep hygiene may help others medication such as Ropinirole or Pramipexole may be beneficial
 
Investigation into other sleep disorders require a referral to a specialist centre with access to tests such as polysomnography (PSG). This may involve overnight stays in hospital with electrodes attached to the scalp to monitor brain activity (EEG). 
These sleep disorders include:
•    Narcolepsy
•    Parasomnia such as sleep walking
•    REM behaviour disorders such as acting out dreams. These are quite violent in nature and can lead to injuries to the individual or bed partner
•    Circadian Rhythm disorders that affect when your body prepares for sleep
The sleep service at GEH can help screen for these symptoms through history taking and can suggest onward referral where appropriate. 

What if there is no evidence of a sleep disorder?
The reason behind excessive daytime sleepiness can be very difficult to pinpoint since it is quite a generic symptom and lots of things can cause it. If there is no evidence of a sleep disorder requirement treatment, it may be appropriate for your GP to look into other causes. This may mean a medication review since many have sleepiness as a side effect or it may mean investigation into other disorders that are commonly associated with sleepiness. This may include diabetes, thyroid problems, heart failure or fibromyalgia.

Home Non-Invasive Ventilation (NIV)

What is Non-Invasive Ventilation

NIV is equipment, including a machine and a mask that is commonly used as a treatment for people who have breathing problems and require help with ventilation, especially when they sleep.

There are several conditions that cause breathing problems such as chronic lung disease, neuromuscular conditions, chest wall deformities and increased weight. They results in low oxygen levels and high carbon dioxide levels in the blood.

Why do I need Non-Invasive Ventilation

NIV is used mostly during sleep, when your breathing muscles are more relaxed and you breath less often and deeply.

If you have a condition listed above your breathing might be affected. This could lead to you: struggling to supply your body with oxygen and struggle to get rid of your carbon dioxide, which is the waste gas in your lungs.

The aim of the NIV is to help reduced the symptoms associated with sleep related breathing problems such as headaches in the morning, poor sleep, tiredness and fatigue. Some people however do not have feel any symptoms. The use of an NIV machine can also help with concentration, increase mood, reduce hospital admissions and in some cases prolong life.

What does a Non-Invasive Ventilation machine do?

The NIV machine blows air at a set pressure into your lungs as you breathe in and blow at a reduced pressure when you breathe out. This will help you take bigger breathes and support your muscles, making breathing easier.

This will help your lung breath more efficiently so your body will get oxygen in and get rid of the carbon dioxide more easily.

How do I prepare for the assessment?

Please continue to take any prescribed medication as normal.
Please remove any nail varnish from fingernails as we might place an oximeter probe onto the finger.
Please contact the department if you have a current or recent chest infection (within the last 4 weeks)

What happens at my Non-Invasive Ventilation appointment?

We will issue you with a NIV machine which will be on loan to you for a long as you need it. You will also be issued with a face mask which has been fitted during the appointment, a circuit tubing which attaches the machine to the mask and some filters for the machine.

We will place you on the NIV machine during the appointment so you can understand what it feels like. We might also take a small blood sample from your ear to see what your oxygen and carbon dioxide levels are.

The machine will be programmed for you, and you will not be able to change these settings yourself. We will show you how to turn the machine on and off and any features that might be relevant to your symptoms.

We have several masks that can be used with the NIV machine, and we will find the right one for you. They do have to fit quite snuggly as to prevent leaks. We will explain how to use the mask and how to adjust and tighten it as required during the night.

Will give you an information leaflet which will have lots more information in it such as cleaning instructions, problems with your face mask and other common problems and troubleshooting, but we will explain this to you during the visit as well. We will also answer any questions you have.

LINK TO LEAFLET

How long should I wear my Non-Invasive Ventilation for?

The NIV machine needs to be used regularly every night for it to be effective. You will be informed of the most appropriate amount of time for use by the NIV team. It is very important to continually use it to get the best benefit from the machine.

I can take a few days or even a few weeks to get used to the machine so please keep trying to use it as much as you can.

When will I be review again?

We will review you again in 4weeks after your initial appointment where we will check how you are getting on with the NIV machine, check your compliance and also take another small blood sample to check your oxygen and carbon dioxide level.

If needs be we will change the settings on your machine depending on what the blood test shows.

How long will the assessment last?

The assessment will last about an hour.

Remote Monitoring of the Non-Invasive Ventilation Machine.

Modern NIV machines are equipped with technology to allow information to be sent to your healthcare team. This allows us to be able to monitor your therapy, especially if you have any problems. This information includes usage, mask leak and breathing information. 

You will however still have to attend a hospital appointment at least yearly for a face-to-face appointment so we can take a blood test.

We will discuss whether we can monitor you remotely, at your
first appointment, and would need your consent to do this.

What if I have problems with my Non-Invasive Ventilation Machine.

If you are having problems with your NIV machine or need a new mask, tubing or filters, you can contact the department on 02476 865013 and leave a message and we will get back to you as soon as we can. The working hours are Mon – Fri, 8am-6pm.  

What is Spirometry
Spirometry is a Lung Function Test that measures how well the lungs and airways are working. We compare the results with the average results of someone of the same age, gender and height.

Why do I need to have Spirometry?

Healthcare professionals commonly request these tests to:
Diagnose for lung disease
Measure severity of lung disease
To determine a treatment plan or monitor how successful a current treatment plan is
To test lung function before an operation

What does spirometry involve

This test gives us information about how much air and how fast you can move the air in and out of your lungs. 
We will ask you firstly to breathe in fully and to perform a relaxed blow out, into a mouthpiece, for as long as you possibly can. This will be done in a seated position with a nose peg on. 
We will then ask you to breathe in fully and to blow out as hard and as fast as possible, until you are completely empty.
We will repeat the test several times to get reproducibility.
We might also give you an inhaler and perform reversibility studies, where you will be asked to repeat spirometry again 20minutes after being given the inhaler.

How do I prepare for the test?

Before attending for your lung function tests, please:

• Do not eat a heavy meal for 2 hours
• Do not take alcohol for 4 hours
• Do not take vigorous exercise for 30 minutes
• Do not wear any tight clothing that may restrict breathing
• Do not smoke for at least 6 hour

You will be given an information leaflet with your appointment letter which will give you instruction on the length of time you will be asked to withhold any inhalers for and which other medications you will need to stop taking for the test, these include antihistamines and many anti-inflammatory drugs. (LINK TO LEAFLET)
Please bring with you a list of your current medications.

Please contact the department if they have experienced any of the following:

Current or recent chest infection (within the last 4 weeks)
Recent eye, stomach or chest surgery
Heart attack or stroke within the last month
Attended Accident & Emergency in the last 2 to 3 days
Chest Pain on the Day of your test

How long will the tests last?

Spirometry should last between 30mins, however if a reversibility test is needed it could be up to 1hrs. So please allow enough time.

Are there any side effects or risks to LFT’s?

Due to the nature of the tests and the full exertion required some patients may feel some chest pain, dizziness or faint during the test. Completing the tests can be tiring but you will be given time to recover between tests. Serious complications are rare, and risks will be kept to a minimum by the physiologist.

How to get the results of the test?

The results will go to the patient's consultant or referring healthcare provider who will discuss them at the next clinic visit.

What is a Fractional exhaled nitric oxide test
Fractional exhaled nitric oxide (FeNO) is a test that measures Nitric oxide in your breath. Nitric oxide is a gas produced by cells involved in the inflammation process associated with asthma. It can be used along with other tests to diagnose asthma. The test is simple and easy to do 

What does the FeNO test involve
You will be asked to take a big breath in until full and then breath out slowly and steadily through a mouthpiece into a small portable device for approximately 10/15 seconds. We may repeat the test several times to get reproducibility.
This test is generally done in conjunction with the lung function tests.

How do I prepare for the test?

Before attending for your FeNO tests, please:

• Do not eat a heavy meal for 2 hours
• Do not take alcohol for 4 hours
• Do not take vigorous exercise for 30 minutes
• Do not wear any tight clothing that may restrict breathing
• Do not smoke for at least 6 hour

You will be given an information leaflet with your appointment letter which will give you instruction on the length of time you will be asked to withhold any inhalers for and which other medications you will need to stop taking for the test, these include antihistamines and many anti-inflammatory drugs. (LINK TO LEAFLET)

Please bring with you a list of your current medications.

If you have a current or recent chest infection (within the last 4 weeks) please contact the department

How long will the tests last?

The FeNO test itself only lasts 5mins, however as mentioned the test is generally done in conjunction with other lung function tests, so you could be longer.

Are there any side effects or risks to FeNO?

No

How to get the results of the test?

The results will go to the patient's consultant or referring healthcare provider who will discuss them at the next clinic visit.
 

What is the Breathlessness Pathway?
The Breathlessness Pathway is a one-stop assessment clinic that brings together expert staff and key tests to investigate the cause of your breathlessness quickly and efficiently. The service is led by respiratory clinical scientists, supported by doctors and nurses.
What to Expect at Your Appointment
·         A full review of your symptoms and medical history
·         A physical examination
·         Tests you may need, such as:
·         Lung function tests (spirometry)
·         Breathing tests
·         Blood tests
·         ECG (heart tracing)
·         Chest X-ray (if needed)

At the end of your appointment, we will either:
·         Explain the cause of your breathlessness and provide a treatment or self-management plan
·         Refer you to a specialist (e.g. heart or lung doctor) for further care
·         Send advice to your GP for follow-up

What Conditions Might Be Assessed?
We investigate a wide range of possible causes, including:
·         Asthma or COPD
·         Heart conditions (e.g. heart failure)
·         Breathing or lung problems
·         Low fitness or weight-related issues
·         Anxiety or stress-related breathlessness
·         Other medical conditions (e.g. anaemia, thyroid problems)

Where Is the Service Located?
The Breathlessness Assessment Clinic is based at the:
Community Diagnostic Centre - George Eliot Hospital, Nuneaton
You will receive full details with your appointment letter.

An ABPI (Ankle/Brachial Pressure Index) is carried out to determine the arterial circulation of the legs. Leg pressure studies is a procedure used to calculate the ABPI.

We compare the blood flow in your arms to that in your legs. This helps us to see the overall blood flow in the arteries to your legs and feet. Dressings will need to be removed before the test can be performed, this test is carried out by technical staff that do not have nursing skills, meaning that they are unable to re dress any dressings after the test, no other preperation is needed for the test.

You will be taken into a room and the test will be explained and you will then be asked to remove your shoes and sock.  We will then take the blood pressure in both your arms and then place a blood pressure cuff around the bottom of your leg. We will apply cold gel to your foot and use a small handheld machine called a Doppler.

This machine uses ultrasound to look at the blood flow. We will use the Doppler probe to listen to the blood flow, the cuff around you leg will then inflate and when we release the pressure of the cuff we will take a blood flow reading.

We will then repeat this on the other leg. The test usually takes 15 - 20 minutes.

After the test has been performed the test results will be calculated and sent to the consultant that referred you. No test results will be given on the date of the test.

What is Oesophageal Manometry?
Oesophageal manometry measures the strength and coordination of the muscles in your oesophagus during swallowing. This test helps diagnose conditions such as:
•    Difficulty swallowing
•    Unexplained chest pain
•    Achalasia or other motility (swallowing) disorders
A thin, flexible tube is gently passed through your nose into the oesophagus to record the strength of your muscle contractions as you swallow small sips of water and small amounts of bread. If you have any specific dietary requirements such as gluten intolerance, it would be recommended to bring your own food to the clinic with you, such as a slice of bread, a small bowl of rice or equivalent. 

Preparation Instructions for Both Tests:
To ensure accurate results, please follow these instructions:
1.    Fasting:
o    Do not eat or drink for at least 6 hours before your appointment.
2.    Medications:
o    You may be asked to stop taking certain medications (e.g., antacids, proton pump inhibitors like omeprazole) a few days before the test, a full list will be in your patient information leaflet.
o    Please check with your doctor or the clinic for specific advice.
3.    Clothing:
o    Wear comfortable, loose-fitting clothing, especially for 24-hour pH monitoring, as you will be wearing a small recording device.
4.    During the 24-hour pH Test:
o    You can go about most of your normal activities, except for swimming or showering/ bathing.
o    You will be asked to keep a diary of your symptoms, medication, and activities to compare with the data recorded.
What to Expect:
These tests are safe and generally well-tolerated. You may feel some temporary discomfort in the nose or throat that should subside after about 20minutes or so, but there are no long-term side effects and you may take paracetamol or the equivelent to ease the inital discomfort.

What is 24-Hour pH Monitoring?
This test measures the amount and duration of acid reflux rising from the stomach into the oesophagus over a 24-hour period. It is useful for diagnosing:
•    Persistent heartburn or reflux (GORD/GERD)
•    Symptoms not responding to medication
•    Reflux-related cough or throat symptoms
A small probe is placed into your oesophagus, through the nose, and placed so the end of the probe sits about 5cm above the opening into the stomach. The probe records acid levels and transmits the data to a monitor worn on an over-the-shoulder strap or belt.

Preparation Instructions:
To ensure accurate results, please follow these instructions:
1.    Fasting:
o    Do not eat or drink for at least 6 hours before your appointment.
2.    Medications:
o    You may be asked to stop taking certain medications (e.g., antacids, proton pump inhibitors like omeprazole) a few days before the test, a full list will be in your patient information leaflet.
o    Please check with your doctor or the clinic for specific advice.
3.    Clothing:
o    Wear comfortable, loose-fitting clothing, especially for 24-hour pH monitoring, as you will be wearing a small recording device.
4.    During the 24-hour pH Test:
o    You can go about most of your normal activities, except for swimming or showering/ bathing.
o    You will be asked to keep a diary of your symptoms, medication, and activities to compare with the data recorded.
What to Expect:
These tests are safe and generally well-tolerated. You may feel some temporary discomfort in the nose or throat that should subside after about 20minutes or so, but there are no long-term side effects and you may take paracetamol or the equivelent to ease the inital discomfort.