Sleep medicine referrals

We're a tertiary referral service which aims to support consultants in secondary care (general and community paediatricians, and CAMHS psychiatrists) in the assessment and management of children and young people with complex, rare and refractory sleep concerns. Due to the highly specialist nature of our service, we accept referrals from a very wide geographical area.

Sleep problems in children and young people are common, and the vast majority of these are expected to be able to be assessed and managed in primary and secondary care. Only a very small proportion are expected to need referral to a tertiary service.

We cannot accept referrals directly from primary care, or where there is no ongoing secondary care follow-up clearly indicated in the referral.

We cannot accept referrals from paediatricians working in private practice, and all referrals must be made and supported by an NHS consultant paediatrician or psychiatrist.

Children can be referred up to the age of 16. Young people aged 17 or over should usually be referred to the adult sleep medicine department at Guy’s Hospital. Exceptions to this can be discussed with one of the consultant team.

All patients referred to our clinic should have been examined before referral by the referring secondary care consultant or team, and this should be documented in the referral. Initial assessment and attempted management of sleep difficulties are expected to have been completed in secondary care, and interventions attempted, and details of these should be documented in the referral.

We will not be able to accept a referral where the referring consultant has discharged the patient from follow-up, or where ongoing follow-up plans are not clearly indicated.

Where there are concerns regarding potential neurodevelopmental diagnoses (for example, social communication disorder, ADHD etc) it is essential that assessment for these conditions has been completed and appropriate support put in place.

We will not be able to accept a referral where this has not yet been done.

Anxiety in children and young people is common, and often has a significant impact on sleep. Our service is not able to provide ongoing support for children with significant anxiety, and this needs to be considered and provided at secondary care level.

Management of complex sleep problems often involves optimisation of management of all other existing medical problems which may impact on sleep. Sleep quality may be adversely affected by symptoms of a wide range of common (and less common) paediatric conditions, including but not limited to asthma, eczema, reflux, epilepsy, autism or ADHD. It is essential that these conditions are identified and managed where present.

Referrals should be made using our referral checklist sleep service referral checklist (Word 88Mb) and emailed to gstt.elch.childrens.sleepreferrals@nhs.net

We offer a comprehensive range of diagnostic sleep investigations for children and young people.

Clinicians within Evelina London can request these directly on the EPR system.

External referrals for diagnostic investigations (only which cannot be done by local services) should be made by referral letter in the first instance stating the background history and investigation required.

In some cases, referral for diagnostic investigation only may not be appropriate and outpatient assessment may be more suitable. We'll discuss this with referring clinicians.

After a referral is accepted, children and their families are offered an initial 1 hour new patient appointment in either the general paediatric sleep clinic (majority of patients) or the paediatric narcolepsy/hypersomnia clinic (selected minority of patients). After this, an opinion and recommendations for management are made.

Patients will be appointed to the next available new patient appointment in the relevant clinic, and not to a specific consultant.

Diagnostic investigations may be carried out as part of the assessment. This may be done before the first outpatient appointment, or discussed and arranged after the initial assessment.

Our service receives a high number of referrals, and waiting times can be up to 3 to 6 months for an initial appointment.

As most children and families for whom a referral is accepted have similarly urgent needs, appointments are offered in order of referral acceptance date, and fast-tracking is usually not possible.

The majority of children and families seen in our service will be seen for a single assessment appointment, and will not be offered long-term follow-up.

Initial appointments are 1 hour long. Patients are appointed to the next available new patient appointment, and not to a specific consultant.

Any recommendations for management from our team should then be considered, and implemented if appropriate, by the referring secondary care consultant or team. Long-term or ongoing follow-up will remain with the referring consultant or team.

A minority of children and young people will be offered long-term follow-up with our service. This will principally be children and young people with a diagnosis of a primary sleep disorder (for example, narcolepsy). Our standard template for long-term follow-up patients is for children and young people to be seen every year in the tertiary sleep clinic, with the majority of follow-up continuing with the referring consultant or team.

For many children, even in those with complex medical backgrounds, behavioural intervention and modification is the foundation of improving sleep quality. Unfortunately we have limited capacity to offer ongoing behavioural support to all of the families that are seen in the clinic and therefore have to ask that behavioural interventions are supported locally. A selected group of children and families may be referred to our advanced sleep workshop, which supports behavioural intervention in the most complex cases.

Please note that due to the high pressure on the service, if a confirmed appointment is not attended without prior cancellation, your patient will be discharged from the waiting list and a new referral will be required.

With the sole exception of sodium oxybate for refractory narcolepsy, we cannot prescribe medicine directly from our service, and responsibility for consideration of prescription and monitoring of recommended medications will remain with the referring secondary care consultant/team. We're very happy to provide input into discussions about medication prescription, adjustment and review where required, for medications which have been recommended following clinic attendance.

Where local shared care arrangements are in place (for example, for methylphenidate) secondary care clinicians may ask GPs or primary care to take over prescription and monitoring of medicine, but this is the responsibility of the referring secondary care consultant to discuss with them.

Information about sleep problems in a healthy child on the BMJ website.

Information about sleep problems in children with neurodisability on the BMJ website.

Information about sleep problems in children and young people with ADHD on the BMJ website.