Sleep Disorders

This condition is treated in the Respiratory and Sleep Medicine clinic.

The sleep disorders clinic is specifically for the investigation and management of people holding current Health Care Cards or Commonwealth Seniors Health Cards with suspected sleep apnoea who have evidence of a high probability of sleep apnoea as identified by formal questionnaires.

All referrals (see Royal Hobart Hospital Sleep Clinic Referral template and Frequently Asked Questions or Primary Health Tasmania downloadable referral) should comply with the referral standards and specifically include:

• History of presenting symptoms including treatments tried
• Current medical conditions and relevant past history
• Current medications list
• Concession card information must be included
• Examination findings including ENT findings
• Smoking history

Emergency Referral Criteria

Criteria for Emergency include: 

Emergency Referral Criteria

• Acute respiratory failure
• Clinical judgement

If you, or someone else, are experiencing a serious and life-threatening injury or illness call triple zero (000) immediately or go to the nearest Emergency Department.

Learn more about when to access emergency care and non-emergency care options if the injury or illness is not serious or life-threatening.

Statewide Referral Criteria (SRC)

Criteria for referral to public hospital specialist clinic services

Red flags are clinical indicators of possible serious underlying conditions requiring further medical intervention. They may or may not indicate an emergency.

Urgent (Category 1)

• Suspected or confirmed sleep hypoventilation with any of the following:
  • Progressive neuromuscular disorder
  • Established daytime hypercapnia (as demonstrated on ABG if performed)
  • Diagnostic sleep investigation demonstrating mean sleep saturation 85-90 per cent
  • Diagnostic sleep investigation demonstrating mean sleep saturation less than 85 per cent (meets criteria for urgent referral - please ensure urgent box is ticked for this referral)
• Suspected or confirmed sleep apnoea with any of the following:
  • Unstable cardiovascular disease e.g. overt heart failure
  • Epworth sleepiness scale score greater than or equal to 16
  • Dozing while driving at least one to two per month
  • MVA or work-related accident related to sleepiness/inattention in last 12 months

Urgent referrals should be accompanied by a phone call to the Respiratory Department and/or the relevant doctor for urgent assessment.

Semi-urgent (Category 2)

• Suspected or confirmed sleep apnoea with any of the following:
  • Occupation involving driving/heavy machinery operation
  • Significant comorbidities for example pulmonary hypertension, previous stroke, heart failure
  • Significant cardia arythmias, neurological disease, acromegaly or hypothyroidism
  • Respiratory disturbance index of greater than or equal to 30 respiratory events per hour on a diagnostic sleep investigation
  • Epworth sleepiness scale score 12 to 15
  • Dozing while driving in last 12 months
  • MVA or work-related accident related to sleepiness/inattention in last 5 years
• Suspected or confirmed sleep disorders/concerns requiring specialist review
  • Unexplained hypersomnolence (Epworth sleepiness scale score greater than or equal to 12), not attributed to inadequate sleep hygiene or environmental factors
  • Suspected or confirmed narcolepsy
  • Suspected or confirmed parasomnia with injury to self or others
  • Sleep related movement disorder with injury to self or others

Routine (Category 3)

• Suspected or confirmed sleep apnoea with any of the following:
  • Epworth sleepiness scale score 8 to 11
• Suspected or confirmed sleep disorders/concerns requiring specialist review
  • Chronic insomnia
  • Circadian rhythm disorders
  • Other (provide detail)

Information to be included in the referral

(Referral may be returned without this)

Essential supporting information

Pathology

• TFTs
• U&E
• BSL (Fasting) or HbA1c
• Iron studies (suspected restless legs or fatigue)
• Vitamin D (if fatigued)

Imaging

• Nil

Investigations/other

• BMI
• SpO2 %
• STOP-BANG score
• Epworth Sleepiness Scale score

Additional information

• History of sleep disorder including duration and severity of symptoms, snoring, witnessed apnoeas, restless sleep, unrefreshing sleep, tiredness, inappropriate falling asleep.
• Management to date, including:
  • any previously tried appliances (mandibular advancement splint, CPAP) and response
  • current medications (including complete list of all patient's medications)
• Full report from all previous sleep investigations (if already performed)
• Occupation
• Driving licence type
• History of motor vehicle accidents or sleepiness/inattention when driving

Interim/GP management

To refer a patient with this condition, please see the Respiratory and Sleep Medicine clinic page for the full referral process and templates.

Referrals will be triaged according to the information supplied, with some patients being directly straight to sleep studies and some patients being seen in clinic first.  Referrals with insufficient information will be returned to the referrer.

Where possible consider reducing narcotic and benzodiazepine use.  Advise weight loss if possible.  Manage comorbidities e.g. hypertension.

People without Health care cards and Commonwealth Seniors Health cards are not eligible for this service and will require assessment in the private sector.

For more information please see the HealthPathways Tasmania website.

• HealthPathways Tasmania - Sleep Disorder Assessment
• HealthPathways Tasmania - Sleep 
• HealthPathways Tasmania - Respiratory

Availability

View all clinic availability