The science of sleep medicine at LoveMyLife

What sleep does

Sleep is not downtime. It is active brain maintenance. During sleep the glymphatic system clears metabolic waste, memory consolidation moves new information from hippocampus to cortex, the immune system remodels, growth hormone peaks, cardiovascular load resets, and the autonomic nervous system recalibrates.

Short or fragmented sleep has measurable consequences: raised blood pressure, impaired glucose tolerance, increased inflammatory markers, reduced vaccine response, worse mood regulation, slower reaction times, and higher long-term risk of cardiovascular disease, dementia, and metabolic disease.

What actually goes wrong

Sleep problems cluster into four categories, and most patients do not know which one they have until tested. Obstructive sleep apnoea is the most underdiagnosed: repeated upper-airway collapse fragments sleep without the patient knowing. Chronic insomnia is the difficulty initiating or maintaining sleep for at least three nights a week for more than three months. Circadian rhythm disorders are a mismatch between body clock and desired sleep schedule. Parasomnias and movement disorders include restless legs, periodic limb movement, and REM-behaviour disorder.

Many patients have two problems at once. Apnoea plus insomnia (COMISA) is common and needs both problems treated.

The WatchPAT One home sleep test

The WatchPAT One is a single-use, wrist-worn device that measures peripheral arterial tone, oxygen saturation, heart rate, and body position overnight. It detects apnoea events, desaturation, sleep stages, and arousal burden, and produces a full polysomnography-equivalent AHI (apnoea-hypopnoea index) and other indices.

Evidence is strong: WatchPAT One has been validated against in-lab polysomnography and performs well for mild, moderate, and severe obstructive sleep apnoea diagnosis. It is not appropriate for suspected central apnoea, complex parasomnias, or paediatric sleep disorders.

The advantage over lab polysomnography is that you sleep in your own bed. The advantage over older home tests is that it does not need a breathing cannula and is comfortable enough that most patients get a normal night's sleep.

How we treat what we find

• Obstructive sleep apnoea: CPAP remains the gold standard. Mandibular advancement devices are a viable alternative in mild to moderate cases. Positional therapy and weight loss are adjuncts. Surgery (UPPP, MMA, Inspire) for specific anatomical presentations

• Chronic insomnia: CBT-I is first-line (structured programme, 6 to 8 sessions, demonstrable efficacy). Short-course medication where appropriate

• Circadian disorders: timed light, timed melatonin, chronotherapy, lifestyle architecture

• Restless legs: iron replenishment first, then dopamine agonists or alpha-2-delta ligands where needed

• REM-behaviour disorder: clonazepam, melatonin, and neurological referral due to association with synucleinopathies

Why we do not default to CPAP retail

A substantial UK sleep market exists that sells CPAP devices to anyone who tests positive for mild apnoea. This is commercially rational but clinically suboptimal for many patients. Mild apnoea (AHI 5 to 15) with minimal daytime symptoms often does not need CPAP. Positional therapy, weight loss, or a mandibular device can be equally effective and less burdensome.

We make the decision on treatment based on AHI, oxygen desaturation, daytime sleepiness, cardiovascular risk, and your preference. CPAP when it is right, not because it is what is available to sell.

The evidence on sleep and long-term health

Untreated moderate-to-severe obstructive sleep apnoea (AHI over 15) approximately doubles cardiovascular event risk, triples stroke risk, and is associated with insulin resistance, atrial fibrillation, and treatment-resistant hypertension. Treating it meaningfully reduces these risks.

Chronic insomnia is associated with depression, cardiovascular disease, and impaired cognition. Treatment (particularly CBT-I) is worth pursuing for health reasons as well as quality-of-life reasons.

Why this matters for your treatment plan

Our approach: find out what is actually happening with a real diagnostic test, treat what the test shows, and integrate sleep with the rest of your health, including cardiovascular risk, metabolic disease, mental health and performance.