Is snoring dangerous?

Occasional mild snoring is usually benign. However, loud habitual snoring may indicate sleep-disordered breathing and should be assessed, particularly if accompanied by daytime sleepiness.

Can weight loss stop snoring?

In many individuals, weight optimisation can significantly reduce snoring by decreasing airway narrowing and collapsibility.

Do I need a sleep study for snoring?

If snoring is persistent, loud, or associated with symptoms such as fatigue or sleepiness, a sleep study can provide important diagnostic information.

Why am I tired even after sleeping 8 hours?

Sleep duration alone does not guarantee restorative sleep. Fragmented sleep, breathing disturbances, circadian misalignment, or nervous system activation can all reduce sleep quality. Even if sleeping sufficient hours there may be factors reducing the depth of sleep leaving you feeling insufficiently rested and restored.

Can sleep apnoea cause constant fatigue?

Yes. Obstructive sleep apnoea is one of the most common medical causes of persistent fatigue. Repeated breathing interruptions during sleep reduce oxygen levels and fragment sleep cycles, leaving individuals feeling exhausted during the day even after a full night in bed.

How do I know if my tiredness is a sleep disorder?

Persistent tiredness may indicate a sleep disorder if it occurs alongside symptoms such as loud snoring, breathing pauses during sleep, morning headaches, difficulty concentrating, or excessive daytime sleepiness. In these situations, a sleep study can help identify the underlying cause.

Can stress make you feel tired all the time?

Yes. Chronic stress activates the body's fight-or-flight response, which increases alertness hormones and prevents deep restorative sleep. Over time this can lead to persistent fatigue, poor concentration, and disrupted sleep patterns.

When should I see a sleep specialist for fatigue?

You should consider seeing a sleep specialist if tiredness persists for several weeks, affects daily functioning, occurs with snoring or breathing disturbances, or causes daytime sleepiness. A specialist assessment can determine whether a sleep disorder, circadian disruption, or lifestyle factor is affecting your sleep quality.

Should I get a sleep test?

If tiredness is ongoing, affecting daily functioning, or associated with symptoms such as snoring or excessive sleepiness, a sleep study can provide valuable diagnostic insight.

Is insomnia the same as not sleeping enough?

No. Insomnia involves difficulty sleeping despite having the opportunity to sleep, often due to heightened arousal or behavioural factors.

Can insomnia go away on its own?

Yes, particularly in acute cases. However, if symptoms persist, targeted intervention such as CBT-I is often required.

Do I need a sleep test for insomnia?

In most cases, insomnia is diagnosed clinically. A sleep study may be considered if another sleep disorder is suspected.

Is sleep apnoea serious?

Yes. While it is treatable, untreated sleep apnoea can increase the risk of cardiovascular disease, metabolic dysfunction, and accidents related to sleepiness.

Can you have sleep apnoea without snoring?

Yes, although snoring is common, some individuals may have OSA without prominent snoring.

Do I need a sleep test if I feel tired?

If tiredness is persistent and associated with symptoms such as snoring or sleepiness, a sleep study may be appropriate.

Which sleep test is best?

The best test depends on the symptoms being investigated. Many people only require a simple home sleep study, while more complex presentations may benefit from full polysomnography.

Can I do these tests at home?

Yes. All sleep studies offered by Grace Sleep are performed in the comfort of your own home.

Will I always need the most advanced sleep study?

No. Most patients can be accurately diagnosed using simpler investigations. More advanced testing is reserved for situations where additional information is needed.

How many time zones do I need to cross for this to be worth it?

Most people notice meaningful jet lag symptoms after crossing three or more time zones, particularly eastbound. For two time zones or fewer, the disruption is usually mild enough to manage without a formal protocol. From three time zones upwards — particularly for eastbound travel or when you need to perform immediately on arrival — a personalised protocol produces a measurable difference.

How far in advance do I need to book?

The earlier the better — the pre-travel component of the protocol typically begins three to five days before departure. For maximum benefit, contact us at least a week before your trip. That said, even a last-minute protocol delivered the day before departure is more effective than no preparation at all, particularly for the in-flight and post-arrival components.

Is melatonin available over the counter in the UK?

Melatonin is a prescription-only medicine in the UK. Your protocol will specify the timing and dosing at which melatonin would be beneficial — and we can advise on how to obtain it via a GP or private prescription. Over-the-counter alternatives and behavioural strategies are also included for those who do not have access to melatonin.

I travel internationally every week. Can this service work for ongoing schedules?

Yes. For cabin crew, frequent flyers, and athletes with complex rosters, we can design an ongoing circadian management strategy that accounts for your pattern of travel — not just individual trips. This is available as a bespoke programme. Contact us to discuss.

What if I am only at my destination for one or two days?

Short trips — two days or fewer — usually benefit from a different strategy: remaining on home time rather than attempting to adapt to the destination time zone. Your protocol will specify this where it applies. The goal is to keep you functional, not necessarily to fully adapt to local time.

Can this be combined with other Grace Sleep services?

Yes — jet lag management can be added to any Grace Sleep pathway or accessed independently. For patients managing insomnia or circadian rhythm disorders alongside frequent travel, the protocols are designed to be compatible and mutually reinforcing. Contact us to discuss how best to combine services for your situation.

Who is sleep optimisation for?

Sleep optimisation is for people who do not have a diagnosed sleep disorder but know their sleep could be better — those who wake unrefreshed, struggle with energy or focus, or feel their sleep is inconsistent or unrestorative. It is also suited to high-performers, athletes, and those with demanding schedules where sleep quality is a significant variable in their health and performance.

Is SleepImage different from a consumer sleep tracker?

Yes — significantly. SleepImage is a medical-grade, clinically validated device that measures physiological signals with diagnostic accuracy. Consumer trackers like Fitbit, Oura, or Apple Watch use movement and heart rate approximations to estimate sleep stages. SleepImage measures cardiopulmonary coupling — a validated clinical method for assessing sleep structure and quality. It is used in clinical research and healthcare settings, not designed as a wellness product.

How many sessions do I need?

The starter programme at £550 provides three sessions — appropriate for focused, specific sleep concerns or those wanting a defined starting point. The six-session core programme allows for a more thorough exploration and greater plan refinement. The twelve-session transformational programme is for those seeking profound, sustained change with longer-term specialist support. Your specialist will recommend the most appropriate programme at your initial consultation.

Are sessions in person or online?

All sessions are delivered via video consultation — available to anyone in the UK or internationally. The SleepImage device is shipped directly to you for the assessment period.

What is Grace Metabolic and how does it connect to sleep?

Grace Metabolic is our specialist metabolic health service — addressing nutrition, glucose regulation, body composition, and long-term metabolic wellbeing. Sleep and metabolic health are deeply interconnected: poor sleep impairs glucose regulation, increases appetite, elevates cortisol, and degrades body composition. Where relevant, we integrate metabolic insights into your sleep optimisation programme so both are addressed together rather than in isolation.

Who is sleep coaching for?

Sleep coaching is for people who want structured, practical support to improve their sleep without a clinical diagnosis or medical programme. It is well-suited to those whose sleep is affected by lifestyle, habits, stress, or environment — and who want gentle, sustained support to make meaningful changes. It is not designed for people with diagnosed sleep disorders such as insomnia disorder or obstructive sleep apnoea, for whom clinical pathways are more appropriate.

What is the difference between sleep coaching and sleep optimisation?

Sleep optimisation uses SleepImage medical-grade digital assessment to measure your sleep objectively across multiple nights before building a personalised plan. It is more data-driven and suited to those who want clinical-level insight into their sleep architecture. Sleep coaching is a behavioural and lifestyle programme — it does not include physiological assessment and focuses on practical habit change, routine building, and lifestyle factors.

How long does the programme take?

The programme consists of six sessions typically spaced one to two weeks apart, meaning the full programme runs over approximately eight to ten weeks. This spacing allows enough time between sessions to implement changes and observe their effect before your next check-in.

Are sessions in person or online?

All sessions are delivered via video consultation and are available to anyone in the UK or internationally. There is no geographic restriction.

What if I think I might have a sleep disorder?

If you suspect you have a clinical sleep disorder such as insomnia disorder or obstructive sleep apnoea, sleep coaching is not the appropriate starting point. Grace Sleep offers specialist clinical pathways for both conditions. Contact us and we will help direct you to the right service.

Can sleep coaching be combined with a Grace Metabolic programme?

Yes — and for many people, combining the two produces better outcomes than either alone. Sleep and metabolic health are deeply connected. If you are following a Grace Metabolic programme, your sleep coaching plan can be aligned with it so that your nutrition, movement, and metabolic goals are fully integrated with your sleep improvement strategies.

How do I know if my snoring is sleep apnoea?

The most common signs that snoring may indicate sleep apnoea are waking unrefreshed despite adequate sleep, excessive daytime sleepiness, a bed partner observing pauses in your breathing, morning headaches, and frequent night-time waking. A home sleep study is the only way to confirm or exclude a diagnosis. Many people are surprised to discover significant OSA with surprisingly few daytime symptoms.

Do I need a GP referral to book?

No. Grace Sleep is a private clinic and you can book directly without a GP referral. We do recommend informing your GP of any diagnosis so it can be recorded in your medical notes and factored into future care.

Is a home sleep study as accurate as a hospital study?

For diagnosing obstructive sleep apnoea, a Level 3 home sleep apnoea test is clinically validated and recommended by NICE and the British Sleep Society as the appropriate diagnostic tool in most cases. Full polysomnography — an in-laboratory Level 1 study — is reserved for cases with complex comorbidities, which we identify from your questionnaire and, where needed, from your consultant assessment.

What happens if I am diagnosed with sleep apnoea?

You receive a detailed written report from a GMC-registered sleep physician, including your AHI score, oxygen saturation data, and a personalised treatment plan. If CPAP is recommended, we initiate the full provision and support programme. If a mandibular device or other approach is more appropriate, we arrange this directly.

Can you treat snoring if I do not have sleep apnoea?

Yes. Primary snoring — snoring without sleep apnoea — is a real condition that disrupts sleep for both the snorer and their partner. Following a sleep study to exclude OSA, we can recommend appropriate management including positional therapy, weight management support, and, where indicated, referral to an ENT specialist.

I already have a CPAP machine but it is not working. Can you help?

Yes. Our CPAP Therapy Service includes a dedicated mask troubleshooting pathway for patients who already have a device but are struggling with comfort, leaks, pressure, or adherence. The most common reason people abandon CPAP is not the device — it is a poorly fitted mask. We assess your anatomy and provide a new one as part of the service.

Do you see patients outside London?

Yes. Our home sleep studies are available anywhere in the UK, and all consultations are conducted by video. We also see international patients remotely. Equipment is dispatched internationally — contact us to confirm availability and timelines for your location.

How quickly will I have a result?

Equipment is typically dispatched within 24 hours of booking and pathway completion. Once the equipment is returned, results are reviewed within 48 hours. Most patients complete the full pathway — from booking to written results — within one week.

Do I need a referral to access CPAP therapy?

No. You can access the pathway directly. You do need an existing sleep study report or CPAP/BiPAP prescription — but you do not need a GP referral to upload one.

What if I already have a CPAP machine?

CPAP or Mask troubleshooting services are designed specifically for you. We will work with your device, unless you want to upgrade, and the data that you can provide us.

Do I need a referral for a sleep test?

No referral is required to arrange a private sleep test with us. You can book directly without going through your GP, though we always recommend informing your GP of any diagnosis so it can be recorded in your medical notes.

Is the sleep test uncomfortable?

No. The devices we use are lightweight and designed to be worn comfortably overnight without disturbing your normal sleep. Most patients report that the equipment has minimal impact on how they sleep.

How long does the sleep test take?

Most tests are completed over two nights of sleep. This allows us to capture night-to-night variation in your sleep patterns, which gives a far more reliable picture than a single night of monitoring alone.

How quickly will I receive my results?

If you opt for Test Only, your results will be sent to you within 2 working days of test completion. If you opt for a pathway that includes a consultation, your clinician will run through the results with you directly during that appointment.

What if I am diagnosed with sleep apnoea?

Our team will guide you through your treatment options and help you find the most appropriate solution — whether that is CPAP therapy, a mandibular advancement device, lifestyle intervention, or further specialist input. Testing is the start of a supported pathway, not an endpoint.

Do you see patients outside London?

Yes. Our home sleep studies are available anywhere in the UK — equipment is posted directly to you, and consultations are conducted via video. Our team is based in London but our service has no geographical boundary.

Louise Berger

Occupational Therapist & Behavioural Sleep Medicine Specialist CBT-I Practitioner · Grace Sleep Clinic

HCPC-Registered Occupational Therapist
Founder, NHS Insomnia Clinic — Royal Surrey County Hospital (est. 2011)
Professional Expert, NICE Insomnia Guidelines
Associate Lecturer, PG Certificate in Sleep Medicine — UWE
Trustee, British Society for Pharmacy Sleep Services

10+

Years in Sleep Medicine

2011

NHS Clinic Founded

NICE

Guidelines Expert

CBT-I

Evidence-Based Treatment

An Unexpected Path to Sleep

Louise Berger is an HCPC-registered Occupational Therapist and one of the UK’s most experienced behavioural sleep medicine specialists. Her route into sleep medicine was not planned — in 2011, while working as an OT in A&E, she was asked to set up a new insomnia service at the Royal Surrey County Hospital Sleep Clinic.

What began with a degree of personal uncertainty quickly became a professional conviction. Working with her first patients, Louise witnessed something she had not fully anticipated: how rapidly and reliably people improved when they received the right treatment. People who had struggled for years — sometimes decades — were sleeping better within weeks.

What began as a profession gradually became a passion. She has now spent over a decade developing one of only a handful of dedicated NHS insomnia services in the UK, working with thousands of people experiencing sleep difficulties of every kind — including those navigating physical health conditions, mental health difficulties, chronic pain, multiple sleep disorders, and major life stress.

Current Positions

Behavioural Sleep Medicine Specialist

Grace Sleep · Grace London Collection

Clinical Lead & Founder, NHS Insomnia Clinic

Royal Surrey County Hospital (est. 2011)

Associate Lecturer

PG Certificate in Sleep Medicine · University of the West of England

Professional Expert

NICE Insomnia Guidelines

Trustee

British Society for Pharmacy Sleep Services

Communications Committee Member

British Sleep Society

Helping People Rebuild Trust in Their Sleep

Louise’s clinical background in Occupational Therapy is not incidental to her work in sleep medicine — it is central to it. Sleep is never simply about sleep. It is shaped by biology, psychology, daily routines, relationships, health conditions, and the environments people live in. Occupational Therapists are trained to understand exactly that intersection.

Her approach to insomnia is rooted in Cognitive Behavioural Therapy for Insomnia (CBT-I) — the internationally recognised gold-standard treatment for chronic insomnia, backed by a substantial body of clinical evidence. CBT-I is consistently shown to outperform sleeping pills, with benefits that last long after treatment ends.

Lasting improvements rarely come from trying harder to sleep. They come from understanding what’s getting in the way — and finding an approach that fits the individual, not just the problem.

Rather than offering rules to follow or things to try, Louise addresses the sleep anxiety, preoccupation, and internal patterns that actually drive chronic insomnia — helping patients rebuild a working relationship with sleep rather than fight it. Her work is evidence-based, practical, and consistently tailored to the person sitting in front of her.

The CALMS Framework — Louise is the creator of the CALMS Framework, a clinical tool she developed to support healthcare professionals delivering behavioural sleep interventions. The framework draws on her decade of clinical experience and is designed to help clinicians structure effective, consistent insomnia treatment.

Qualifications & Registration

HCPC Registered

Occupational Therapist · Health & Care Professions Council

Behavioural Sleep Medicine

Specialist — Insomnia & CBT-I

Co-author

Expert Consensus Guidelines for CBT-I Minimum Standards of Practice · Royal Society of Medicine

CALMS Framework

Creator — clinical tool for behavioural sleep interventions

Member

WINK Sleep — professional community for sleep clinicians

Specialising in Insomnia & Behavioural Sleep Medicine

Louise works with adults experiencing a wide range of sleep difficulties, with a particular depth of expertise in chronic insomnia and the behavioural and psychological factors that sustain it.

Book a Consultation

No referral needed. Video consultations available UK-wide and internationally.

Specialist insomnia treatment · CBT-I

Shaping the Future of Sleep Care in the UK

Louise’s contribution to sleep medicine extends well beyond individual clinical practice. She teaches on the University of the West of England’s Postgraduate Certificate in Sleep Medicine — one of the UK’s primary routes for clinicians entering the specialty — helping shape the next generation of sleep practitioners.

She serves as a Professional Expert for the NICE guidelines on digital insomnia treatment, contributing to the national standards that determine how insomnia is diagnosed and treated across the NHS. She is also co-author of the Expert Consensus Guidelines for CBT-I Minimum Standards of Practice, developed through the Royal Society of Medicine.

As a trustee of the British Society for Pharmacy Sleep Services and a member of the Communications Committee of the British Sleep Society, Louise is active in developing better sleep services, improving access to effective treatment, and raising professional standards across the field.

Her work reflects a conviction that good sleep care should be available to everyone — not just those fortunate enough to find the right specialist.

Ready to sleep better?

Book a private consultation with Louise Berger. No referral required. Video appointments available UK-wide and internationally.