Inside the Sleep Service with Professor Heather Elphick
The Sleep Service at Sheffield Children’s is one of the UK’s leading children’s sleep services. As one of a handful of dedicated centres in the country, it offers a vital and comprehensive range of sleep services for children and young people, and the biggest behavioural sleep service in the country.
Meet Professor Heather Elphick, Consultant in Paediatric Respiratory and Sleep Medicine
Why is children's sleep so important?
The children helped by the service often only sleep for 2-3 hours a night due to underlying medical conditions. When a child is this sleep deprived, it impacts not only on them but also their wider family. They can develop difficult, emotional behaviour. It can also impact how well they can concentrate at school, leading to problems both with their learning and their relationships.
Parents’ relationships can break down or they may have to give up work. Not only are they having to deal with a child that is distressed, but they are also often sleep deprived themselves too. Parents often take responsibility and can be unfairly blamed if their child is not sleeping, which is an isolating experience for parents if they feel they are going to be judged by others.
How much of a difference does the Sleep Service make?
Since the service was established in 2008, the number of beds and the duration of opening times have since more than doubled. The team had to expand quickly to keep up with the number of patients and the unprecedented demand for support at Sheffield Children’s. As a result, we conduct around 1,000 sleep studies a year and patients come from within a radius 100 miles. For those needing support for rare sleep conditions, the distance is even further with patients from areas including Birmingham, Morecambe Bay and York.
In 2016, we established a behavioural sleep service, which is nurse-led with sleep practitioners. The peak ages for behavioural problems are toddlers and teenagers. We see lots of infants that are struggling to establish a good sleep routine, while teenagers can get into unhealthy sleeping habits by staying up late or gaming.
What conditions does the Sleep Service specialise in and how many patients come for care at Sheffield?
One of the main conditions we specialise in is sleep apnoea, which is when your breathing stops and starts while you sleep. For the most severe cases, we look after around 160 children who need overnight ventilation for their breathing problems. Our service for Narcolepsy, which is a rare brain condition that causes uncontrollable sleepiness, sees around 80 children from across the North of England.
We also see patients for parasomnia, which includes sleep walking and night terrors, as well as limb movement disorders in sleep. Patients with sleep disturbances caused by environmental habits or other medical problems, including eczema, bowel or joint problems are also seen by our service.
The behavioural sleep service began with one nurse working one morning a week, but a team of health professionals now see 1,300 patients a year, with one recent family from Exeter in Devon travelling to Sheffield for specialist treatment.
The demand for our services is growing both because of our reputation as a comprehensive service, but there’s also more awareness of the importance of sleep and the help available. The attitude that people should put up with it and get on with it is being replaced by one where people know they can, and feel they should, seek support.
How has COVID-19 affected children's sleep?
Sadly, there have also been more sleep problems because of the changes during the COVID-19 pandemic. We’ve found that as teenagers spent more time at home, they suffered from a lack of structure to their days. They would enter a cycle of sleeping late and find it very difficult to return to their normal routine when returning to school. We also saw an increase in children with anxiety, brought on by the fear of relatives getting ill and the uncertainty changes brought to their everyday lives.
There have also been some positive changes. We’ve been doing virtual appointments, and in many cases, that’s worked really well. It’s more convenient, and if the child has complex needs, it saves the parent bringing them what can be a very long way on a difficult day out. It also means we help patients from further afield in the comfort of their own home without having to travel miles for an appointment.
How will the Sleep Service change in the years to come?
At the beginning of 2021, we also moved to our new Sleep House away from the main hospital site. It’s a more of a home from home with a much less clinical appearance, which allows us to show children straight to their bedrooms. We’ve had some great feedback and many patients are sleeping much better. The sleep studies are also more accurate with fewer disturbances.
Developing the service further is crucial and I am the lead for Sleep in the National Children and Young People’s MedTech Co-operative based at Sheffield Children’s. We’re leading research into the development of technology that could enable sleep studies to take place at home. As well as being more comfortable and convenient, it would also provide a more realistic picture of their sleeping experiences.
We’re currently working with Imperial University, both of the Sheffield Universities and Southampton Children’s Hospital to develop medical devices that improve diagnosis and treatment. We’re also continually trying to develop pathways to enable more local community support for children. We’ve come a long way and have got a lot further in Sheffield than anywhere else, but there’s more work we can do to work together with other sleep practitioners in the community to reduce waiting times here at home.
How do donations to The Children's Hospital Charity help?
They have supported some of our research, which is clearly going to benefit children in the future. They also fund an annual Narcolepsy Day, which is incredibly well-received and families that come for support and meet other families that are having similar experiences- that’s unique to us here in Sheffield.
The Charity have also supported the move to Sleep House as well, with furnishings and improvements to the garden to make it more child-friendly and a better working environment. It’s made a huge difference and it wouldn’t have been possible without charitable support.
What makes Sheffield Children's special to you?
I love working at Sheffield Children’s. We have a brilliant team, everyone is committed and dedicated to what they do. Everyone wants to make it the best experience they possibly can for every child and family we meet, and I’m incredibly proud to be a part of that.