Cosmetic Nasal Surgery Explained

Should I have my Rhinoplasty performed by an ENT surgeon or a plastic surgeon?

This is something that is best decided after talking with your GP, however there are no firm reasons why you would require one over the other. An Ear nose and throat surgeon would perform a lot more rhinoplasties during their training as cosmetic rhinoplasty is not permitted on the NHS, but functional rhinoplasty (to improve nasal breathing) is and it is almost always carried out by an ENT surgeon. This means that ENT surgeons have extensive experience in rhinoplasties before they become consultants. Also, the external shape of the nose if often affected by bends or deviations in the nasal septum which is inside the nose. An ENT Surgeon will be better placed to be able to assess the impact of any such nasal septal deformity on the appearance of the nose and to correct this at the same time as the rhinoplasty.


Will my nose look like it has been operated on?

The aim is to perform a rhinoplasty that results in a normal looking nose. This could mean straightening a bent nose, removing a lump, turning up a down pointed nose etc but it will never mean making a nose look artificial. A good and well trained surgeon will leave you with the nose as close to your ideal nose as possible and no tell tale signs.


Which way of performing the surgery is best, closed technique or open technique?

An open technique rhinoplasty is done with a small cut at the base of the nose and also an internal cut. A closed technique means solely working on the inside of the nose. Both techniques can produce amazing results and the approach chosen should be down to the individual needs of the patient. A good surgeon will explain to you which method they intend to use and their reason why they intend to use it.


Can I have a second rhinoplasty if I am unhappy with the result of my first?

This depends on the individual factors, but assuming the aim is a reasonable and realistic one and all risks of surgery are understood by the patient then there should be no reason why a second, or even (rarely) a third rhinoplasty procedure can not be performed and achieve the desired results. The complexity of each subsequent rhinoplasty does however increase as do the potential risks so it is essential to think very carefully about what you are trying to achieve before proceeding with revision rhinoplasty surgery. Your surgeon will evaluate your aims and align them to what is technically and realistically achievable. The key is to arrive at a clear goal to avoid requiring more procedures than are necessary.

A Five Minute Guide To Glue Ear In Children

screen-shot-2016-12-04-at-13-58-33Glue ear?  What is it, how do you get it, and more importantly how can you get rid of it?  Here’s a quick guide from the experts at madeformums

What is glue ear?

Glue ear is a common childhood condition that occurs when the area behind the eardrum, known as the middle ear, fills with a sticky, glue-like fluid rather than air. This substance prevents the ear from working correctly, and affects the ability to hear. Glue ear is also known as otitis media with effusion (OME), or serious otitis media.

What causes it?

Doctors don’t know exactly what triggers glue ear, but it’s thought to be related to the eustachian tube, through which fluid normally drains away from the middle ear. When this stops functioning properly, fluid builds up in the middle ear, causing glue ear. Over time, this build-up of fluid prevents the eardrum from working like it should. Remember, this substance is behind the eardrum, so you won’t be able to see it or clean it out, so leave those cotton buds well alone!

What are the main symptoms?

The main symptom of glue ear is moderate hearing loss in one or both ears. To your child, this will be a similar sensation to the one you experience when you put your fingers in your ears. Keep an eye out for signs that may suggest your little one is having problems hearing. This can include struggling to keep up with conversations when there is a lot of background noise, and difficulty understanding people who are far away, or speak quietly. Some children with glue ear also suffer from mild ear pain or balance problems, although this isn’t very common.

What age group does it tend to affect most?

Glue ear usually affects children under the age of 7, and is most likely to be seen in those between the ages of 2 and 5. In fact, around one in five children around the age of 2 are affected by the condition.

Why should I be worried if my child has it?

Glue ear can occasionally delay language and speech development, particularly if hearing loss persists. Always see your GP if you’re worried that your child may be having problems with her hearing.

Is glue ear contagious?

No, glue ear is not contagious, although the cold virus which may have caused it can be. If your child has glue ear, your needn’t be concerned about infecting other children.

How is it treated?

In most cases, glue ear will clear up on its own within three months, so doesn’t need to be treated, just monitored by your doctor. However, if symptoms do persist, your GP may recommend treatment, especially if he’s concerned that the hearing loss may interfere with your child’s language and speech development. In these circumstances, grommets or t-tubes may be suggested. These are inserted during a minor operation, and will drain the glue-like fluid from the middle ear.

Will it have any lasting health effects?

It’s very unlikely that your child will suffer any long-lasting effects, so try not to worry. However, in very few cases there can be a minor delay in speech and language development, due to the moderate hearing problems caused by glue ear. This is usually only temporary and is more likely to occur in children who suffer from recurrent glue ear – when the condition returns even after treatment.

Here at The London ENT we can help to solve the ongoing problem of Glue Ear in children.  There are many medical treatments which have been tried over the years, including antihistamine medication for allergy, steroid nasal sprays and drops, steroid medication by mouth and antibiotics. The vast majority of these have not been shown to be effective in the long term treatment of glue ear. One of the few non-surgical treatments which have been shown to be helpful in selected cases is a balloon inflation device such as the OtoventTM balloon. This is used by placing one end of the device into one of the nostrils and inflating the balloon. This sends a jet of air into the nose, which in turn opens up the Eustachian tube and allows better ventilation of the middle ear. Once air reaches the middle ear, this encourages displacement of the glue ear out of the middle ear. The procedure needs to be repeated often several times a day for many days or even weeks. It is suitable for both children and adults and many patients find this effective.

Another option is for your child to be fitted with a hearing aid. Although this does not cure the underlying glue ear, it does allow your child to hear normally without the need for any other treatments or surgery. This then allow sufficient time for the glue ear to disappear by itself.

Call us today on (0)7969 562855 to find out more.


When Is A Sore Throat More Than A Sore Throat?


Tonsillitis and a throat infection have many similar symptoms. That’s because strep throat can be considered a type of tonsillitis. But people with strep throat will have additional, unique symptoms.
Symptoms of tonsillitis Symptoms of a sore throat
large, tender lymph nodes in the neck large, tender lymph nodes in the neck
sore throat sore throat
redness and swelling in the tonsils small red spots on the roof of your mouth
difficulty or pain when swallowing difficulty or pain when swallowing
fever higher fever than in people with tonsillitis
stiff neck body aches
upset stomach nausea or vomiting, especially in children
white or yellow discoloration on or around your tonsils swollen, red tonsils with white streaks of pus
headache headache
 Tonsillitis can be caused by a variety of germs, including viruses and bacteria. It’s most commonly caused by viruses, however, such as:
  • influenza
  • coronavirus
  • adenovirus
  • Epstein-Barr virus
  • herpes simplex virus
  • HIV

Tonsillitis is only one symptom of these viruses. Your doctor will need to run tests and review all of your symptoms to determine which virus, if any, is the cause of your tonsillitis.

Strep throat is caused specifically by the group A Streptococcus bacteria. No other group of bacteria or virus causes it.

Risk factors for tonsillitis and sore throats include:

  • Young age. Tonsillitis caused by bacteria is most common in children ages 5 to 15.
  • Frequent exposure to other people. Young children in school or day care are frequently exposed to germs. Similarly, people who live or work in cities or take public transportation may have more exposure to tonsillitis germs.
  • Time of year. Sore throats are most common in the fall and early spring.

You can only have tonsillitis if you have tonsils.

In extreme cases, strep throat and tonsillitis can lead to the following complications:

  • scarlet fever
  • kidney inflammation
  • rheumatic fever

You may not need to see a doctor for tonsillitis or strep throat. In most cases, symptoms will resolve within a few days of home care, such as rest, drinking warm liquids, or sucking on throat lozenges.

You may need to see a doctor, however, if:

  • symptoms last longer than four days and show no signs of improvement or have gotten worse
  • you have severe symptoms, such as a fever over 102.6°F (39.2°C) or difficulty breathing or drinking
  • intense pain that won’t subside
  • you have had several cases of tonsillitis or strep throat in the past year


Your doctor will ask you about symptoms and do a physical exam. During the physical exam, they will examine your throat for swollen lymph nodes, and check your nose and ears for signs of infection.

If your doctor suspects tonsillitis or a sore throat, they will swab the back of your throat to take a sample. They can use a rapid strep test to determine if you are infected with strep bacteria. They can get results within a few minutes. If you test negative for strep, your doctor will use a throat culture to test for other potential bacteria. The results of this test usually take 24 hours.

Based on your test results and symptoms, your doctor should be able to give you a diagnosis.


Most treatments will relieve your symptoms instead of actually treating your condition. For example, you can use anti-inflammatory medications to relive pain from fever and inflammation, such as paracetamol or ibuprofen

To relieve symptoms of sore throat, you can try these home remedies:

  • rest
  • drink lots of water
  • drink warm liquids, such as broth, tea with honey and lemon, or warm soup
  • gargle with salty warm water
  • suck on hard candy or throat lozenges
  • increase humidity in your home or office by using a humidifier


If you have tonsillitis caused by a virus, your doctor will not be able to treat it directly. If your tonsillitis is caused by bacteria, your doctor may prescribe antibiotics to treat the infection. Make sure to take antibiotics exactly as directed by your doctor.

Taking antibiotics will also help you reduce your risk of infecting other people. A research study involving 2,835 cases of sore throat showed that antibiotics reduced the duration of symptoms by an average of 16 hours.

In more extreme cases, your tonsils may be so swollen that you can’t breathe. Your doctor will prescribe steroids to decrease inflammation. If that doesn’t work, they will recommend a surgery called tonsillectomy to remove your tonsils. This option is used only in rare cases. Recent research also questions its effectiveness, with one study noting that tonsillectomy is only modestly beneficial.

Strep throat

A sore throat is caused by bacteria, so your doctor will prescribe an oral antibiotic within 48 hours of the illness starting. This will reduce the length and severity of your symptoms, as well as the complications and risk of infecting others. You can also use home remedies to manage the symptoms of inflamed tonsils and sore throat.


Tonsillitis and a sore throat are both contagious, so avoid being around other people while you’re sick, if possible. With home remedies and lots of rest, your sore throat should clear up in a few days. See your doctor if your symptoms are extreme or persist for a long time.

10 Tips for people who sleep with a snorer

We often see patients who suffer from very loud bursts of snoring.  Well, actually it is generally their partners who suffer from it as sleeping with a snorer can mean you lose, on average, an hours sleep a night. has come up with a pretty good list of tips to help you get more shut eye, we thought we would share them with you:

Changing your pillows to elevate the head can help to reduce snoring

Roll them over
Lying on your back makes the base of your tongue collapse to the back wall of your throat, often causing the snoring sound. Gently roll your partner over on to their side, and wedge some pillows snugly against their back to make sure they don’t revert to their previous position.

Change your pillows 
People with allergies are most likely to be snorers, as their nasal passages regularly get congested. To eliminate allergens, and decrease the severity or likelihood of snoring, dust regularly and replace your pillows every six months. Margo also recommends elevating your head by sleeping on a thicker pillow. “This will help open up your airways,” she explains.

Get a bigger bed
Sharing a tiny bed can be difficult at the best of times. But having limited space when your partner is snoring is particularly frustrating, launching a double-pronged attack on your potential for a decent night’s sleep. Both of you may find you sleep better in a wider bed.

Earplugs are a cheap and effective way of handling snoring. While basic earplugs usually do the trick, you can buy specialist earplugs that combat the low-frequency snoring sound.

Advise them to avoid alcohol before bed
Your whole body relaxes during sleep, but drinking alcohol can relax your muscles even further, which is no good thing. When your throat muscles relax too much, your tongue falls backwards into the airway, causing you to snore. “Also stay away from sleeping pills and antihistamines, as they too relax your airways,” Margo advises.

Invest in blackout curtains
To increase your chances of having a full sleep cycle when sharing a bed with a snorer, make sure other distractions are limited. Blackout curtains block both natural and artificial light from outside. The thick lining also means they’re also good at muffling outside noise.

Invest in white noise
White noise, a neutral sound, can dim our perception of sounds like snoring, making it more bearable. You can download white noise files online, or buy a white-noise machine that works alongside different sounds.

Having a comfortable mattress is half the battle to getting good sleep

Get your partner to shower 
Snoring happens when nasal passages are congested. One way to free up your sinuses is to take a long, hot shower and breathe in the steam. Another method is to breathe in steam from a cup of boiling salt water.

Choose the right mattress
Having a comfortable mattress is half the battle to getting good sleep, even if your partner snores. Mattress springs compress over time, meaning your spine gets less support. As well as trying them for yourself, it’s worth getting advice from staff when buying a new mattress.

Be understanding 
It can be frustrating trying to fall asleep when someone’s snoring, or to be woken by the sound. But getting angry can often exacerbate the struggle to get to sleep. Try to keep calm and tune out, rather than focusing on how irritated you are.

• Sammy Margo is a chartered physiotherapist sleep expert, and author of The Good Sleep Guide and The Good Sleep Guide for Kids

Here at London ENT we can help to treat snoring when it becomes a real problem.  Sleep apnea is a recognised medical condition which can be dangerous for the sufferer.  Call us today on (0)7969 562855 to book a consultation.

Avoid Hay Fever Hotspots This Summer

Screen Shot 2016-09-06 at 23.23.19Planning a holiday getaway in the UK this summer?  With the kids on school holidays, and the weather this month being pretty good so far, it’s tempting to pack up the car and head for the sunshine.  But, if you are suffering from the dreaded summer hay fever, are parts of the country going to to see you sneezing more than others?

A city break could be out of the question as high levels of pollution can, quite literally, really get up your nose! In fact, the top 10 hay fever hotspots in Britain are as follows:

1. London

2. Birmingham

3. Manchester

4. Cambridge

5. Leicester

6. Leeds

7. Reading

8. Liverpool

9. Edinburgh

10. Brighton

Research by the Surrey Allergy Clinic in London has also shown that in urban areas, pollens attach to the diesel exhaust particles from cars, which are adept at carrying pollen deeper into the airways or attaching to nasal membranes. This means busy, car-heavy cities could make your condition feel so much worse.

Heading to the beach may offer you some welcome respite, but you should probably avoid very busy beaches or built up areas (like Brighton for example).

Of course, the open countryside could also have you running to the tissues as the plethora of grasses and plants set off allergies that could be confused with hay fever, but may in fact be something else entirely.  Experts at the National Pollen and Aerobiology Research Unit said that a cold spring like the one we had this year makes for delayed tree pollen which could be in the air at the same time as grass pollen.

So, how do you deal with hay fever during your summer holiday.  Well, by now you have probably found some ways and means to help calm the itching and sneezing, but when going away with the family keep these top tips in mind:

  1. Use you cars air condition system.  This will trap pollen in its filters, but make sure you keep those windows closed.

  2. Keep your sunglasses to hand to act as a physical guard against pollen around the sensitive eye area. Wear wraparound types if you can.

  3. Drink plenty of water.  The body produces more histamine when you’re ­dehydrated, meaning an increase in hay fever symptoms. Drinking water also thins mucous and drains the nasal passages.

  4. Leave the perfume at home. Strong smells can trigger a hay fever attack, so chose fragrance free suntan lotions and other holiday potions.
  5. Finally – head for the beach. Pollen counts are lower on the beach than inland, so consider a break to the seaside if the count to head off those nasty symptoms.

Whatever you are doing this summer, we hope you enjoy it.  Of course, you could speak to us about effective and long-lasting treatments we offer for hay fever and allergy sufferers of all kinds.  Call us today on 07969 562855 to find out more about us.


How To Clear A Blocked Nose In Seconds

Whatever the time of year, a blocked up nose can be a real pain in the backside.  A blocked up nose can be caused by a cold, allergies or even certain chronic conditions.

But instead of reaching for the Lemsip, Prevention Magazine suggests trying these simple techniques first:

Screen Shot 2016-08-09 at 13.56.32

Hold your breath for as long as you possibly can, then when you finally take a deep breath your sinuses will clear. Apparently this works because your brain kicks into survival mode realising you’re not getting enough oxygen, and so gets to work clearing your sinuses.

The second option is slightly more complicated, but still easily done even from an office chair.

First, press your tongue against the roof of your mouth. After you’ve done that, tap two fingers on your forehead between your eyebrows and your nose. Repeat the whole sequences (press, tap, release) again and again for about 20 seconds.

Screen Shot 2016-08-09 at 13.57.27 Screen Shot 2016-08-09 at 13.57.57

So next time you feel the first tickles of a stuffy nose, see if either of these little tricks work.

Of course, here at London ENT we can treat the symptoms of a variety of different causes of a blocked nose including:

  • Swelling of the lining of the nose
  • Deviated nasal septum
  • Collapse of the nasal valves
  • Nasopharyngeal obstruction (adenoid enlargement)
  • Nasal polyps

If we could help you breathe easily again, call us today on (0)7969 562855 to book a consultation.

Royal Society of Medicine Trainee Sinus Dissection Prize Day

Paul was one of three expert assessors at the Royal Society of Medicine Trainee Sinus Dissection Prize Day. This was the first such occasion at which senior surgical trainees in ENT Surgery were invited to participate in a day of advanced dissections, with the quality of the surgical dissections being assessed carefully by the three assessors and a Prize given for the dissection judged to be the best. This was a very successful day of training and assessment and will hopefully be repeated in future years.

Everything you ever wanted to know about vertigo (but were too dizzy to ask)

This is a great article.  Vertigo and dizziness are more commonplace than people realise, and perhaps you may even have experienced it yourself at some point.  There can be a variety of underlying causes, and here at London ENT we often treat people with these symptoms.

Feel stable again – come and see us here at London ENT.

With thanks to

Screen Shot 2016-05-30 at 10.40.19Everything you ever wanted to know about vertigo (but were too dizzy to ask)

Is it the result of stress? Or an ear infection? And will it actually go away if rest is avoided?

Photograph: Courtney Keating/Getty Images

Up to one in 10 people will experience vertigo, dizziness or unsteadiness in any given year. In the vast majority of cases, the symptoms are unpleasant but harmless, and get better without treatment. Vertigo is used by health profressionals to describe the feeling that you, or the world around you, is moving when it is not: Alfred Hitchock’s masterpiece Vertigo is actually about a man’s morbid fear of heights (acrophobia) and not true vertigo, although the terms are often used interchangeably.

Have I got dizziness or vertigo?

Specialist physiotherapist Nicola Harris says “dizziness covers a multitude of things. It can be a lightheaded feeling, like you are going to faint, which is more likely to be a cardiovascular or breathing pattern problem. Or you may feel unsteady on your feet. When you move your head, it can feel like what you are looking at has to ‘catch up’ with you afterwards.”

Dr Diego Kaski, neuro-otologist at London’s Charing Cross hospital, says vertigo creates the illusion of movement. Normally, the brain recognises that you are moving by integrating signals from your eyes, inner ear and receptors that sense body movement in the neck and limbs. But in true vertigo, you feel as though you are standing still while the world moves around you.

What causes it? 

Vertigo is often attributed to an inner ear infection called vestibular neuritis that starts after a cold and can last for up to a couple of weeks. But Kaski says vertigo is often mislabelled as this when in fact benign paroxysmal positional vertigo(BBPV), and vestibular migraine are the more common and likely culprits.

BPPV is a mechanical problem of the inner ear. We have crystals inside the inner-ear balance organs that move when we do, but if the signals lag behind those emitted from the eyes and limbs, it creates an illusion of movement. In vertigo, the inner-ear signals cause jerky, uncoordinated eye movements, known as nystagmus, which conflict with the brain’s other movement signals. The repeated attacks usually last less than 30 seconds, and are precipitated by head movements including rolling over in bed or looking up.

It could be a migraine

One in 10 people with migraines get bouts of vertigo which come and go, that don’t necessarily coincide with the more typical symptoms of a headache and can last from a few seconds to a few days. These people may be hypersensitive to light, noise and smells. The treatment is the same as managing migraine headaches: try to identify and avoid triggers, short-term painkillers and anti-sickness medication and long-term preventive treatments such as beta blockers.

How do I treat vertigo?

It depends on the cause. Medical advice for vestibular neuritis is to avoid bed rest and get back to normal life as quickly as possible. This kick-starts the brain into compensating for the vertigo so it doesn’t become a long-term problem. BPPV can be cured by head movement exercises (for example, the Epley manoeuvre or Brandt-Daroff exercises) that reset the inner-ear organ of balance. Kaski is exploring novel ways of delivering this treatment using virtual reality glasses and a mobile phone app. You will be guided through the exercises without having to wait months for an appointment with a trained physiotherapist. Drug treatment of BPPV doesn’t work very well, according to Kaski. Prochlorperazine is good for nausea, but Betahistine, often prescribed by GPs, doesn’t help much at the doses that are given.

Kaski is interested in non-invasive brain stimulation. An electrical coil is placed over the head overlying the part of the brain – the parietal lobe – that processes balance. Modifying the electrical activity in this may relieve vertigo.

Can it be caused by stress?

There is certainly a link to stress; animals, including us, rely on signals about movement of predators and prey to survive. Illusions of movement activate the autonomic nervous system, which includes an adrenaline-fuelled fight-or-flight reaction. The extra adrenaline can cause unpleasant symptoms such as palpitations and anxiety. Conversely, anxiety itself can cause unsteadiness; people say it feels as if the world is moving under their feet.

Why do some people get vertigo more than others?

Some people are prone to vertigo because they are more visually dependent than others. This group will think they are moving because the signal from their eyes isn’t being integrated with the information from their body. We all experience this to a certain extent; when you are sitting on a train and it pulls out slowly from the station, it can be hard to know what’s moving.

What else could it be?

Meniere’s disease is a rare condition that affects the inner ear. It causes sudden attacks of vertigo lasting two to three hours, with ringing in the ears (tinnitus) and progressive hearing loss. Harris says further investigations, scan and consultations are important if there are any red-flag symptoms suggesting more serious underlying disease. These rare but potentially dangerous conditions include head injuriesstrokesmultiple sclerosisacoustic neuromas (benign growths on the nerve in the inner ear) and brain tumours.

National Epistaxis Consensus Day in Leeds, UK

Paul was invited to attend a National Epistaxis Consensus Day in Leeds, UK. He was one of several invited experts gathered to consider the evidence for various aspects of the treatment pathway for patients with nose bleeds requiring admission to hospital, with the aim of formulating some common guidelines to try to reduce variability and raise standards in the treatment of this condition throughout the UK.

Almost Half Of British Women Are Sleep Deprived And Risking Long-Term Health Effects, Report Warns

Here at London ENT we regularly trScreen Shot 2016-05-30 at 10.33.55eat patients with sleep apnea.  Not only does the condition interfere with your nightly sleep patterns, leaving you feeling tired and listless, it can also be a sign of underlying health conditions.  Here is some information on why woman seem to suffer more than men.  With thanks to

If you struggle to get out of bed in the morning, you’re not alone.

Almost half of British women (43%) say they are not getting enough sleep. In fact, 45% do not feel well-rested when they wake up.

The results are part of the ‘Reclaim Your Sleep’ survey of 4,100 UK adults, conducted by YouGov and supported by the Sleep Apnoea Trust Association (SATA).

Health experts are now warning of the detrimental effect sleep deprivation can have on long-term health.

The survey uncovered that women are more likely to experience difficulty sleeping than men.

When asked about their sleeping patterns, 46% of women said they have trouble sleeping compared to 36% of men.

Women were also more prone than men to waking up during the night and having trouble getting back to sleep afterwards (36% compared to 23%).

More than half of women surveyed (60%) admitted to feeling irritable during the day because of their sleep problems and a further 33% said they felt less confidence in their appearance as a result of a bad night’s sleep.

Commenting on the findings, Professor John Stradling, a sleep expert from Oxford University said: “Often women think that feeling exhausted is just part of modern life when in fact it could be something more serious.

“Remaining untreated leaves women at risk of reduced quality of life and serious health conditions, so it is important that they speak to their GP about any sleep problems that they have – the sooner their sleep issues are addressed by a sleep expert, the better.”

Despite sleep problems clearly having a negative impact on a lot of women, only a minority of those surveyed said they have spoken to their GP about problems nodding off.

Bill Johnston, chairman from the Sleep Apnoea Trust Association warned that sleep problems such as restlessness could indicate more serious health problems such as sleep apnea.

Obstructive sleep apnoea (OSA) is a debilitating condition affecting around 1.5 million adults in the UK.

Pregnancy and the menopause can increase a woman’s risk of having sleep apnoea, yet according to the survey, the majority of women in the UK are unaware of this.

The symptoms of sleep apnea present themselves differently in women than men and include: softer snoring, lower report of sleepiness, insomnia, restless legs, fatigue/day-time sleepiness, depression, headaches and muscle pain.

If left untreated, the condition can lead to other more serious health problems such as stroke and heart disease.

Johnston said: “The overall lack of awareness around sleep apnoea symptoms and its impact on a person’s health may mean that many are suffering in silence so it is important that we work with healthcare professionals to uncover this missing group and help minimise the impact of sleep problems on their lives.

“Women also need to help their doctor understand how they sleep to avoid misdiagnosis. Discussing their sleep quality, and any difficulties sleeping (such as insomnia, frequent awakenings, snoring and sleepiness or tiredness during the day), will really help.”