Respiratory Sleep Ltd
Private consultant-led assessment for sleep apnoea, CPAP problems, excessive sleepiness, restless legs, circadian disorders, and complex sleep symptoms — available remotely across the UK.
Consultant in Sleep & Respiratory Medicine
Senior Honorary Clinical Lecturer
Quick answers
Do I need a GP referral?
No. You can contact us directly. A referral letter is welcome but not required.
How do I book?
Use the enquiry form or email info@respiratorysleep.org. We respond within 48 hours.
How much does it cost?
Fee information is available on enquiry. We are recognised by Bupa and AXA Health. Self-pay is also welcome.
Can you review my existing sleep test?
Yes. Upload your reports and we will provide a written consultant opinion. This is one of our most requested services.
Where do consultations take place?
All consultations are currently by secure video. Home sleep testing is available nationwide.
Will insurance cover this?
We are recognised by Bupa and AXA Health. Please check your policy and contact us before booking if you wish to use insurance.
"Dr Manuel is a kind, caring, professional and knowledgeable doctor in the areas of cardiorespiratory disease and sleep disorders. As a patient, and medically qualified myself, I have found his listening skills to be excellent, knowledge profound, and a compassionate ability to take on complex problems. I would recommend him to any patient."
— Dr KM, Patient
Where to start
Most patients arrive with one of three needs. Tell us which fits best and we will direct you to the right pathway.
New diagnosis, CPAP problems, or escalation to BiPAP or ASV? We provide comprehensive assessment and device optimisation — including obesity hypoventilation and complex ventilatory failure.
Start here →Tired despite CPAP? Unexplained daytime sleepiness? Restless legs? Circadian problems? We investigate what others have missed and provide a clear diagnosis and treatment plan.
Start here →Unclear diagnosis, conflicting advice, or a sleep test you do not fully understand? Share your records and receive an independent written consultant opinion within 5 working days — no appointment needed.
Find out more →Full service list
We see the full breadth of adult sleep and respiratory medicine. Complex, atypical, and previously investigated cases are especially welcome.
Full diagnostic assessment, CPAP initiation and review, and escalation to BiPAP or adaptive servo-ventilation (ASV) where indicated. We also assess obesity hypoventilation syndrome (OHS) and complex ventilatory failure.
Type 1 and Type 2 narcolepsy, MSLT/MWT interpretation, and management including pitolisant (Wakix, NICE TA677) for non-controlled wake-promotion. Also residual excessive daytime sleepiness (EDS) on established CPAP therapy.
Drawing on DPhil research at Oxford in obesity-related respiratory failure, we offer integrated assessment of OSA, OHS, metabolic drivers, and weight management pathways including referral for GLP-1 agents (e.g. tirzepatide / Mounjaro) where clinically appropriate. Serum bicarbonate interpretation in the era of GLP-1/SGLT2 inhibitors is a particular expertise.
For patients who have not responded to standard CPAP. Includes high-flow nasal therapy options and upper airway assessment. Where appropriate, we refer for mandibular advancement devices (dental appliances) or hypoglossal nerve stimulation assessment.
Assessment of RLS and PLMD, including dopaminergic augmentation management and iron replacement (IV or oral). We work to optimise ferritin targets and review second-line treatment options for refractory cases.
Delayed sleep-wake phase disorder, shift-work sleep disorder, non-24-hour rhythm disorder, and irregular sleep-wake rhythm. Treatment includes timed light, chronotherapy, and melatonin management. We address systemic health implications including metabolic and cardiovascular effects.
OSA prevalence increases substantially after menopause due to changes in airway-protective hormones. Women often present atypically. We provide integrated sleep and hormonal assessment.
Ambulatory sleep monitoring for patients with fibromyalgia, chronic pain, and fatigue syndromes. Objective biomarkers including hypoxic burden, heart rate variability, and cardiopulmonary coupling are used where standard AHI measures are insufficient.
Objective sleep and respiratory biomarker profiling following Covid-19 or other post-infection presentations. Dr Manuel has published research on Covid-19 respiratory outcomes and post-acute follow-up pathways.
Bidirectional relationships between sleep quality, testosterone, cortisol, thyroid function, and metabolic health. OSA and its treatment interact significantly with hormonal axes — this is assessed as part of comprehensive review.
SleepImage is a ring-worn ambulatory monitoring platform that generates cardiopulmonary coupling (CPC) spectrograms, autonomic indices, hypoxic burden measures, and sleep quality scores — without a sleep laboratory. It is particularly valuable where standard AHI-based assessment is insufficient: post-Covid fatigue, chronic pain, unexplained tiredness, and performance recovery. Results are analysed by Consultant and interpreted in full clinical context.
Elite sport has long understood sleep's centrality to performance. For the parkrunner, amateur cyclist, or weekend triathlete, the same biology applies without the support infrastructure. Mild sleep-disordered breathing, nasal obstruction, or restless legs can quietly erode recovery quality without being severe enough to register as an obvious "sleep problem." Objective sleep monitoring — including HRV, hypoxic burden, and cardiopulmonary coupling — can identify what's limiting your overnight recovery and what's measurable and correctable.
Independent consultant review of sleep studies, previous diagnoses, or treatment failures. A written report is provided within 5 working days. Suitable for patients, referring clinicians, and medicolegal contexts.
Getting started
The process is straightforward and fully remote.
Use the enquiry form or email us. No GP referral needed. Describe your concern briefly and we will respond within 48 hours.
A secure video consultation with Dr Manuel. He will review your history, previous tests, and current treatments in detail.
Home sleep testing dispatched to you if needed. We also review existing NHS or private investigations you already have.
A written consultant letter sets out the findings and a clear treatment or management plan. Shared with you and your GP.
Featured service
This is one of the most valuable things a specialist sleep consultant can offer — and one of the hardest things to access in the NHS. If you have had a sleep study but are not sure what the result means, received conflicting advice, or feel that your symptoms have not been adequately explained, this service is designed for you.
Fee information on enquiry. Recognised by Bupa and AXA Health.
Dr Ari Manuel
Consultant in Sleep & Respiratory Medicine
LinkedIn profile →
About
Consultant in Sleep & Respiratory Medicine · Senior Honorary Clinical Lecturer
Ari Manuel is a Consultant Physician in Sleep and Respiratory Medicine with over a decade of experience in NHS tertiary sleep and ventilation practice. His clinical interests include complex sleep-disordered breathing, obesity hypoventilation syndrome, narcolepsy and hypersomnolence, NIV and ventilatory weaning, and the interface between sleep, metabolism, and chronic disease.
He completed a DPhil at the University of Oxford investigating adipose tissue hypoxia and respiratory muscle physiology in obesity-related respiratory failure — work that underpins his current integrated approach to managing patients with OSA, OHS, and metabolic comorbidity. His research has been published in Sleep, CHEST, BMJ Open Respiratory Research, the European Respiratory Journal, and other peer-reviewed journals. His most recent work, published in Sleep (2025), addressed the limitations of serum bicarbonate as a screening tool in the era of GLP-1 receptor agonists and SGLT2 inhibitors.
He has contributed to BTS driving guidelines for OSA, holds advisory and regulatory experience through NICE guideline development, and has presented at the World Sleep Congress (Singapore). He is a Royal Society of Medicine Council Member for Sleep Medicine and a member of the European Respiratory Society and British Sleep Society.
Selected publications
Clinical insights
Written by Dr Manuel for patients and referring clinicians.
Physiology · Phenotyping · Precision sleep medicine
Loop gain, arousal threshold, upper airway muscle responsiveness, and Pcrit — the ALZHAR framework explains why CPAP works for some patients and fails others, and how phenotyping changes treatment.
Read more →Sleep apnoea · CPAP · Evidence
The evidence that CPAP improves cardiovascular outcomes in mild OSA is weak. In some patients, initiating CPAP causes more problems than it solves. What the trials actually show.
Read more →Sleep apnoea · Devices
Not everyone with sleep-disordered breathing is optimally managed on standard CPAP. Understanding when escalation is needed.
Read more →Obesity · Respiratory
OHS is underdiagnosed and often inadequately treated. What it means and how it is managed in the era of GLP-1 agents.
Read more →Narcolepsy · Hypersomnolence
Type 2 narcolepsy is frequently missed. Pitolisant (Wakix) offers a non-controlled alternative — here is how it works.
Read more →Restless legs · Iron
Augmentation is the main long-term problem with dopaminergic therapy. Iron replacement changes the picture.
Read more →Circadian · Metabolic
Disrupted body clocks affect far more than sleep quality — glucose, cardiovascular function, immunity, and mood are all involved.
Read more →Second opinion
Sleep study results require clinical context. A borderline AHI, unexplained symptoms, or persistent problems after treatment are all valid reasons.
Read more →Weight · OSA · GLP-1
New weight-loss medications are transforming how we think about OSA. What the evidence says and what changes in clinical practice.
Read more →Women · Menopause · OSA
Women present differently from the classic snoring male phenotype. Menopause dramatically increases risk — but diagnosis often comes late.
Read more →Diagnostics · Objective monitoring · Beyond AHI
Standard sleep studies report an AHI. SleepImage reports how your autonomic nervous system, heart, and lungs interact during sleep — a fundamentally different and often more clinically useful picture.
Read more →Sport · Recovery · Nasal breathing
If you're training consistently, eating well, and still stagnating — something may be happening overnight that's measurable and correctable.
Read more →Chronic pain · Central sensitisation
Slow-wave sleep is when descending pain inhibitory control is most active. Disruption drives central sensitisation — and is rarely addressed in pain management.
Read more →Testosterone · Depression · Sleep
Three conditions in a bidirectional relationship, consistently assessed in separate silos. Treating the sleep may resolve all three.
Read more →Recognised by
Fee information is available on enquiry. Please contact us before booking if you intend to use health insurance, so we can confirm your cover.
Face to face clinics in Hereford — May 2026 TBC
Contact & Enquiries
Use the form to enquire about a consultation, request a second opinion, or ask a question. We will respond within 48 hours.
Fee information is available on enquiry. We are recognised by Bupa and AXA Health. Self-pay patients are welcome. Please mention if you wish to use health insurance when you contact us.
We will respond within 48 hours. All information is handled confidentially.