Curriculum standards
Knowledge guides
LG 14: Central disorders of hypersomnolence
Key presentations and conditions
Advanced Trainees will have a comprehensive depth of knowledge of these presentations and conditions.
Less common or more complex presentations and conditions
Advanced Trainees will understand these presentations and conditions.
Advanced Trainees will understand the resources that should be used to help manage patients with these presentations and conditions.
Epidemiology, pathophysiology, and clinical sciences
Advanced Trainees will have a comprehensive depth of knowledge of the principles of the foundational sciences.
Investigations, procedures, and clinical assessment tools
Advanced Trainees will know the scientific foundation of each investigation and procedure, including relevant anatomy and physiology. They will be able to interpret the reported results of each investigation or procedure.
Advanced Trainees will know how to explain the investigation or procedure to patients, families, and carers, and be able to explain procedural risk and obtain informed consent where applicable.
Important specific issues
Advanced Trainees will identify important specialty-specific issues and the impact of these on diagnosis and management and integrate these into care.
Presentations
- Cataplexy
- Decreased energy
- Difficulty concentrating
- Difficulty waking up from sleep
- Excessive daytime sleepiness (EDS)
- Memory and speech difficulties
- Mood changes, such as anxiety and irritation
- Sleeping more than average
Conditions
- Hypersomnia associated with a psychiatric condition
- Hypersomnia due to a medical condition or substance
- Idiopathic hypersomnia
- Insufficient sleep syndrome
- Narcolepsy type 1
- Narcolepsy type 2
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients' needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
Presentations
- Disinhibited behaviours
- Hallucinations
- Isolated sleep paralysis
Conditions
- Kleine–Levin Syndrome, and other variants of recurrent hypersomnias
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients' needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
Assessment of hypersomnolence disorders
- Common causes of hypersomnia, including:
- behavioural and environmental factors
- medical
- medication use
- primary sleep disorders
- psychiatric conditions
- Common causes of persistent EDS in patients with treated obstructive sleep apnoea (OSA)
- Genetics, presentation, and treatment of narcolepsy
- Important behavioural factors that influence subjective and objective sleepiness and neurocognitive function, such as chronic sleep restriction
Diagnostic categories
- Contents of the International Classification of Sleep Disorders (ICSD-3)
- Other medical conditions that are associated with EDS, recognising the actions of centrally acting pharmacological agents and their interactions with sleep
- Primary hypersomnias of central origin that are associated with EDS, including:
- idiopathic hypersomnolence
- narcolepsy
Impact of hypersomnolence disorders
- Daytime neurocognitive consequences of abnormalities of sleep-wake regulation
- Impact of drowsiness / sleepiness on road and work safety
- Impact of sleep disorders on quality of life and behaviour
- Occupational and lifestyle implications of EDS and other sleep disorders
Pathophysiology
- How disease states and medication use can affect sleep-wake regulation and EDS
- Models of sleep deprivation and sleep disruption, and the effects on daytime function
- Normal neurobiology and neuropharmacology of sleep-wake regulation
Investigations
- Assess severity of daytime consequences of sleep disorders
- Discuss the range of limited channel sleep studies available
- Identify EDS or inability to maintain wakefulness based on tests of sleep propensity
- Interpret raw data from sleep studies, including:
- airflow parameters
- airway pressures
- body position
- ECG
- effort parameters
- electroencephalography (EEG)
- electromyography (EMG)
- electro-oculogram (EOG)
- measures of CO2
- oxygen saturation
- video of motor activity, including cataplexy
- Interpret results of investigations regarding EDS and daytime consequences of sleep disorders in the clinical context of the patient
- Perform a thorough history, examination, and sleep specific assessment
- Perform the relevant neurological, respiratory, neurological and general physical examinations
- Synthesise patient symptoms and signs into a comprehensive differential diagnosis, and plan further investigation if needed
- Take a thorough sleep history from the patient, bed partner, and other relevant persons
- Understand essential features of a sleep study report used in clinical decision making
Procedures
- Clinical context in which vigilance studies are indicated:
- criteria for defining the severity of daytime sleepiness or inability to maintain wakefulness
- essential features of reports on tests of sleep propensity used in clinical decision making
- limitations of current available tests for assessment of EDS and daytime consequences of sleep disorders, and identify current research developments
- maintenance of wakefulness test (MWT)
- multiple sleep latency test (MSLT)
- normative data for sleep architecture and tests of sleep propensity
- Indications for CSF orexin testing – key indications, limitations, and precautions
- Polysomnography (PSG)
- Sleep diary and/or actigraphy
- Urine drug screen
- Assess and advise patients with EDS regarding fitness to drive
- Determine optimal treatment settings from treatment sleep study parameters
- Determine the requirement for further evaluation in the event of an indeterminate limited channel sleep study
- Determine when a MSLT and MWT might be appropriate
- Explain and manage drug misuse and withdrawal
- Explain behavioural strategies to reduce the symptoms of EDS and the daytime consequences of sleep disorders, such as schedule modification and sleep education
- Explain occupational and lifestyle implications of EDS and daytime consequences of sleep disorders
- Generate reports for diagnostic and treatment sleep studies
- Identify pathological hypersomnolence or inability to maintain wakefulness based on tests of hypersomnolence
- Interpret results and formulate a management plan
- Monitor the pharmacotherapies for central nervous system disorders of hypersomnolence, including recognition and management of adverse effects, especially the impact on mental health, such as anxiety
- Prescribe pharmacotherapy for REM intrusion symptoms, such as cataplexy
- Prescribe pharmacotherapy to reduce symptoms of EDS and daytime consequences of sleep disorders in accordance with state and national legislation (e.g., use of schedule 8 medications in Australia)
- Recognise the indications for completion of a sleep diary:
- explain the completion of a sleep diary to patients
- interpret sleep diaries, applying knowledge of normal sleep duration and timing according to age
- use sleep diary information to inform treatment decisions
- Recognise the limitations and clinical applicability of various types of limited channel sleep studies, including:
- cardiorespiratory sleep studies
- limited channel PSG studies
- overnight oximetry
- Understand and advise patients on use of medications during pregnancy and while breastfeeding