Presentations
- Abnormal or no regular sleep pattern
- Chronic sleep disturbances
- Difficulty falling asleep
- Difficulty waking
- Excessive daytime sleepiness
- Insomnia symptoms
- Mood changes, such as depression and irritability
- Reduced concentration
- Reduced performance at school and/or social spheres
- Waking up excessively early
Conditions
- Adolescent sleep phase disorder
- Delayed and advanced sleep-wake phase disorders
- Irregular sleep-wake rhythm disorder
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- conduct an appropriate examination
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
- establish a differential diagnosis
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- plan and arrange appropriate investigations
- recognise the clinical presentation
- take a comprehensive clinical history, including psychosocial assessment in relevant groups (such as adolescents)
Manage
- involve multidisciplinary teams
- prescribe therapies tailored patients’ needs and conditions
- provide evidence-based management
- recognise potential complications of disease and its management, and initiate preventative strategies
Consider other factors
- consider age-appropriate treatment options based on maturity and mental understanding
- identify individual and social factors and the impact of these on diagnosis and management
Conditions
- Circadian rhythm disorders that are part of an underlying developmental or neurogenetic condition, such as Angelman syndrome and Smith–Magenis syndrome
- Jet lag
- Non-24-hour sleep-wake rhythm disorder
- Shift work disorder
- Sleep disorders in the severely visually impaired
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- conduct an appropriate examination
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
- establish a differential diagnosis
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- plan and arrange appropriate investigations
- recognise the clinical presentation
- take a comprehensive clinical history, including psychosocial assessment in relevant groups (such as adolescents)
Manage
- involve multidisciplinary teams
- prescribe therapies tailored patients’ needs and conditions
- provide evidence-based management
- recognise potential complications of disease and its management, and initiate preventative strategies
Consider other factors
- consider age-appropriate treatment options based on maturity and mental understanding
- identify individual and social factors and the impact of these on diagnosis and management
- Actions of pharmacological agents and their interactions with sleep
- Circadian effects on sleep duration and timing
- Clinical features, evaluation, and management associated with jet lag and shift work-related circadian rhythm disorders, and how they may produce apparent insomnia symptoms
- Clinical features, evaluation, and management of delayed and advanced sleep phase syndrome
- Contents of the International Classification of Sleep Disorders (ICSD -3)
- Effect of physical impairments, such as blindness, on circadian disorders
- Normal sleep and circadian physiology, including variation by age
- Principles of pharmacological management of sleep disorders
- Underlying neurological disorders and their effect on circadian disorders
Investigations
- Assess severity of daytime consequences of sleep disorders
- Interpret subjective and objective measures of circadian rhythm
- Perform a thorough history, examination, and sleep-specific assessment
- Perform the relevant general physical, neurological, and respiratory examinations
- Recognise the indications for actigraphy in the clinical context:
- explain carrying out actigraphy patients and carers
- interpret actigraphy results, applying knowledge of normal sleep duration and timing
- use actigraphy information tinform treatment decisions
- Synthesise patients’ symptoms and signs intcomprehensive differential diagnoses, and plan further investigations if needed
- Take a thorough sleep history from the patient, as well as bed environment and sleep hygiene behaviour, including bedtime routine, diet, and screen time
Procedures
- Actigraphy (when available)
- Physiologic circadian phase markers, such as core body temperature monitoring and saliva or urine melatonin level monitoring
- Polysomnography (PSG)
- Sleep diary
- Apply and locate sensors for monitoring sleep disorders
- Consideration of lifestyle modifications
- Deliver comprehensive sleep education patients
- Explain and manage drug misuse and withdrawal
- Explain role (if any) of video PSG and home video for diagnosis patients
- Explain sensors, filters, gain, sampling times (frequencies), and linearity of the equipment used in the sleep laboratory technical and other staff
- Explain strategies for rapid adjustment new schedules or time zones
- Explain the concept of ‘social jet lag’ patients and families, and the importance of a regular sleep schedule
- Explain the management of altered sleep phase, such as:
- bedtime scheduling
- light therapy
- lifestyle changes, including:
- engaging in external activities
- leaving the bedroom / house
- morning sunlight
- regular meals
- melatonin administration
- Prescribe and give advice about use of pharmacotherapy, in particular melatonin and melatonin agonists
- Recognise the indications for completion of a sleep diary:
- explain the completion of a sleep diary patients and carers
- interpret sleep diaries, applying knowledge of normal sleep duration and timing according age
- use sleep diary information inform treatment decisions
- Recognise when referral another specialist is indicated
- Understand the impact of delayed sleep phase in adolescence on daytime functioning, including school attendance, and the complex interaction / overlap in presentation with mental health disorders and/or school refusal
