Presentations
- Circadian variation in symptoms (e.g., worse in evenings)
- Effect of movement on symptoms
- Grinding teeth
- Headaches
- Hypnic jerks
- Jaw pain / Lock jaw
- Leg cramps
- Periodic limb movements (PLMs) in sleep
- Uncomfortable sensations in legs
- Urge to move legs when at rest
Conditions
- Periodic limb movement disorder (PLMD)
- Restless leg syndrome (RLS)
- Sleep bruxism
- Sleep-related leg cramps
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
Manage
- involve multidisciplinary teams
- prescribe therapies tailored to 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
Presentations
- Humming
- Repetitive rhythmic movements, such as body rocking and head rolling
Conditions
- Emerging sleep disorders, such as RLS
- Propriospinal myoclonus at sleep onset (PSM)
- Rhythmic movement disorder
- Sleep-related hypermotor epilepsy (SHE)
- Sleep-related movement disorder due to a medical disorder, medicine, or substance
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
Manage
- involve multidisciplinary teams
- prescribe therapies tailored to 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
- Abnormalities in sleep architecture, respiration or body movements, including PLMs
- Actions of centrally acting pharmacological agents and their interactions with sleep and PLMs
- Bruxism, hypnic jerks, rhythmic movement, and sleep talking
- Clinical context in which limited channel sleep studies might be useful, including tests performed in the home, and the range of limited channel sleep studies available
- Clinical features and differential diagnosis of RLS and PLMD
- Clinical features and differential diagnosis of sleep-related movement disorders
- Essential features of a sleep study report used in clinical decision making, and on tests of sleep propensity used in clinical decision making
- Measurement of PLMs
- Psychiatric disorders with sleep movements, behaviours, and experiences as symptoms
- Range of tests available to diagnose and manage sleep movement disorders, including polysomnography (PSG)
- Secondary causes and other precipitating factors that may cause RLS
Investigations
- Apply an investigation plan for suspected RLS / PLMD, especially looking for secondary causes
- Assess severity of daytime consequences of sleep disorders
- Interpret and report on typical PSG findings in PLMD, including seizure disorders
- Interpret raw data from sleep studies, including:
- airflow parameters
- airway pressures
- body position
- chin electromyography
- effort parameters
- ECG
- electroencephalogram (EEG)
- electromyography (EMG)
- electro-oculogram (EOG)
- leg sensors to measure movements
- measures of CO2
- oxygen saturation
- Perform a thorough history, examination, and sleep-specific assessment
- Perform the relevant general physical, neurological, and respiratory examinations
- Synthesise patients’ symptoms and signs into comprehensive 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
- The role of iron in the pathogenesis and treatment of movement disorders, and the interpretation and limitations of iron studies in children
- Apply and locate sensors for monitoring sleep disorders
- 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
- Explain role of video PSG and home video for diagnosis to patients
- Generate reports for diagnostic and treatment sleep studies
- Interpret results, and formulate management plans
- Manage and explain how drug misuse and withdrawal may impact on RLS / PLMD
- Monitor for efficacy and side effects from RLS / PLMD pharmacotherapy
- Prescribe and supervise drug management of RLS / PLMD
- Recognise the limitations and clinical applicability of various types of limited channel sleep studies, including:
- cardiorespiratory sleep studies
- limited channel PSG studies
- overnight oximetry
- Recognise when referral to another specialist is indicated
- Role of non-pharmacological therapy for RLS / PLMD
- Weigh and synthesise history and examination information to produce provisional and differential diagnoses, and formulate and undertake management plans
