Presentations
- ‘Curtain calls’ / Bedtime resistance
- Behavioural problems
- Daytime sleepiness
- Difficulty concentrating
- Difficulty falling asleep, staying asleep, or waking too early at night
- Fatigue
- Learning difficulties
- Mood changes
- Separation anxiety
- Sleep association
Conditions
- Insomnia:
- insomnia associated with drug and alcohol use
- insomnia due to irregular sleep schedules
- insomnia due to underlying psychiatric disorders, such as depression or anxiety
- nocturnal feeding / drinking disorder
- sleep-onset association 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
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 and developmentally-appropriate treatment options based on maturity and mental understanding
- identify individual and social factors and the impact of these on diagnosis and management
Conditions
- Chronic insomnia
- Insomnia due to underlying physical conditions, such as neurological or respiratory conditions (e.g., autism spectrum disorder)
- Psychophysiological insomnia
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 and developmentally-appropriate treatment options based on maturity and mental understanding
- identify individual and social factors and the impact of these on diagnosis and management
- Developmental types of insomnia, including behavioural insomnia of childhood limit-setting type, and behavioural insomnia of childhood sleep-onset association type
- Different types of insomnia and their clinical features
- How circadian factors, such as shift work and advanced and delayed sleep, may produce apparent insomnia symptoms
- How other medical and psychiatric illness may produce symptoms of insomnia
- How other sleep disorders, such as sleep apnoea and restless leg syndrome, may produce symptoms of insomnia
- Increased prevalence of insomnia in children / adolescents with neuro-disabilities
- Indications and limitations of assessment tools for insomnia, including actigraphy, sleep diaries, and polysomnography (PSG)
- Interaction, overlap, and interrelationship of psychiatric disorders with sleep disorders
- Non-pharmacological treatment options for insomnia
- Pharmacological treatment options for insomnia
- Relevant sections in the International Classification of Sleep Disorders (ICSD-3)
- The theory underlying management strategies for insomnia
Investigations
- Ask about medications, including OTC medications and recreational drug use
- Perform the relevant general physical, neurological, and respiratory examinations
- Psychiatric assessments, with a focus on mood disorders
- 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 / appropriate)
- Sleep diaries
- Use of validated screening questionnaires
- Ability to tailor treatment strategies according to patient age and developmental stage, and in the context of the family environment and dynamics
- Asses the role of online delivered cognitive behavioural therapy for insomnia (CBT-I), especially when access to psychologists is limited
- Deliver comprehensive sleep education to patients, including the important of sleep hygiene
- Evaluate behavioural therapies, clinical circumstances, and pharmacological treatments to formulate individual treatment strategies
- Explain and manage drug misuse and withdrawal
- Explain the implementation of treatment strategies for insomnia, including behavioural measures and sleep education, such as bedtime restriction, cognitive behavioural therapy, relaxation therapies, and stimulus control
- Prescribe and monitor pharmacological treatments for insomnia
- Recognise when referral to another specialist is indicated, particularly specialist sleep psychologists and psychiatrists
- Techniques used for management of behavioural / developmental aspects of night-wakings
- Weigh and synthesise history and examination information to produce provisional and differential diagnoses, and formulate and undertake management plans
