Presentations
- Hypnic jerks
- Jaw pain
- Leg cramps
- Periodic limb movements 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
- 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
- Humming / Groaning
- Repetitive rhythmic movements, such as body rocking and head rolling
Conditions
- 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
- 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
- Abnormalities in sleep architecture, respiration, or body movements, including period limb movements (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 sleep study reports used in clinical decision making, and on tests of sleep propensity used in clinical decision making
- How PLMs are measured
- 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)
- measures of carbon dioxide (CO2)
- oxygen saturation
- Perform the relevant neurological, respiratory, upper airway, 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
Procedures
- EEG
- Multiple sleep latency test (MSLT)
- PSG
- 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 dopaminergic augmentation, and outline strategies for prevention, monitoring, and management
- Explain sensors, filters, gain, sampling times (frequencies), and linearity of the equipment used in the sleep laboratory to technical and other staff
- Explain the role of video PSG and home video for diagnosis to patients
- Generate reports for diagnostic and treatment sleep studies
- Interpret results and formulate a management plan
- Monitor for efficacy and side effects from RLS / PLMD pharmacotherapy
- Prescribe and supervise drug management of RLS / PLMD, including in complex patients who may require second line or combination therapy
- 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
- Understand the role of non-pharmacological therapy for RLS / PLMD
- Understand treatment options for RLS / PLMD
- Weigh and synthesise history and examination information to produce provisional and differential diagnoses, and formulate and undertake management plans
