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
