Presentations
- Bedwetting
- Confusion when waking
- Daytime sleepiness
- Difficulty sleeping
- Eating / Drinking with limited awareness or responsiveness
- Episodes of incomplete awakening and limited responsiveness
- Exploding sensation in head upon waking
- Inability to move upon falling asleep or waking
- Movement during sleep, such as punching or kicking
- Screaming / Crying when waking
- Sexual behaviours during sleep
- Sleepwalking
- Vivid dreams that cause feelings of intense fear / anxiety
- Vocalisations during sleep
Conditions
- Catathrenia (sleep-related groaning)
- NREM disorders:
- confusional arousal
- night terrors
- sleep-related eating disorder
- sleepwalking
- REM disorders:
- nightmare disorder
- REM sleep behaviour disorder (RBD)
- sleep paralysis
- Sexsomnia (sleep-related sexual behaviours)
- Sleep enuresis (bedwetting)
- Somniloquy
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
- Exploding head syndrome
- Sleep-related hallucinations
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
- Actions of pharmacological agents and their interactions with sleep that may exacerbate parasomnias
- 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 for NREM arousal disorders and their variants, such as confusional arousals, sleep terrors, and sleepwalking
- Clinical features of REM sleep behaviour disorder and its variants
- Compare the differences between nightmares and sleep terrors
- Contents of the International Classification of Sleep Disorders (ICSD-3)
- Differential diagnoses of parasomnias, including nocturnal frontal lobe epilepsy and psychiatric disorders
- Essential features of sleep study reports used in clinical decision making and on tests of sleep propensity used in clinical decision making
- Impact of medications on propensity for parasomnias, such as selective serotonin reuptake inhibitors (SSRIs) and REM behaviour disorder
- Impact of sleep test findings on fitness to drive
- Mental health conditions that can cause or mimic parasomnias, such as PTSD
- Neurological conditions which can cause and are associated with parasomnias, such as Parkinson disease
- Principles of pharmacological and non-pharmacological management of parasomnias
- Recognise coexisting sleep pathology which can exacerbate parasomnias, such as obstructive sleep apnoea
- Review the predisposing factors that may trigger episodes of parasomnias
- Spectrum of parasomnias and the basic features of:
- confusional arousals
- REM sleep behaviour disorder
- sleep terrors
- sleepwalking
Investigations
- Assess severity of daytime consequences of sleep disorders
- Interpret and report on typical polysomnography (PSG) findings in NREM arousal disorders, REM sleep behaviour disorder, and seizure disorders
- Interpret raw data from sleep studies, including:
- airflow parameters
- airway pressures
- body position
- effort parameters
- ECG
- electroencephalography (EEG)
- electromyography (EMG)
- electro-oculogram (EOG)
- measures of CO2
- oxygen saturation
- video
- Interpret the clinical implications of cerebral CT and MRI scans
- Interpret video and EEGs during a paroxysmal event at night, and report differential diagnosis
- Perform a thorough history, examination, and sleep specific assessment
- Perform the relevant neurological, respiratory, and general physical examinations
- Recognise features which may suggest parasomnia or seizure
- Synthesise patient symptoms and signs into a comprehensive differential diagnosis, and plan further investigation if needed
- Take a thorough sleep history from patients, their bed partner, and other relevant persons
Procedures
- EEG, including full EEG
- Neurologic exams, such as CT scan or MRI
- PSG, including video
- Apply and locate sensors for monitoring sleep disorders
- Deliver comprehensive sleep education to patients, and understand the clinical and ethical implications of diagnosis of RBD and neurodegenerative 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 and manage drug misuse, side effects, and withdrawal
- Explain non-pharmacological and pharmacological measures for management of NREM parasomnias and REM sleep behaviour disorder
- 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
- Prescribe and monitor drug management
- 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 when referral to another specialist is indicated, such as a psychologist and neurologists, especially in the context of REM sleep behaviour disorder and its associations with neurodegenerative diseases
- Weigh and synthesise history and examination information to produce provisional and differential diagnoses, and formulate and undertake management plans
