Presentations
- Daytime sleepiness
- Difficulty initiating and/or maintaining sleep at night
- Fatigue
- Mood changes
Conditions
- Insomnia:
- Insomnia due to irregular sleep schedules
- Paradoxical insomnia (sleep state misperception)
- Psychophysiological insomnia
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
Conditions
- Insomnia associated with drug and alcohol use
- Insomnia due to underlying physical conditions, such as neurological or respiratory conditions
- Insomnia with comorbid circadian rhythm disorder
- Insomnia with comorbid mental health disorder
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
- Definition of insomnia, including within the International Classification of Sleep Disorders (ICSD-3), and the daytime consequences
- Discuss the interaction between other sleep disorders, such as sleep apnoea and restless leg syndrome (RLS), and the development of insomnia
- Identify circadian factors, such as shift work and advanced and delayed sleep, which may produce apparent insomnia symptoms
- Identify different types of insomnia and their clinical features
- Indications and limitations of assessment tools for insomnia, including actigraphy, sleep diaries and polysomnography (PSG)
- Interaction, overlap, and interrelationship of medical disorders with sleep disorders
- Interaction, overlap, and interrelationship of psychiatric disorders with sleep disorders
- How pregnancy and menopause influence sleep
- Principles of pharmacological treatment options for insomnia
- Recognise comorbid insomnia and obstructive sleep apnoea (COMISA), and implications for assessment and management
- Relevant sections in the ICSD-3
- The theory underlying management strategies for insomnia
Investigations
- Familiarity with validated insomnia questionnaires, such as insomnia severity index
- Perform relevant neurological, respiratory, and general physical examinations
- Psychiatric assessment with a focus on mood disorders
- Take a thorough sleep history from patients, their bed partner, and other relevant persons, and ask about medications, including OTC medications and recreational drug use
Procedures
- Actigraphy:
- explain the role to patients
- identify indications
- interpret results
- Sleep diary:
- explain usage to patients
- interpret results
- Assess the role of online delivered cognitive behavioural therapy (CBT), especially as access to psychologists is limited
- Deliver comprehensive sleep education to patients, including the importance of sleep hygiene
- Explain and manage drug misuse and withdrawal
- Explain the implementation of treatment strategies for insomnia, including sleep education and behavioural measures, such as bedtime restriction, CBT, relaxation therapies, and stimulus control
- Pharmacological treatment of short-term insomnia
- Prescribe and monitor pharmacological treatment for insomnia
- Recognise when referral to another specialist is indicated, particularly specialist sleep psychologists and psychiatrists
- Synthesise history and examination information to produce provisional and differential diagnoses, and formulate and undertake management plans
- Understand the components of cognitive (e.g., cognitive restructuring) behavioural (e.g., sleep restriction) therapy for insomnia (CBT-I), and the evidence supporting this treatment as first line therapy for chronic insomnia
- Understand the mechanisms of action of major drug classes, including the evidence for effect and potential side effects
