Presentations
- Chronic sleep disturbances
- Difficulty falling asleep
- Difficulty waking
- Excessive daytime sleepiness
- Insomnia symptoms
- Mood changes, such as depression and irritability
- Reduced concentration
- Reduced performance in work and/or social spheres
- Waking up excessively early
Conditions
- Delayed and advanced sleep-wake phase disorders
- Irregular sleep-wake rhythm disorder
- Jet lag
- Non-24-hour sleep-wake rhythm disorder
- Shift work sleep-wake rhythm 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
Presentations
- Sleep-wake cycle disturbances related to:
- medications
- neurodevelopmental disorders
- psychiatric conditions
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
- Circadian effects on sleep duration and timing
- Clinical features, evaluation, and management associated with jet lag and shift work-related circadian rhythm disorders, and how they may produce apparent insomnia symptoms
- Clinical features, evaluation, and management of delayed and advanced sleep phase syndrome
- Contents of the International Classification of Sleep Disorders (ICSD-3)
- Effect of physical impairments, such as blindness, on circadian disorders
- Identify and discuss common comorbidities (e.g., normal aging, mental health disorders, and underlying neurological disorders) and their effect on circadian disorders, with an awareness of underlying neurobiological changes that occur
- Normal sleep and circadian physiology
- Occupational / driving / health risks of shift work associated with circadian rhythm disturbances
- Principles of pharmacological management of sleep disorders
- Psychosocial impact of circadian disorders, such as difficulties with employment and family life
- Relationship between circadian rhythm disturbances and psychiatric disease
Investigations
- Assess severity of daytime consequences of sleep disorders
- Interpret subjective and objective measures of circadian rhythm
- Perform a thorough history, examination, and sleep specific assessment
- Perform the relevant general physical, neurological, and respiratory examinations
- Recognise the indications for actigraphy in the clinical context:
- explain carrying out actigraphy to patients
- interpret actigraphy results, applying knowledge of normal sleep duration and timing
- use actigraphy information to inform treatment decisions
- Synthesise patients’ symptoms and signs into comprehensive differential diagnoses, and plan further investigations if needed
- Take a thorough sleep history from patients, their bed partner, and other relevant persons
Procedures
- Actigraphy:
- explain to patients
- indications
- interpretation
- reporting
- Polysomnography (PSG)
- Sleep diary:
- explain usage to patients
- indications
- interpretation
- reporting
- Apply and locate sensors for monitoring sleep disorders
- Consideration of lifestyle modifications
- Deliver comprehensive sleep education to patients
- 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
- generate reports for diagnostic and treatment sleep studies
- interpret results, and formulate management plans
- Explain and manage drug misuse and withdrawal
- Explain sensors, filters, gain, sampling times (frequencies), and linearity of the equipment used in the sleep laboratory to technical and other staff
- Explain strategies for rapid adjustment to new schedules or time zones
- Explain the management of altered sleep phase, such as bedtime scheduling, light therapy, and melatonin administration
- Explain the role of video PSG and home video for diagnosis to patients
- Prescribe and give advice about use of pharmacotherapy, in particular melatonin and melatonin agonists
- 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
