The Sleep Medicine Experience

Catalog description

This course is designed to provide senior medical students a comprehensive experience in Sleep Medicine in an outpatient setting at the outpatient Sleep Medicine Specialty Clinic. Students will function as sub-interns and will be paired with a Sleep Medicine Fellow. Students will be assigned sleep medicine patients to see independently and present to the attending physician based on the student’s knowledge and skills.This is a Monday-Friday 8am-5pm experience. No night call and no weekend call is required. The exception to this is that all rotating students must come in to the Sleep Lab during testing hours (8pm) to observe at least one polysomnographic setup, along with the initial portion of a sleep study (typically we like students to see at least one REM cycle!). This is a vital portion of the rotation, as it will help “de-mystify” the experience of sleep diagnostic testing. This experience lasts 2-3 hours typically. Goals: The purpose of this selective is for fourth-year medical students to build comprehensive knowledge and skills in the application of the principles of Sleep Medicine in an out-patient setting.To acquire an extended knowledge of the principles of Sleep Medicine and the practice thereof within an academic outpatient Sleep Medicine specialty clinic. Objectives: Upon completion of this elective course, the student will be able to identify and apply specific knowledge and skills of Sleep Medicine in caring for and managing patients in the outpatient Sleep Medicine Specialty Clinic. Demonstrate the ability to obtain and document a comprehensive sleep medicine history. Demonstrate an understanding of the basic neuroanatomy of Sleep and Wake, with a knowledge of the neurotransmitters and structures involved. Demonstrate an ability to discuss the “two-process model” of sleep-wake regulation and describe how this may be used to understand perturbations of sleep and wake. Discuss the mechanisms by which sleep apnea can contribute to cardiovascular risk. Demonstrate the ability to perform and document a physical exam with an emphasis on the upper airway, to establish presence of features predisposing to sleep apnea. Discuss the pharmacologic principles and patient-relevant issues (such as adverse effects of) various types of medications used to treat daytime sleepiness. Discuss the pharmacologic principles and patient-relevant issues (such as adverse effects of) various types of medications used as hypnotics. Discuss the various types of sleep diagnostic studies, including full night polysomnogram, split night polysomnogram, titration polysomnogram, The student will be able to: (PC) Demonstrate the ability to obtain and document a comprehensive sleep medicine history. (MK) Demonstrate an understanding of the basic neuroanatomy of Sleep and Wake, with a knowledge of the neurotransmitters and structures involved. (MK) Demonstrate an ability to discuss the “two-process model” of sleep-wake regulation, and describe how this may be used to understand perturbations of sleep and wake. (MK, PC) Discuss the mechanisms by which sleep apnea can contribute to cardiovascular risk. (PC) Demonstrate the ability to perform and document a physical exam with an emphasis on the upper airway, to establish presence of features predisposing to sleep apnea. (PC, MK) Be able to discuss the pharmacologic principles and patient-relevant issues (such as adverse effects of) various types of medications used to treat daytime sleepiness. (PC, MK) Be able to discuss the pharmacologic principles and patient-relevant issues (such as adverse effects of) various types of medications used as hypnotics. (PC, MK) Discuss the various types of sleep diagnostic studies, including full-night polysomnogram, split night polysomnogram, titration polysomongram, out of center sleep testing, actigraphy, and sleep logs, and be able to discuss when these should be used. (PC, MK) Discuss diagnostic criteria for common sleep medicine problems, such as obstructive sleep apnea, restless legs syndrome, narcolepsy, idiopathic hypersomnia, and REM behavior disorder. (PC, MK) Demonstrate the ability to perform a positive airway pressure (PAP) follow up visit, and discuss a methodical approach to troubleshooting PAP intolerance. (I&CS) Communicate pertinent patient information relevant to Sleep Medicine problems to supervising providers in an efficient and logical way. (SBP) Discuss health care delivery issues as related to underserved and unfunded patients with Sleep Medicine problems. (PBL&I) Use online resources in investigation of clinical questions, to improve patient care, and support personal education. (P) Attend all clinics and conferences attended by the clinic team and keep the team informed of their whereabouts at all times. (I&CS, P, MK, PBL&I) Demonstrate the ability to present a Sleep Medicine-pertinent subject in an academic setting (Sleep Medicine Grand Rounds). (MK, PC). Describe and recognize common signals used in formal polysomnographic testing, and recognize the common scored events in such studies, such as obstructive and central apneas, hypopneas, respiratory effort related arousals, and periodic limb movements of sleep. (MK, PC) Describe the features of different sleep stages, and recognize these patterns on a standard polysomnogram.