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Objectives of Sleep Fellowship

Medical Expert

  1. The fellow will be able to obtain a history relevant to sleep disorders. This includes:
    1. symptoms that indicate sleep pathology
    2. clinical factors that predict the presence or absence of particular sleep disorders
    3. history of sleep habits and rituals; sleep hygiene
    4. family history, where relevant
    5. impact of sleep disorder on the patient’s quality of life and health
  2. The fellow will demonstrate knowledge of the epidemiology, prevention, pathogenesis, clinical manifestations, laboratory testing, treatment, prognosis and complications of:
    1. Obstructive Sleep Apnea
    2. Central Sleep Apnea
    3. Cheyne-Stokes Respiration
    4. Sleep Hypoventilation
    5. Insomnia
    6. Narcolepsy
    7. Restless Legs Syndrome and Periodic Limb Movement Disorder
    8. Parasomnias
  3. The fellow will demonstrate an approach to the diagnosis and management of the following common sleep related complaints:
    1. Hypersomnolence
    2. Insomnia
    3. Abnormal nocturnal behaviour
    4. Snoring
  4. The fellow will be able to manage:
    1. Obstructive Sleep Apnea
    2. Central Sleep apnea
    3. Sleep Hypoventilation/Chronic Respiratory failure
    4. Insomnia
    5. Restless Legs Syndrome and/or Periodic Limb Movement Disorder - This includes the ability to prescribe and titrate CPAP, BiPAP, Average Volume Assured Pressure Support (AVAPS) and Adaptive Servo -Ventilation (ASV).
  5. The fellow will be able to score and interpret Polysomnography/MSLT/MWT including:
    1. Recognition of normal and abnormal sleep architecture
    2. Recognition of sleep stages, arousals and awakenings from sleep
    3. Scoring of respiratory events including apneas, hypopneas, increased upper airway resistance, hypoventilation and Cheyne Stokes Respiration
    4. Evidence for Parasomnias such as REM Behaviour Disorder, sleep walking , and bruxism
    5. Evidence for Narcolepsy / abnormal MSLT
  6. The fellow will understand the limitations of diagnostic tests in Sleep Medicine including:
    1. PSG +/- tcCO2
    2. MSLT, MWT and OSLER
    3. Ambulatory, level 3 testing for sleep disordered breathing
    4. Clinical prediction rules
    5. Empiric trials of therapy
    6. Actigraphy

Communicator

The practice of sleep medicine requires humane, informed and open discussions with patients about their symptoms, disease and course of treatment. Effective and empathetic listening skills including the use of verbal and non-verbal communication skills will be demonstrated.

Collaborator

Sleep physicians work with several other members of the sleep healthcare team to achieve optimal outcomes for patients. Our Sleep Centre uses a multidisciplinary approach and patients will see several health care providers throughout their evaluation and treatment. The Sleep Fellow will consult with other physicians and health care professionals and contribute effectively to the team’s objectives and management plan. An understanding of the roles and responsibilities of other health care providers is required for effective leadership and participation within this model of patient care. 

Manager

Appropriate health care resource utilization is integral to the practice of sleep medicine especially in a time of changing resources, guidelines and protocols. As a manager the sleep fellow will incorporate quality assurance and resource allocation into daily activities. The Sleep Centre’s wait list time is long (up to one year) and this provides an excellent incentive and opportunity to consider alternate care models and/or triage systems for our patients.

Health Advocate

The sleep fellow must recognize his/her overall role within society and his/her ability to influence public policy as well as individual patient care. The physician must be prepared to advocate for patients and for communities. Physician advocacy for individuals and for communities is often required with regard to securing funding and qualification for CPAP, BiPAP and supplemental oxygen therapy.  

Scholar

Sleep Medicine is a relatively young field with significant gaps in knowledge and thus many opportunities for research. The sleep physician will demonstrate awareness of the current state of knowledge and ask questions where data is lacking. A commitment to life long learning in this rapidly evolving field is essential. Ongoing journal clubs, research and teaching opportunities will enhance this competency in our fellows.

Professional

As a sleep physician, there is a need for commitment to professional standards including ethical practice. In addition, the sleep fellow will demonstrate an understanding of provincial legislation for reporting of unfit drivers.