Aims: To become conversant with terminology and basic concepts within the field of sleep medicine and sleep science. Content: Sleep as an Active Process: In contradistinction to common perception, sleep does not involve so much the switching off of neural systems, but the activation of certain areas within the brain, situated in structures such as the medulla, thalamus and basal forebrain. This module introduces basic neural anatomy and physiology necessary for the understanding of the process of sleep. Basic Respiratory Physiology: Understanding mechanisms underlying the maintenance of adequate gas exchange is essential to the study of sleep science and medicine. This module is a short introductory review of respiratory physiology as it relates to sleep medicine.

Aims: To understand the milestones that shaped our understanding of the nature of sleep; to understand the development of the concepts of sleep stages, chronobiology and the concept that sleep is not a steady state cycle, but changes through the night; to appreciate importance of polysomnography and the all-night sleep study. Content: Development of Sleep Research: The importance of sleep has been recognized throughout history. However, until recent times sleep was thought to be the intermediate state between wakefulness and death. This section elucidates the observations that have lead to the modern concept of an active dynamic condition we call sleep - from the observation of biological cycles, through the discovery of REM sleep, to the all-night sleep study. Introduction to Methods in Sleep Research: Sleep research involves the use of specific equipment and techniques. The early reports of sleep were confined to case histories and, later, short-term samples of biophysical recording were made. However, it was not until the early 1950s that researchers began to undertake all-night recordings and so polysomnography was born. Polysomnography and the meaning of the biophysical measurements made during full sleep studies will be introduced. In addition, the concepts of sleep stages and the normal changes of cardiorespiratory control and EEG will be introduced.

Aims: To understand the nature of sleep and gain an overview of normal sleep; to appreciate the changes in sleep associated with aging; to recognize various stages of sleep on a polysomnograph (this will be introduced in this unit, but extended significantly later in the course); to understand the range of sleep disorders, their presentation and diagnosis, including respiratory disturbances (OSA, central apnoea, pulmonary disease), sleep deprivation and fragmentation and general medical disorders which impact on sleep; to understand the epidemiology of sleep disorders and their impact on public health.
Content: Normal Sleep: This module will explain the definitions of sleep states and describe the progression of sleep through the night. The cyclic nature of sleep in humans and animals will be examined with some discussion of factors that affect sleep architecture, including age and drugs.
Introduction to Sleep Stage Scoring: This module will define the various stages of sleep from a practical standpoint, based on polysomnograph records. Candidates will be introduced to the standard methods of scoring sleep states which will be expanded during the practicum. Normal sleep and its variations will be the primary focus, with some discussion on the effects of drugs.
Respiratory Disturbances and Sleep: Respiratory sleep disturbance has a long history of comment in the literature generally, whereas, understanding of the medical significance of this has been a relatively recent phenomenon. This module will present an overview of the types of respiratory disturbances associated with sleep and the clinical presentation and evaluation of these. The natural history of sleep disordered breathing changes during the human lifestyle and the concept of a developmental path for sleep apnoea will be discussed.
Obstructive Sleep Apnoea: OSA has arguably been the most obvious type of sleep disordered breathing throughout history. Severe OSA is a major impediment to quality of life and is potentially life-threatening, not only as cause of impairment of day-time function, but as a predisposing factor to cardiovascular disease and stroke. OSA will be discussed in terms of its occurrence and polysomnographic identification. Reference will be made to OSA throughout life and treatments, however, these will dealt with in more detail in the Sleep and Breathing Units I,II & III.
Central Apnoea: The occurrence and identification of central apnoea will be introduced. This module will give an overview of the range of this phenomenon from apnoea of infancy to Cheyne-Stokes respiration.
Introduction to Respiratory Scoring: This module will introduce respiratory scoring, which is very often a major part of scoring a polysomnographic study. It will define the guidlines used to identify and mark respiratory events throughout a polysomnographic study using the recommendations taken from the Report of The Academy of Sleep Medicine Task Force. The types of devices used to measure respiratory variables will also be discussed.
The Importance of Sleep: The importance of sleep in the maintenance of physical and psychological wellbeing will be covered.

Aims: To be familiar with the resources of the Medical Library; to be able to conduct an online literature searches and download the results into bibliographic software; to be able to develop a research plan, including hypothesis development and the choice of appropriate methods; to be able to choose the appropriate statistical methods for analysis and read research literature critically.
Content: The Medical Library: In this module the online resources of the Medical Library of the University of Sydney will be utilised and candidates will be able to use their UniKey account to access on-line tutorials, journal articles, catalogues, Medline and other databases for retrieval of information.
Applied Literature Searching: Candidates will be required to choose a topic for a short review (2,000 words), and demonstrate the ability to search for references and utilize bibliographic software for the management of those references. Instruction in the use of suitable bibliographic software integrated with a word processor, will be included in this module.
Study Design: In this module you will learn about different types of basic, clinical and epidemiological study designs, which may be implemented to answer a research question relating to sleep and/or sleep disorders. You will be introduced to the concept of blinding of subjects and/or researchers, crossover study designs, and the use of placebo controlled studies.
Introduction to Statistical Methods: This module will provide a practical overview of some of the statistical tests and ways of presenting data used in various aspects of biological research, including: student t-test; c 2 test; ANOVA; a priori and post hoc testing; standard deviation; standard error of the mean; confidence intervals; significance; and the differences between types of studies, such as case-controlled, double-blind or meta studies. Particular emphasis will be placed on the choice of appropriate tests for different types of data.
Seminar Presentation Skills: In this module you will learn how to prepare a seminar presentation, including the order of presentation, suggested software packages, and suggested colour schemes. You will learn how to effectively present data to a group of peers, including strategies to maximize audience interest. Effectively answering questions at the conclusion of your presentation will also be discussed.

Aims: To understand cardiorespiratory control as it relates to sleep; to recognize the physiological mechanisms underlying the characteristic EEG of different sleep stages; to understand how motor control changes during the sleep cycle and the importance of this in regulation of sleep; to understand the regulation of homeostasis during sleep.
Content: Respiratory Control I: Review of respiratory control mechanisms and neuroanatomy. Central circuits involved in respiratory control and changes in the modulation of these central control mechanisms during the sleep cycle. Respiratory Control II:Control of ventilation alters during sleep. Responses to hypoxia and hypercapnia will be discussed. In addition, the pattern of respiration during the sleep cycle and the influence of altered arousal and muscle tone on this system will be included in this module. Cardiovascular Control I: Central and autonomic regulation of cardiovascular function during the sleep cycle. Sleep-dependent changes in cerebral and peripheral circulation. Cardiovascular Control II: Integration of cardiovascular and respiratory control mechanisms. The peripheral chemoreceptor and baroreceptor mechanisms. Brain Electrical Activity: Characteristics of EEG and EOG in REM and NREM sleep and wakefulness. Cellular origins of EEG signals. Low frequency oscillations of corticothalamic origin during NREM - spindle, delta and slow waves. Brainstem and thalamic circuits involved in arousal and REM. The Brainstem and REM Sleep: This module describes the ontogeny of REM sleep and the brainstem sites of generation.
Motor Control During Sleep: During the sleep cycle, somatic muscle activity is reduced during NREM and centrally inhibited during REM. The process underlying these changes are complex and will be introduced in this module.
Physiological Function During Sleep: Homeostatic mechanisms during sleep including control of temperature regulation and metabolism.

Aims: To understand the presence and physiological basis of biological rhythms and the ramifications for the sleep-wake cycle; to understand the normal modulation of circadian cycles and the effects when these are disrupted. Content: Chronobiology: The circadian rhythm and its relationship to the sleep cycle is examined along with the concepts of photic and nonphotic zeitgebers. Neural basis of Circadian Rhythm. The neurophysiology of the pacemaker in the suprachiasmatic nucleus and the neural circuits modulating its function. The genetic basis of circadian rhythm generation will also be discussed. Effects of Circadian Rhythms on Physiology I: The internal sleep structure is governed by circadian rhythms and these rhythms also impact upon levels of alertness and cognitive performance. This module deals with this topic and the ramifications for general day-time performance and quality of life if these rhythms are disrupted such as with sleep fragmentation or jet lag. Effects of Circadian Rhythms on Physiology II: This module continues the themes of 2.1.3 and considers the effects of such things as sleep deprivation and shift work on homeostasis and sleep regulation. In addition, the physiological effects and role of chronobiotic agent such as melatonin will be introduced. Circadian Rhythms and Ageing: The timing of sleep wake cycles is controlled by at least two neural clocks in the brain. Throughout the animal world there are numerous examples of cellular clocks, with the sleep wake cycle being the most visible example. Sleep wake patterns and rhythms change with age with alterations in both timing and content of sleep. This module introduces the area of chronobiology and the changes in sleep wake patterns with ageing. Importance of Sleep: Sleep occupies about one third of life and there is clear evidence of its importance for the wellbeing and proper function of many animals. This module provides an introduction to the evidence for the key role of sleep in growth, development and brain function.

Aims: To understand the way the control of ventilation is affected by the normal sleep cycle; to understand the relationship between the anatomy and physiology of the airways and the mechanics of ventilation during sleep; to introduce the physiological basis for pathologies of ventilation during sleep, especially OSA and central apnoeas. Content: Breathing During Sleep: The changes in spontaneous breathing during sleep and how this differs between REM and NREM sleep are reviewed. The mechanisms underlying these changes are also discussed. Anatomy and Physiology of the Upper Airway During Sleep: The upper airway and in particular the pharynx is particularly involved in the pathogenesis of OSA. The anatomy of the area and the control of muscles that are important for maintenance of airway patency are reviewed in this module. Snoring & Obstructive Sleep Apnoea-Hypopnoea: In this section, the physiology of snoring and OSA will be discussed in terms of its physiological determinants, occurrence and polysomnographic identification. The treatment of these conditions will be introduced. Central Apnoea: The physiology, occurrence and identification of central apnoea will be discussed with the clinical significance.

Aims: To understand the specific role of hormones in modulating circadian rhythms and sleep architecture; to appreciate the direct and indirect effects of disorders in hormone systems on sleep. Content: Melatonin & the Pineal: The anatomy and physiology of the pineal and its role in sensing photoperiod. Melatonin as a chronobiotic and its role in normal function and possible therapeutics. Sleep and the Menstrual Cycle: The influence of female sex hormone levels on sleep architecture during the menstrual cycle. Some reference to menopause will be made, however, this will be dealt with in future modules. Sex Hormones & Corticosteroid Disorders: The influence of male sex hormones and imbalances of steroids such as in Cushing's diseases which may have direct or indirect effects on sleep. Management of such conditions is discussed in relation to sleep. Acromegaly, Hypothyriodism and Diabetes: These hormonal imbalances lead to pathophysiological changes that adversely affect sleep. This module examines these changes and management of such patients.

Aim: To gain knowledge of the neurotransmitter systems and pharmacology involved in control of sleep and circadian rhythms. Content: Neurotransmitter Systems in Sleep: In order to understand the conditions and treatments for a range of sleep disorders and parasomnias, the neuropharmacology must be understood. These sections discuss sleep mechanisms from the perspective of neurotransmitters and neuromodulators. Some basic physiology will be included for background. Neurotransmitter Systems in Arousal.

Aims: To understand the importance of psychological factors in sleep medicine; to examine the specific interaction between the physiological and psychic factors that produce some sleep disorders, using insomnia as an example; to understand the cognitive processes that occur in sleep. Content: Insomnia: The occurrence and origins of this disorder will be discussed in the context of psychological and behavioural problems. The occurrence, clinical presentation and treatment of insomnia. Dreaming & Perception in Sleep: Theories on the origins and function of dreams will be discussed along with methods for study of dreams. Psychophysiology of Dreams: The relationship to dreaming and biophysical state will be examined along with the effect on dreams of various substances such as alcohol and psychiatric disorders. Dreaming Disorders: Nightmares and other phenomenon that have a disturbing effect on patients will be discussed.

The practicum component involves application of the theory presented during the previous two semesters work. A presentation will be recorded electronically by the student who is expected to use the knowledge gained to present a well structured, well referenced coherent presentation on a topic of their choice. Nocturnal recordings, with the software required to analyse it will be provided. The student will score and comment on these studies.

Aims:To understand the range of parasomnias and their classification; to understand the way in which neurological disorders in a range of systems can influence sleep. Content: Parasomnias I: Parasomnias are disorders of arousal, partial arousal and sleep transition. This module will discuss arousal disorders and sleep-wake transition disorders, such as sleep walking and rhythmic movement disorder. Parasomnias II: This module continues the discussion of the range of parasomnias including those associated with REM sleep such as REM behaviour disorder and other parasomnias such as bruxism. Degenerative Disorders: This section discusses the sleep effects of degenerative diseases such as Parkinson's disease and dementia, which also relates to the REM sleep disorders introduced in the Parasomnias II module. Restless Legs Syndrome & Other Disorders: This module discusses the sleep disturbances that involve the control of movement during sleep and include abnormalities in the amount of movement, loss of control of movement and abnormal forms of movement.

Aims: To develop understanding of the clinical assessment and management of pathologies of ventilation during sleep; to understand the theory of the current methods of treatment of snoring and sleep apnoea-hypopnoea; to gain knowledge of developing therapies. Content: Clinical Aspects of OSA: The presentation and clinical assessment of OSA. Nocturnal Asthma: Introduction to the pathophysiology of asthma, clinical presentation and management in the context of sleep. Continuous Positive Airway Pressure: The theory and practice of CPAP in the treatment of OSA. Surgical Therapy: Early attempts at a surgical cure. Uvulopalatoplasty and the more modern elegant techniques such as mandibular distraction. Oral Devices: The role of oral appliances for treatment of OSA. Medical Therapy: This module discusses the options such as treatment of obesity and nasal appliances that are used to treat OSA and hypopnoea. Cardiovascular Disease and OSA. The epidemiological and medical evidence for the links between OSA and cardiovascular disease. Bilevel Pressure Support & Automatic Devices. Sophisticated appliances for the treatment of OSA and central apnoeas such as Cheyne-Stokes ventilation.

Aims: To understand the pharmacological basis of effects of different classes of drugs on sleep; to become familiar with drugs used therapeutically in various aspects in sleep medicine. Content: Drugs That Alter Sleep: This module introduces the types of prescription drugs that disturb sleep or waking function and may affect sleep disordered breathing. Hypnotics: This module looks at drugs with hypnotic-sedative effects, their effects on sleep and uses in sleep medicine. Stimulants: Drugs that increase arousal, motor activity and alertness will be examined in terms of their physiological action and uses in sleep medicine. Drugs of Addiction: A number of drugs of abuse and addiction, including nicotine and alcohol will be examined in relation to their effects on the sleep cycle and relevance to sleep medicine.

Aims: To gain knowledge of the effects of psychiatric disorders on sleep and some appreciation of the management of such patients; to understand the concept of sleep hygiene and the importance of behavioural modification as therapy. Content: Psychiatric Disorders and Sleep: Anxiety disorders mood disorders & schizophrenia all have a significant impact upon sleep and are examined in the context of patient management. Behavioural Therapies and Sleep Hygiene: Behavioural modification is very important in the management of a range of sleep disorders and such treatments are examined in this module.

Aims: To understand the changes in function of other organ systems in relation to sleep; to understand the effect of sleep on other organ systems and particular the effect of sleep disorders on the function of the body generally; to understand the changes that occur in sleep when the body is challenged by other diseases. Content: Hypertension, Stroke and Cardiovascular Function: Sleep and the problems associated with it in relation to cardiovascular problems will be discussed in this module. In addition, the association with sleep-disordered breathing will be discussed. Disruption of Rhythm: Shift work, jet lag and sleep disruption lead to generalized physiological and immunological problems. Gastrointestinal Physiology: The alterations in autonomic function during sleep have effects on gastrointestinal motility and function. As well as the normal gastrointestinal function during sleep, pathological conditions such as gastrooesophageal reflux will be discussed. Immunological Responses: Sleep is affected by bacterial challenge and other alterations of immunological state. These considerations are examined.

Aims: To understand sleep and sleep disorders during early development; to be introduced to paediatric sleep medicine and patient management. Content: Development of Respiratory Control: Respiratory control and its relationship to the sleep-wake cycle is not constant throughout life, but displays marked changes during development. These developmental stages are discussed from fetal biophysical states through to childhood are discussed in this module. Central Apnoea & OSA in Children: The occurrence and clinical significance of these conditions are examined. Paediatric Parasomnias: Parasomnias that are of interest in paediatrics are discussed, from night terrors to SIDS. Medical Management of Paediatric Sleep Disorders: The diagnosis and treatment of sleep disorders in children. Dental Management of Paediatric Sleep Disorders: Identification of the role of Dentistry in sleep disorders in children, and exploration of dental treatment options.

Aims: To understand the impact of respiratory disorders and diseases on sleep and breathing; to understand the principles of clinical management of these patients in the context of sleep medicine. Content: chronic obstructive pulmonary disease (COPD); neuromuscular disorders; restrictive lung disease; cystic fibrosis.

Aims: To understand how knowledge of the neuropharmacology of a sleep disorder is gained and how this is used to develop therapeutic strategies; to gain an appreciation of the direction of current research into drug therapies for sleep disorders and the problems associated with this; to understand methods used to assess the efficacy of drugs and how to critically appraise trials of therapies generally. Content: Narcolepsy: This condition has been studied extensively in humans and animal models and the neuropharmacology is reasonably well understood. This module examines the study of this condition and drug therapies. Possible Drug Therapies for OSA: The pharmacology of systems involved in OSA is examined and ways in which these might be targeted by drug therapy and the problems that are encountered. Pharmacology and Chronobiology: Drugs that alter the circadian clock (chronotropes) are discussed and their efficacy in treating sleep disorders. Assessment of Drug Therapy: This module deals with the critical analysis of drug effect. The methods of assessment and the ways in which the data is presented are discussed.

Aims: To understand sleep and sleep disorders throughout life; to understand issues specific to adult sleep medicine and patient management. Content: Cardiorespiratory Physiology Through the Life-Cycle: This module charts the development of the cardiorespiratory systems from adolescence to old age with reference to sleep disorders. Sleep in Pregnancy & Lactation: Sleep architecture is altered during these states and during pathological conditions such as preeclampsia. Studies of these aspects of the life cycle are reviewed. Medical Management of Sleep Disorders: From OSA to geriatric sleep fragmentation, this module considers clinical presentation and management of different age-groups. Epidemiology of Sleep and Public Health: Sleep research over the last fifty years has indicated that disorders of sleep such as snoring are not just an annoyance, but have serious ramifications for public health. Dental Management of Adult Sleep Disorders: Students will explore the role of craniofacial factors in the development of sleep disorders, and discuss the management implications.

In this unit the theory presented during the previous four semesters work will be used in practice. Students will prepare and electronically record a presentation on a topic of their choice using the knowledge gained throughout the course. The student will be given case studies (including sleep studies) to analyse, and investigate, then discuss treatment options.