Chapter 8 Eating and Sleep-Wake Disorders Flashcards
Bulimia nervosa
- An eating disorder involving recurrent episodes of uncontrolled excessive (binge) eating followed by compensatory actions to remove the food (for example: deliberate vomiting, laxative abuse, and excessive exercise)
- Eating disorder involving recurrent episodes of uncontrolled excessive (binge) eating followed by compensatory/purging actions to remove the food (for example, fasting, deliberate vomiting, laxative abuse, and excessive exercise). Intense fear of gaining weight. Belief that others’ impressions, popularity, and self-esteem are determined by weight and body shape. Usually close to normal weight. Westernized sociocultural origins.
Binges
Relatively brief episode of uncontrolled, excessive consumption, usually of food or alcohol.
Anorexia nervosa
- an eating disorder characterized by recurrent food refusal, leading to dangerously low body weight
- 15% below expected weight (usually much lower when seek treatment). Eating disorder characterized by recurrent food refusal, leading to dangerously low body weight. Intense fear of gaining weight. Out-of-control and overly successful weight loss. Westernized sociocultural origins, often begins as dieting. 2 subtypes.
Binge-eating disorder
- A pattern of eating involving distress-inducing binges not followed by purging behaviors; being considered as a new DSM diagnostic category
- Pattern of eating involving distress-inducing binges not followed by purging behaviors (so not bulimia); being considered as a new DSM diagnostic category. Better response to treatment than others. Many are obese, tend to be older, more psychopathology vs non-binging obese. Concerned about shape/weight. Westernized sociocultural origins.
Obesity
- excessive weight or body fat. Individuals are considered obese if they have a BMI of 30 or greater
• Not considered an official disorder in the DSM
• The more overweight someone is at a given height, the greater the risks to health - Excess of body fat resulting in a body mass index (BMI, a ratio of weight to height) of 30 or more. Not an eating disorder under DSM. Epidemic in US. Related to heart disease, stroke, type 2 diabetes, and certain types of cancer. Huge medical costs. Increasing statistics.
Purging techniques
In the eating disorder bulimia nervosa, the self-induced vomiting or laxative abuse used to compensate for excessive food ingestion.
Night eating syndrome
- One of the forms of maladaptive eating patterns in people who are obese.
- Occurs in between 6% and 16% of obese individuals seeking weight-loss treatment but in as many as 55% of those with extreme obesity seeking bariatric surgery
- Consume a third or more of their daily intake after their evening meal and get out of bed at least once during the night to have a high-calorie snack.
- In the morning, however, they are not hungry and do not usually eat breakfast.
- Do not binge during their night eating and seldom purge.
- Occasionally, nonobese individuals will engage in night eating, but the behavior is overwhelmingly associated with being overweight or obese.
Bariatric surgery
- Surgical approach to extreme obesity, usually accomplished by stapling the stomach to create a small stomach pouch or bypassing the stomach through gastric bypass surgery
Rapid eye movement (REM) sleep
- Periodic intervals of sleep during which the eyes move rapidly from side to side, and dreams occur, but the body is inactive.
- REM sleep seems related to depression
- CBT
Dyssomnias
Problems in getting to sleep or in obtaining sufficient quality sleep (amount, quality, or timing of sleep). Ex: insomnia disorder, hypersomnolence disorder, narcolepsy, all breathing-related sleep disorders.
Treatment of dyssomnias
Prevention by establishing good sleeping habits. Short-acting drugs that induce sleep (but don’t cause anxiety). Long-acting drugs may have more side effects, dependence is a risk, REBOUND insomnia, risk of injury/death due to sleepwalking. Phase delays. Use of light to reorient sleep cycle. Psychological stimulus control (bed only for sleep), CBT.
Parasomnias
Abnormal behaviors or psychological events such as nightmares or sleepwalking that occur during sleep. Ex: non-REM sleep arousal disorders (sleep terror disorder), nightmare disorder, REM sleep behavior disorder, nocturnal eating syndrome, hypnagogic hallucinations
Treatment of Parasomnias
All decrease with age. No treatment/definitive research for nightmare disorder. Also no effective treatment for sleepwalking disorder. Sleep terror disorder–scheduled awakenings ~30 min before usual time of episode, use for several weeks and fade.
2 categories of sleep disorders.
- Dyssomnias.
- Parasomnias.
DSM now includes criteria for data from polysomographic studies and sometimes medical tests.
Polysomnographic (PSG) evaluation
- Assessment of sleep disorders in which a client sleeping in the lab is monitored for heart, muscle, respiration, brain wave, and other functions.
- The patient spends one or more nights sleeping in a sleep laboratory and being monitored on a number of measures, including respiration and oxygen desaturation (a measure of airflow); leg movements; brain wave activity, measured by an electroencephalogram; eye movements, measured by an electrooculogram; muscle movements, measured by an electromyogram; and heart activity, measured by an electrocardiogram.
Polysomnography
Sleep readings
Actigraph
Small electronic device that is worn on the wrist like a watch and records body movements. This device can be used to record sleep-wake cycles.
Sleep efficiency (SE)
Percentage of time actually spent sleeping of the total time spent in bed.
Microsleeps
Short, seconds-long periods of sleep that occur in people who have been deprived of sleep.
Insomnia disorder
Trouble falling asleep (initiating), staying asleep (maintaing), or wake up too early and can’t go back to sleep. Can be episodic (less than 3 months, but at least 1 per month), persistent (lasts >3 months), or recurrent (2 or more episodes in a year). Many people experience it during times of stress.
Hypersomnolence
Sleep dysfunction involving an excessive amount of sleep (hypersomnia) that disrupts normal routines. Sleep all night; appear rested when awakened, but fall asleep during the day. Have to rule out other potential causes: sleep apnea, insomnia, and other psychological considerations.
Sleep apnea
- Disorder involving brief periods when breathing ceases during sleep. 3 kinds–obstructive, central, mixed.
- Have difficulty breathing at night
- Often snore loudly, pause between breaths, and wake in the morning with a dry mouth and headache.
Narcolepsy
Sleep disorder involving sudden and irresistible sleep attacks. Rare disorder. Includes both daytime irrepressible sleepiness and cataplexy. Occurs 3x per week for at least 3 months. Often also report sleep paralysis. DSM 5 criteria reference CSF testing and criteria from nocturnal polysomograph.
Breathing-related sleep disorders
- Sleep disruption leading to excessive sleepiness or insomnia, caused by a breathing problem such as interrupted (sleep apnea) or labored (hypoventilation) breathing.
- People whose breathing is interrupted during their sleep often experience numerous brief arousals throughout the night and do not feel rested even after 8 or 9 hours asleep.
- Breathing is contricted a great deal and may be labored (hypoventilation) or, in the extreme, there may be short periods (10 to 30 seconds) when they stop breathing altogether, called sleep apnea.
- Only minimally aware of breathing difficulties and doesn’t attribute the sleep problems to the breathing.
Sleep apnea
- Breathing is contricted a great deal and may be labored (hypoventilation) or, in the extreme, there may be short periods (10 to 30 seconds) when they stop breathing altogether, called sleep apnea.
- Only minimally aware of breathing difficulties and doesn’t attribute the sleep problems to the breathing.
Circadian rhythm sleep disorder
Sleep disturbances resulting in sleepiness or insomnia, caused by the body’s inability to synchronize its sleep patterns with the current pattern of day and night (associated with hypothalamus). Light usually determines sleepiness/awakeness. Health impact can be extreme: increased rates of cardiovascular disease, ulcers, breast cancer, and greater risk of personality disorders. Can be jet lag type, shift work type, delayed sleep phase type
There are several types of circadian rhythm sleep disorders
- Jet lag type
- Shift work type
- Sleep phase type
- Advanced sleep phase type
- Irregular sleep-wake type
- non-24-hour sleep-wake type
Jet lag type
- Caused by rapidly crossing multiple time zones
2. Usually report difficulty going to sleep at the proper time nd feeling fatigued during the day
Shift work type
- Are associated with work schedules
- Work at night or must work irregular hours
- May have problems sleeping or experience excessive sleepiness during waking hours
- May contribute to cardiovascular disease, ulcers, and breast cancer in women
Delayed sleep phase type
- Extreme night owls, people who stay up late and sleep late, may have this problem
Advanced sleep phase type
Early to bed and early to rise
Sleep-wake type
People who experience highly varied sleep cycles
non-24-hour sleep-wake type
E.g. sleeping on a 25-or 26-hour cycle with later and later bedtimes ultimately going throughout the day
Nightmares
- Occur during REM or dream sleep
- About 10% to 50% of children and about 9% to 30% of adults experience them regularly
- These experiences must be so distressful that they impair a person’s ability to carry on normal activities
- Distinguish nightmares from bad dreams by whether or not you wake up as a result
- Disturbing dreams that awaken the sleeper; bad dreams are those that do not awaken the person experiencing them.
- Are thought to be influenced by genetics, trauma, medication use, and are associated with some psychological disorders
- Both psychological intervention and pharmacological treatment
Sleep terrors
- scheduled awakenings ~30 min before usual time of episode, use for several weeks and fade.
- Episodes of apparent awakening from sleep (usually during 1st to 3rd phase), accompanied by scream and signs of panic, followed by disorientation and amnesia for the incident. Intense fear and signs of autonomic arousal such as mydriasis, tachycardia, rapid breathing and sweating. Relatively unresponsive to ppl trying to comfort them. More children and more males. These occur during non-REM sleep and so do not involve frightening dreams.
- Which most commonly afflict children, usually begin with a piercing scream.
- The child is extremely upset, often sweating, and frequently has a rapid heartbeat.
- Appear to resemble nightmares- the child cries and appears frightened- but they occur during NREM sleep and therefore are not caused by frightening dreams.
- Children cannot be easily awakened and comforted, as they can during a nightmare.
- Children do not remember sleep terrors
Scheduled awakenings
- Instructed parents of children who were experiencing almost nightly sleep terrors to awaken their child briefly approximately 30 minutes before a typical episode (these usually occur around the same time each evening)
- This simple technique, which was faded out over several weeks, was successful in almost eliminating these disturbing events.
Sleepwalking/somnambulism
Leaves bed or sits up in bed. Repeated sleepwalking that occurs during non-REM sleep and so is not the acting out of a dream. The person is difficult to waken and does not recall the experience. Typically occurs during early hours of sleep. Blank, staring face, hard to awaken. May be disoriented if awakened but will come around in a few minutes. More children than adults.
Nocturnal eating syndrome
Consuming 1/3 or more of daily food intake after the evening meal and waking up at least once (up to 4x) during the night to have a high-calorie snack. In the morning, however, they are not hungry and do not usually eat breakfast. Do not binge during their night eating and seldom purge. Usually wake up during episode. Display unrestrained compulsive and aggressive behavior during episode. Associated with obesity. Onset in 30s. About equal men and women. Can be caused by stressful life events.
Sexsomnia
- Acting out sexual behaviors such as masturbation and sexual intercourse with no memory of the event
- Can cause relationship problems and, in extreme cases, legal problems when cases occur without consent or with minors.
DSM Bulimia
- Recurrent episodes of binge eating, characterized by an abnormally large intake of food within a discrete period of time combined with a sense of lack of control over eating during the episode
- Recurrent, inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting, misuse of laxatives or diuretics, fasting or excessive exercise
- On average, the binge eating and inappropriate compensatory behaviors both occur at least once a week for 3 months
- Self-evaluation is unduly influenced by body shape and weight
Bulimia Medical Consequences
- Salivary gland enlargement caused by repeated vomiting, which gives the face a chubby appearance.
- Erode the dental enamel on the inner surface of the front teeth as well as tear the esophagus
- Upset the chemical balance of bodily fluids, including sodium and potassium levels
- This condition, called an electrolyte imbalance, can result in serious medical complications if unattended, including cardiac arrhythmia (disrupted heartbeat) seizures, and renal (kindey) failure, all of which can be fatal
- Young women with bulimia also develop more body fat than age - and weight matched healthy controls
Anorexia DSM
- DSM-5 Disorder Criteria
- Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health
- Intense fear of gaining weight, or persistent behavior that interferes with eight gain, even though at a significantly low weight
- Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent ack of recognition of the seriousness of the current low body weight
- DSM-5 specifies two subtypes of anorexia nervosa (subtypes mean only in the last 3 months)
- Restricting type: individuals diet to limit calorie intake
- Binge-eating-purging type: they rely on purging. Unlike individuals with bulimia, binge-eating-purging anorexics binge on relatively small amounts of food and purge more consistently, in some cases each time they eat
- Staying the same weight or gaining any amount of weight from one day to the other is likely to cause intense panic, anxiety, and depression
Anorexia Medical Consequences
- Cessation of menstruation (amenorrhea) - it was dropped from the DSM criteria though however
- Dry skin, brittle hair or nails, and sensitivity to or intolerance of cold temperatures.
- Cardiovascular problems, such as chronically low blood pressure and heart rate.
- If vomiting is apart of anorexia, electrolyte imbalance and resulting cardiac and kidney
Binge Eating DSM
- Recurrent episodes of binge eating
- The binge-eating episodes are associated with three or more of the following (1) eating much more rapidly than normal (2) eating until feeling uncomfortably fill, (3) eating large amounts of food when not hungry, (4) eating alone because of feeling embarrassed by how much one is eating and (5) feeling disgusted with oneself, depressed, or guilty afterward
- Marked distress regarding binge eating is present
- The binge eating occurs, on average, at least once a week for 3 months
- The binge eating is not associated with the recurrent use of inappropriate compensatory behavior
Causes of obesity
Spread of modernization (sedentary lifestyle + high fat foods). Genetics (~30% of the cause). Biological factors. Psychosocial factors (impulse control, etc).
Treatment for obesity
Self-directed weight loss problems, commercial self-help programs, behavioral modification programs, bariatric surgery. Moderately effective for adults. More effective for kids and adolescents, esp. with family involvement.
Associated features and medical consequences of anorexia nervosa
Body image disturbance, pride in diet and control, rarely seek treatment. Amenorrhea (although dropped from DSM 5), dry skin, brittle hair/nails, sensitivity to cold temps, lanugo (downy hair on limbs/face), cardiovascular problems, electrolyte imbalance.
Comorbidity of bulimia nervosa
Anxiety, mood disorders, and substance abuse (respectively). And substance abuse increases suicide risk.
2 subtypes of bulimia nervosa
- Purging (most common)–vomiting, laxatives, or diuretics. 2. Nonpurging–exercising and/or fasting.
Cross-cultural considerations for eating disorders
North American minority populations. Immigrants to Western cultures experience significant changes in eating and foods available–increase in eating disorders and obesity. Cultural values. Standards for body image.
Treatment of eating disorders
Drug treatments (not effective for anorexia), short-term efficacy of antidepressants (tricyclics and prozac) for bulimia, when used to supplement psychological treatment.
Statistics of anorexia nervosa
More females than males. Caucasian, middle to upper class. Onset age 13-18. Chronic, resistant to treatment.
Comorbidity of anorexia nervosa
Anxiety (OCD-rituals to avoid eating), mood disorders, substance abuse (suicide).
2 Psychological treatments of bulimia nervosa
1) Cognitive-behavior therapy (CBT)–treatment of choice, target problem eating behaviors and dysfunctional thoughts; may work quicker. 2) Interpersonal psychotherapy–improve interpersonal functioning, similarly effective, long-term.
2 subtypes of anorexia nervosa
- Restricting (limit caloric intake through diet and fasting). 2. Binge-eating-purging (~1/2 of anorexics).
Developmental considerations of eating disorders
Adolescent onset (parent, peer, and cultural considerations). Weight gain with normal hormonal changes and changes in body associated with puberty and maturation. Media impact–interaction with social ideals.
Psychological treatment of anorexia nervosa
Weight restoration; may require hospitalization. Target dysfunctional attitudes–body shape, control, and thinness=worth idea. Family involvement (communication about eating/food, attitudes about body shape). Long-term prognosis is poorer than bulimia.
Causes of eating disorders
Social dimensions (cultural imperatives, thin=success, happy), dieting. Ideal body size standards. Artificial standards in media. Internal and perceived social and gender standards. Family influences (driven, success, history of mother dieting). Biological (perfectionism, hypothalamus/serotonin, reaction to stress). Psychological (loss of control, low self-confidence, mood intolerance, etc).
Prevention of eating disorders
Identify specific targets (early weight concerns). Screening for at-risk groups. Provide education (normal weight limits, effects of calorie restriction, “healthy weight”).
3 treatments of binge eating disorder
- CBT- similar to bulimia. 2. IPT- as effective as CBT. 3. Medications- possible benefit from, Meridia, no benefit from Prozac.
Medical consequences of bulimia nervosa
Salivary gland enlargement, erosion of dental enamel, electrolyte imbalance (kidney failure, cardiac arrhythmia, seizures), intestinal problems, permanent colon damage, hand calluses.
Statistics of bulimia nervosa
WOMEN: Mostly female Caucasian, middle to upper class. Onset age 10-21. Chronic if untreated. MEN: Some men Caucasian, middle to upper class. Gay or bisexual men or athletes with weight regulations. Onset later than women.
Hypersomnolence disorders
Sleep dysfunction involving an excessive amount of sleep (hypersomnia) that disrupts normal routines. Sleep all night; appear rested when awakened, but fall asleep during the day. Have to rule out other potential causes: sleep apnea, insomnia, and other psychological considerations.
Rebound insomnia
In a person with insomnia, the worsened sleep problems that can occur when medications are used to treat insomnia and then withdrawn.
Primary insomnia
Difficulty in initiating, maintaining, or gaining from sleep; not related to other medical or psychological problems.
Comorbidity of sleep-wake disorders.
Can be comorbid with other psychological disorders. “Disturbed sleep”–Schizophrenia, ASD, Major Depression, and Anxiety Related Disorders. Substance use disorders can also significantly impact sleep cycle and are associated with sleep disorders.
Sleep stages
A complete sleep cycle is the progression of the 4 stages of non-REM, then–about 90 min after sleep onset–REM. After a period of REM, the sleep cycle restarts–each recurring stage lengthens and final one may last an hour.
Sleep stage 1
A reduction in movement and all body activity between wakefulness and stage 1 sleep. Eyes closed. Can be awakened easily. If aroused, may feel as if haven’t slept. May last 5-10 minutes. May experience hypnic myoclonia.
Hypnic myoclonia
During stage 1. Feeling of falling asleep, may cause a sudden muscle contraction.
Sleep stage 2
Light sleep. Spontaneous periods of muscle tension mixed with periods of muscle relaxation. Heart rate slows, body temp decreases. Body prepares to enter into deep sleep.
Sleep stage 3 (and 4 is same but more intense
Deep sleep. Called slow-wave, or delta, sleep. If aroused, a person may feel disoriented for a few minutes. Body repairs and regenerates tissues, builds bone and muscle, and may strengthen the immune system. As you age, you sleep more lightly and get less deep sleep and less sleep overall–but your need for it does not decrease.
REM
Brainwave patterns similar to being awake. Eyes move rapidly in different directions. Intense dreaming occurs as result of heightened brain activity. Paralysis of major voluntary muscle groups + brain (encephalic) excitement = paradoxical sleep. Infants get most, least in elderly.
Effects of little sleep
Disrupted sleep is common; many ppl sleep <6 hrs/day. If chronic–problematic in brain function and impairs concentration, causes unclear thinking, irritability, physical exhaustion, and more susceptibility to illnesses. Associated with many mental disorders.
Insomnia disorder statistics
Women report it more than men. 25-40% of children. Higher rates among teens, more than 1/4 of older adults, about 21% over 65. Maybe partly due to learned behavior.
Cataplexy
In narcolepsy–you are awake and experience a strong emotion, lose muscle tone, immediately falls into deep (REM) sleep.
Hypnagogic hallucinations
Vivid and terrifying experiences at the beginning of sleep (either during daytime sleep episodes or at night). Very realistic and include visual (simple forms, color), tactile, hearing, and sensations of body movement.
Obstructive apnea
Airflow stops despite continued activity by the respiratory system (narrow airway, abnormality, or damage associated with age, obesity, use of drugs such as ecstasy) about 10-20% of US population; more males
Central apnea
Complete cessation of breathing associated with damage to central nervous system - wake frequently, tend not to report, and often unaware (not well studied)
Mixed apnea
Combination of obstructive and central
Treatment of dyssomnias
Prevention by establishing good sleeping habits. Short-acting drugs that induce sleep (but don’t cause anxiety). Long-acting drugs may have more side effects, dependence is a risk, REBOUND insomnia, risk of injury/death due to sleepwalking. Phase delays. Use of light to reorient sleep cycle. Psychological stimulus control (bed only for sleep), CBT.
Preventing sleep disorders
Maintaining a regular bedtime, having a regular bedtime routine. Avoiding caffeine, alcohol, and nicotine. Use bedroom only for sleep, avoid stressful activities in bedroom. Wake at same time each day. Exercise in day, but not 2 hrs before bedtime. Reduce noise/light and avoid extreme heat in bedroom. Drink milk before bed. Increase exposure to daytime natural light.
REM sleep behavior disorder
Repeated episodes of arousal during REM sleep including motor behaviors and vocalizations. Usually at least 90 min after onset of sleep. Individual is completely unaware of actions during episode and after awakening. Upon awakening, is completely alert and not confused. Ex: violence including murder, sexsomnia, and nocturnal eating syndrome.
Manny has been having episodes lately when he eats prodigious amounts of food. He’s been putting on a lot of weight because of it. Which disorder?
Binge-eating disorder
I noticed Elena eating a whole pie, a cake, and two bags of potato chips the other day when she didn’t know I was there. She ran to the bathroom when she was finished and it sounded like she was vomiting. This disorder can lead to an electrolyte imbalance, resulting in serious medical problems. Which disorder?
Bulimia nervosa
Joo-Yeon eats large quantities of food in a short time. She then takes laxatives and exercises for long periods to prevent weight gain. She has been doing this almost daily for several months and feels she will become worthless and ugly if she gains even an ounce. Which disorder?
Bulimia nervosa
Kirsten has lost several pounds and now weighs less than 90 pounds. She eats only a small portion of the food her mother serves her and fears that intake above her current 500 calories daily will make her fat. Since losing the weight, Kirsten has stopped having periods. She sees a fat person in the mirror. Which disorder?
Anorexia nervosa
Many young women with ______ disorders have a diminished sense of personal control and confidence in their own abilities and talents, are perfectionists, and/or are intensely preoccupied with how they appear to others.
Eating
Biological limitations, as well as the societal pressure to use diet and exercise to achieve nearly impossible weight goals, contribute to the high numbers of people with _____ ______ and _____ ______.
Anorexia nervosa and bulimia nervosa
One study showed that ____ consider a smaller female body size to be more attractive than ____ do.
Females; men
Antidepressants help individuals overcome ______ but have no effect on _____.
bulimia nervosa; anorexia nervosa
Cognitive-behavioral treatment (CBT) and interpersonal psychotherapy (IPT) are both successful treatments for bulimia nervosa, although ___ is the preferred method.
CBT
Attention must be focused on dysfunctional attitudes about ___ ___ in anorexia, or relapse will most likely occur after treatment.
Body shape
_____ is the single most expensive health problem in the United States, surpassing both smoking and alcohol abuse.
Obesity
Individuals with ___ _____ _____ consume at least 1/3 or more of their daily intake after their evening meal.
Night eating syndrome
Fatty foods and technology are to blame for the ____ _____ in the United States.
Obesity epidemic
Professionally directed _____ _____ programs represent the most successful treatment for obesity
Behavior modification
Timothy wakes up frequently every night because he feels he is about to hyperventilate. He can’t seem to get enough air, and many times his wife will wake him to tell him to quit snoring. What type of disorder?
Breathing-related sleep disorder
Sonia has problems staying awake throughout the day. Even while talking on the phone or riding the bus, she unexpectedly loses muscle tone and falls asleep for a while. Which disorder?
Narcolepsy
Jaime sometimes awakens and cannot move or speak. What is this frightening experience called?
Sleep paralysis
Brett has started a new job that requires him to change shifts monthly. He sometimes has day shifts and at other times has night shifts. Since then he has had considerable trouble sleeping
Circadian rhythm sleep disorder
Rama is extremely overweight. His wife suspects he may be suffering from ___ ___ because he snores every night and often wakes up exhausted as though he never slept.
Sleep apnea
Melinda sleeps all night and still finds herself falling asleep throughout the next day. This happens even when she goes to bed early and gets up as late as possible. Which disorder?
Hypersomnolence disorder
Jaclyn’s dad is sometimes awakened by his daughter’s screams. He runs to Jaclyn’s room to comfort her and is eventually able to calm her down. Jaclyn usually explains that she was being chased by a big, one-eyed, purple monster. The events typically happen after watching scary movies with friends. Which sleep problem?
Nightmares
Sho-jen’s parents hear her piercing screams on many nights and rush to comfort her, but she does not respond. During these episodes, her heart rate is elevated, and her pajamas are soaked in sweat. When she gets up the next day, however, she has no memory of the experience. Which sleep problem?
Sleep terrors
Jack has made a serious commitment to his diet for more than a month but continues to gain weight. He has no memory of eating but noticed that food is always missing from the refrigerator. Which sleep problem?
Nocturnal eating syndrome
Karen wakes up screaming every night, disregarding her parents’ efforts to comfort her. Her heart rate is elevated in these episodes, and her pajamas are soaked in sweat. The next day, she has no memory of the experience. To help reduce these night terrors. Karen’s pediatrician used ____________.
Scheduled awakenings
After George’s wife died at the age of 68, he could not sleep. To help him through the hardest first week, Dr. Brown prescribed _________ for his insomnia.
Benzodiazepines
Carl’s doctor suggested some relatively simple lifestyle changes otherwise known as good when he expressed concern about developing a sleep disorder.
Sleep hygiene
