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.