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
