Sleep-Wake Disorders and Feeding-Eating Disorders Flashcards
T or F. Drugs used to treat depression may also help curb bulimic binges
T
T or F. Sleeping pills are an awesome solution for insomnia
F! They are a short-term solution and can actually worsen insomnia
Two main types of eating disorders
Anorexia Nervosa and Bulimia Nervosa
Anorexia Nervosa
- primarily affects young women
- maintenance of an abnormally low body weight
- distortion of body image
- intense fears of gaining weight
- amenorrhea (in females)
Amenorrhea
cessation of menses
DSM 5 - Anorexia Nervosa
- Restriction of energy intake
- Intense fear (almost phobic/panic) of gaining weight
- Disturbance in the way in which one’s body weight or shape is experienced
Specifiers of Anorexia Nervosa (Types)
- Restricting Type: go out of way not to eat that much; eat enough to stay alive
- Binge-Eating/Purging Type: excessive eating then induce vomiting then go back to longer periods of self-starvation
Severity of Anorexia is largely based on this. Why is this a problem?
Body Mass Index (kg/m^2)(calculated from weight in kg and height in m); fails to take body composition into account!
According to WHO, what is the low end of normal range, etc.
Normal - 25-18.5 Mild - greater than or equal to 17 Moderate - 16.99-16 Severe - 15.99-15 Extreme - less than 15
- 5 low end of normal
* *Partial remission - some but not all criteria met for a sustained period of time
* *Full remission - no criteria met for a sustained period of time
A better method than BMI
Displacement of tank when person sinks to the bottom
Medical complications of Anorexia:
- Amenorrhea: low estrogen (can happen pretty quickly depending on caloric deprivation)
- Osteoporosis: fractures, inadequate dietary calcium
- Kidney damage: dehydration, laxative abuse
- Heart arrhythmias: electrolyte imbalance; brady- and tachycardia
- Hypotension
- Anemia
- Death (~15% of patients): malnutrition, suicide
Bulimia Nervosa
Recurrent pattern of binge eating followed by self-induced purging and accompanied by persistent over-concern with body weight and image
Bulimia Nervosa does NOT include anorexia
no severe caloric deprivation
Binge-Eating Disorder
New DSM-5 diagnostic category that involves the same binge-eating features found in Bulimia Nervosa but without the behaviour aiming to compensate for the bingeing (eg. purging)
Medical complications of Bulimia
- tooth erosion, cavities, and gum problems
- blockage of salivary ducts
- pancreatitis
- water retention, swelling, and abdominal bloating
- acute stomach distress
- fluid loss with low potassium levels (extreme weakness, near paralysis and heart arrhythmias)
- irregular periods (esophagus damage, including rupture)
- weakening of rectal walls (laxative use)
Behavioural complications of Bulimia
- substance abuse (30-70%)
- impulsive behaviours (up to 50%): promiscuity, cutting (parasuicidal), theft
Risk factors for both Anorexia and Bulimia
- participation in competitive activities that emphasize endurance, aesthetics, and weight levels put athletes at risk for this
- female gender
- age in late teens to early 20s
- having a first degree relative with an eating disorder
- social pressures including distorted media portrayals
- emotional issues such as: low self-esteem, perfectionism, anger issues, depression, anxiety, OCD, impulsivity
Treatment of Anorexia and Bulimia
- hospitalization
- cognitive analytic therapy (CAT)
- family therapy
- CBT
- interpersonal psychotherapy
Infancy and Early Childhood Feeding and Eating Conditions
- Pica: ingestion of non-nutritive substances
- Rumination Disorder: food id regurgitated, chewed, and either spat out or re-swallowed
- Feeding Disorder of Infancy or Early Childhood: difficulty in transitioning from breastmilk to real food
- Prader-Willi Syndrome
- Cyclic Vomiting Syndrome: food in stomach then throw up several times an hour over a period of hours or days; not bingeing or purging; infants
Adolescents and Adults Feeding and Eating Conditions
- Anorexia Athletica : reduction or no appetite + excessive exercise to lose weight
- Muscle Dysmorphia (Bigorexia): misperception that muscles are incredibly small
- Orthexia Nervosa: preoccupation with superfoods
- Night-Eating Syndrome: eat more than half of daily caloric intake after supper but before breakfast the next day
- Nocturnal Sleep-Related Eating Disorder: variant on sleep walking; not a fully awaken state; go to refrigerator (doesn’t involve preparation or cooking) but just grabbing and eating whatever they can
- Gourmand Syndrome: often associated with brain damage; preparation and rituals
Diagnostic category representing persistent or recurrent sleep-related problems that cause significant personal distress or impaired functioning
Sleep-wake disorders
Dyssomnias
- Insomnia Disorder
- Hypersomnolence Disorder
- Narcolepsy
Breathing-Related Sleep Disorders
- Central Sleep Apnea
- Sleep-Related Hypoventilation
- Circadian Rhythm Sleep-Wake Disorders
Parasomnias
- Nightmare Disorder (during REM stage)
- Non-REM Sleep Arousal Disorders (Sleep terrors and sleepwalking)
- REM Sleep Behaviour Disorder
- Restless Leg Syndrome
- Substance/Medication Induced
As we age, slow wave ….
(stages 3 and 4) sleep decreases and stage 1 increases which makes us easier to wake
- -> heighten incidence of insomnia
- -> over 65
Narcolepsy
- loss of the chemical hypocretin in the hypothalamus
- cataplexy
- dysregulation of sleep stages (fast movement into deep sleep = muscle paralysis at dangerous times)
Breathing-Related Sleep Disorders: Apnea and Snoring
- airway closes partially or completely
- more likely in obese or sedated individuals (sleeping pills or alcohol)
- airway remain closed up to 90 seconds!
> usually sleeper reflexively sits up
> causes profound interruption in sleep as it occurs many times per night
> poor oxygenation
> highly disruptive to sleeping partner
Sleep apnea can make __________ much worse
narcolepsy
T or F. Typically, you can wake up from sleep apnea
T, up to 500x per night; more likely to occur in REM or stage 3/4
Treatment for Sleep Apnea
- Continuous positive air pressure (CPAP) machine - ensures that enough pressure in the back of throat so that tissue doesn’t collapse
- surgery, typically laser to remove excess tissue enlargements
Sleeping Beauty Syndrome
Kleine-Levin Syndrome (KLS): recurring periods of excessive amounts of sleep, behaviour changes, and impaired understanding of the world ; episodes may continue for ten years or more!
Treatment of Sleep-Wake Disorders
- Anxiolytics: should only be used short-term; many drugs can suppress REM sleep
- Psychological Approaches: cognitive-behavioural techniques lower physiological arousal and address sleep hygiene and emotional state
Sleep Terrors vs. Nightmares
Sleep terrors - more common in children and can increase their insomnia (tend to decrease overtime)
Nightmares - stay constant or increase over time
Nightmare Disorder
- during REM
- wakes up
- tend to remember dreams; true dreams
Sleep Terror
- Non-REM (stages 3 and 4)
- dream not remembered
- awaken confused and disoriented
Sleepwalking
- Non-REM
- don’t usually wake up
- often confused and disoriented if awoken
- little recollection of dream content
- ‘sexsomnia’ variant and nocturnal sleep-related eating disorder
Treatment of sleep disorders
- Biological: Benzodiazepines (anxiolytics - risk of dependence, diminished REM)
- Psychological: cognitive-behavioural techniques (people can develop anticipatory anxiety that may respond to identifying rational alternate thoughts)
