EATING, FEEDING AND SLEEP-WAKE DISORDERS

Obesity

The more overweight someone is at a

given height, the greater the risks to health.

Produced by the consumption of a greater number

of calories than are expended in energy

Bulimia Nervosa

out-of-control eating

episodes, or binges, are followed by self-induced vomiting,

excessive use of laxatives, or other attempts to purge (get rid

of) the food

Salivary gland enlargement

repeated vomiting

result to puff cheeks.

Electrolyte Imbalance

continued vomiting may

upset the chemical balance of bodily fluids, including

sodium and potassium levels.

Anorexia nervosa

the person eats nothing beyond

minimal amounts of food, so body weight sometimes drops

dangerously.

Restricting type

individuals’ diet to limit calorie

intake. Not engaged in recurrent episodes of binge

eating or purging behavior.

Binge-eating–purging type

they rely on purging.

Has engaged in recurrent episodes of binge eating

or purging behavior

Rumination Disorder

Repeated

regurgitation of food over a period of at least 1 month.

Regurgitated food may be re-chewed, re-swallowed, or spit

out.

Avoidant/Restrictive Food Intake Disorder

An eating or feeding disturbance (e.g., apparent

lack of interest in eating or food; avoidance based on the

sensory characteristic of food; concern about aversive

consequences of eating) as manifested by persistent failure

to meet appropriate nutritional and/or energy needs.

SLEEP-WAKE DISORDERS

interrupts sleep

Dyssomnia

involve difficulties in getting enough sleep,

problems with sleeping when you want to (not being able to

fall asleep until 2 a.m. when you have a 9 a.m. class), and

complaints about the quality of sleep, such as not feeling

refreshed even though you have slept the whole night.

Parasomnia

characterized by abnormal behavioral or

physiological events that occur during sleep, such as

nightmares and sleepwalking.

Polysomnographic (PSG) evaluation

evaluation

assesses an individual’s sleep habits with various electronic

tests to measure airflow, brain activity, eye movements,

muscle movements, and heart activity. Results are weighed

with a measure of sleep efficiency (SE), the percentage of

time spent asleep.

Actigraph

records the number of arm movements, and the

data can be downloaded into a computer to determine the

length and quality of sleep.

Sleep efficiency (SE)

percentage of time actually spent

asleep. To know the average number of hours the individual

sleeps each day.

Daytime sequelae

determine whether a person has a

problem with sleep; behavior while awake.

DYSSOMNIA

Disturbances in the timing, amount, or quality

of sleep.

Insomnia Disorder

Difficulty falling

asleep at bedtime, problems staying asleep throughout the

night, or sleep that does not result in the person feeling

rested even after normal amounts of sleep.

Microsleeps

a sleep that last several seconds or

longer

Primary insomnia

sleep problems were not related to other medical or psychiatric problems.

Hypersomnolence Disorders

involve sleeping too much (hyper means “in great amount” or

“abnormal excess”). Excessive sleepiness that is displayed

as either sleeping longer than is typical or frequent falling

asleep during the day

Narcolepsy

Episodes of irresistible attacks of refreshing

sleep occurring daily, accompanied by episodes of brief loss

of muscle tone (cataplexy)

Sleep paralysis

brief period after awakening

when they can’t move or speak that is often

frightening to those who go through it.

Hypnagogic hallucinations

vivid and often terrifying experiences that begin at the start of sleep

and are said to be unbelievably realistic because

they include not only visual aspects but also touch,

hearing, and even the sensation of body movement.

(e.g. being caught in a fire)

BREATHE-RELATED SLEEP DISORDERS

A variety of breathing disorders that occur during sleep and that lead to

excessive sleepiness or insomnia

Sleep apnea

breathing is constricted that there

may be short periods (10 to 30 seconds) when they

stop breathing altogether.

Sleep attacks

heavy sweating during the night,

morning headaches, and episodes of falling asleep

during the day with no resulting feeling of being

rested

Central sleep apnea

– involves the complete cessation of

respiratory activity for brief periods and is often associated

with certain central nervous system disorders, such as

cerebral vascular disease, head trauma, and degenerative

disorders

Sleep-related hypoventilation

decrease in airflow without

a complete pause in breathing. This tends to cause an

increase in carbon dioxide (CO2) levels, because insufficient

air is exchanged with the environment.

Circadian Rhythm Sleep Disorder

A discrepancy between the sleep–wake schedule required by a person to

be rested and the requirements of the person’s environment

(e.g., work schedules) that leads to excessive sleepiness or

insomnia

Jet lag type

rapidly crossing multiple time zones

Shift work type

people work at night or must work

irregular hours; as a result, they may have problems

sleeping or experience excessive sleepiness during

waking hours.

Delayed sleep phase type

Extreme night owls,

people who stay up late and sleep late.

dvanced sleep phase type

early to bed and early to rise

irregular sleep–wake type

people who experience highly varied sleep cycles.

non-24-hour sleep–wake type

sleeping on a 25- or 26-hour cycle with later and later bedtimes

ultimately going throughout the day

Episodic

Symptoms last at least 1 month but less than 3 months.

Persistent

Symptoms last 3 months or longer.

Recurrent

Two or more episodes occur within the

space of 1 year.

PARASOMNIAS

Abnormal behaviors that occur during

sleep.

Sleep Terrors

Recurrent episodes of abrupt terror arousals

from sleep, usually beginning with a panicky scream. There

is intense fear and signs of autonomic arousal, such as

mydriasis, tachycardia, rapid breathing, and sweating, during

Sleepwalking

somnambulism; occurs during NREM sleep.

Repeated episodes of rising from bed during sleep and

walking about. While sleepwalking, the person has a blank,

staring face; is relatively unresponsive to the efforts of others

to communicate with him or her; and can be awakened only

with great difficulty.

Non-Rapid Eye Movement Sleep Arousal Disorders

Recurrent episodes of incomplete awakening from sleep

usually occurring during the first third of the major sleep

episode.

Nightmares (or nightmare disorder)

occur during REM or dream, sleep terrors, and incomplete

awakening. Repeated occurrences of extended, extremely

dysphoric, and well-remembered dreams that usually involve

efforts to avoid threats to survival, security or physical

integrity and that generally occur during the second half of

the major sleep episode

Substance-Induced Sleep Disorder

Severe sleep disturbance that is the result of substance intoxication or

withdrawal.

Treatment for Bulimia Nervosa

Drug treatment, such as

antidepressants. Short-term cognitive-behavioral therapy

(CBT) to address behavior and attitudes on eating and body

shape. Interpersonal psychotherapy (IPT) to improve

interpersonal functioning. Tends to be chronic if left untreated

Treatment for Anorexia Nervosa

Hospitalization (at 70%

below normal weight). Outpatient treatment to restore weight

and correct dysfunctional attitudes on eating and body shape.

Family therapy. Tends to be chronic if left untreated; more

resistant to treatment than bulimia.

Treatment for Binge-Eating Disorder

Short-term CBT to

address behavior and attitudes on eating and body shape.

IPT to improve interpersonal functioning. Drug treatments

that reduce feelings of hunger. Self-help approached.