T9: Eating Disorders and Sleep-Wake Disorders

• Pica Disorder is a childhood disorder in which a child eats nonfood substances for extended periods.
• Rumination Disorder is a repeated regurgitation of foods.
• Bulimia nervosa is an eating disorder that is 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. The hallmark of it is eating a larger amount of food--typically, more junk food than fruits and vegetables.
• In anorexia nervosa (which means a "nervous loss of appetite" --an incorrect definition) is an eating disorder in which the person eats nothing beyond minimal amounts of food, so body weight sometimes drops dangerously. It is associated with an intense fear of obesity and relentlessly purse thinness. It is also often present with anxiety and mood disorders, as well as, OCD.
• In binge-eating disorder, individuals may binge repeatedly and find it distressing, but they do not attempt to purge the food.
• Electrolyte imbalance is one of the medical consequences of chronic bulimia caused by continued vomiting upsetting chemical balance of bodily fluids, including sodium and potassium levels. It can result in serious medical conditions if unattended, including cardiac arrhythmia (disrupted heartbeat), seizures, and renal (kidney) failure.
• DSM-5 specifies two subtypes of anorexia nervosa. In the restricting type, individuals diet to limit calorie intake; in the binge-eating–purging type, they rely on purging.
• One common medical complication of anorexia nervosa is cessation of menstruation (amenorrhea), which also occurs relatively often in bulimia. This feature can be an objective physical index of the degree of food restriction but is inconsistent because it does not occur in all cases.
• Purging Techniques:

  • Vomiting
  • Laxatives (drugs that relieve constipation)
  • Diuretics (drugs that result in fluids through greatly increased frequency or urination)
• Reverse anorexia nervosa is an eating disorder syndrome in men in which they were extremely concerned about looking small, even though they were muscular.
• Night eating syndrome consumes 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.
• Nocturnal eating syndrome are individuals who get up during the night and raid the refrigerator but never wake up. They also may eat uncooked or other dangerous foods while asleep.
• Sleep–wake disorders are divided into two major categories: dyssomnias and parasomnias.
• Dyssomnias is sleep-wake disorder 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.
• Parasomnias is sleep-wake disorder characterized by abnormal behavioral or physiological events that occur during sleep, such as nightmares and sleepwalking.
• Polysomnographic (PSG) determines the clearest and most comprehensive picture of sleep habits.
• Actigraph is a wristwatch-size instrument that records the number of arm movements, and the data can be downloaded into a computer to determine the length and quality of sleep.
• Insomnia is one of the most common sleep-wake disorders. It is being awake all the time. People who experience this have trouble falling asleep at night (difficulty initiating sleep), if they wake up frequently or too early and can’t go back to sleep (difficulty maintaining sleep), or even if they sleep a reasonable number of hours but are still not rested the next day (non-restorative sleep).
• Sleep apnea is a sleep disorder that involves obstructed nighttime breathing.
• Periodic limb movement disorder is a sleep disorder that involves excessive jerky leg movements.
• Hypersomnolence disorder involves in sleeping too much. In identifying it, the clinician needs to rule out insomnia, sleep apnea, or other reasons for sleepiness during the day.
• Narcolepsy is a sleep disorder that affects the ability to wake and sleep. People with it have intense, uncontrollable daytime sleepiness. They may suddenly fall asleep at any time during any type of activity. Normally, people are going through the four nonrapid eye movement (NREM) stages that typically precede REM sleep, but in this case, it progresses right to this dream-sleep stage almost directly from the state of being awake.
• Two other characteristics of narcolepsy:

  • Sleep paralysis - a brief period after awakening when they can’t move or speak.
  • Hypnagogic hallucinations - vivid and often terrifying experiences that begin at the start of sleep and are said to be unbelievably realistic because they include visual aspects but also touch, hearing, and even the sensation of body movement.
• Cataplexy is a condition that experiences a sudden loss of muscle tone. It occurs while the person is awake and can range from slight weakness in the facial muscles to complete physical collapse. It lasts from several seconds to several minutes; it is usually preceded by strong emotion such as anger or happiness.
• Three types of apnea:

  • Obstructive
  • Central
  • Mixed sleep apnea
• Obstructive Sleep Apnea-Hypoapnea Syndrome (OSAHS) is a breathing-related sleep disorder that occurs when airflow stops despite continued activity by the respiratory system. Everyone in a group of people with this condition reported snoring at night.
• Central sleep apnea is a breathing-related sleep disorder 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 is a breathing-related sleep disorder in which there is a decrease in airflow without a complete pause in breathing.
• Circadian Rhythm Sleep Disorder is a sleep disorder characterized by disturbed sleep (either insomnia or excessive sleepiness during the day) brought on by the brain’s inability to synchronize its sleep patterns with the current patterns of day and night.
• Several types of circadian rhythm sleep disorders:

  1. Jet lag type is caused by rapidly crossing multiple time zones.
  2. Advance sleep phase type is "early to bed and early to rise." Sleep is advanced or earlier than normal bedtime.
  3. Delayed sleep phase type are people who stay up late and sleep late. Sleep is delayed or later than normal bedtime.
  4. Irregular sleep-wake type are people who experience highly varied sleep cycles.
  5. Non-24-hour sleep-wake type are people who sleeps on a 25 or 26-hour cycle with later bedtimes all day.
  6. Shift work type is associated with work schedules.
• Melatonin is a hormone produced by the pineal gland that contributes to the setting of our biological clocks that tell us when to sleep.
• Nightmare disorders are disturbed dreams or bad dreams experiences that is distressful causing to impair a person's ability to carry on normal activities (such as making a person too anxious to try to sleep at night).