Eating and Sleeping Disorders PDF

Eating and Sleeping Disorders Tags Done Book Chapters Barlow (8) ; Kring (11) Main @03/08/2024 Major Types of Eating Disorders Overview bulimia nervosa → out-of-contro...

Eating and Sleeping Disorders Tags Done Book Chapters Barlow (8) ; Kring (11) Main @03/08/2024 Major Types of Eating Disorders Overview bulimia nervosa → out-of-control eating episodes (binges) followed by self-induced vomiting, excessive use of laxatives, or other attempts to purge the food anorexia nervosa → person eats only minimal amounts of food or exercises vigorously to offset food intake so body weight sometimes drops dangerously has the highest mortality rate of any psychological disorder, including depression binge-eating disorder → individuals may binge repeatedly and find it distressing, but they do not attempt to purge the food the chief characteristic of eating disorders is an overwhelming, all-encompassing drive to be thin unlike most others, the strongest contributions to etiology seem to be sociocultural rather than psychological or biological factors Bulimia Nervosa Clinical Description hallmark is eating a larger amount of food—typically, more junk food than fruits and vegetables—than most people would eat under similar circumstances just as important as the mount of food eaten is that the eating is experienced as out of control the individual attempts to compensate for the binge eating and potential weight gain, almost always by purging techniques Eating and Sleeping Disorders 1  include self-induced vomiting immediately after eating, using laxatives, and diuretics (drugs that result in loss of fluid through greatly increased frequency of urination some people use both methods; others attempt to compensate in other ways some exercise excessively (although it is more characteristic of anorexia nervosa) fasting for long periods between binges purging is not a particularly efficient method of reducing caloric intake vomiting reduces approx. 50% of calories just consumed—less if it is delayed at all laxatives and related procedures have little effect, acting, as they do, so long after the binge the major features of the disorder (bingeing, purging, overconcern with body shape, and so on) “cluster together in someone with this problem Medical Consequences repeated vomiting causes: salivary gland enlargement, which gives the face a chubby appearance erode the dental enamel on the inner surface of the front teeth tear the esophagus may upset the chemical balance of bodily fluids, including sodium and potassium levels called electrolyte imbalance results in conditions such as cardiac arrythmia, seizures, and renal failure if left unattended intestinal problems due to laxative abuse causes: severe constipation permanent colon damage people with bulimia have marked calluses on their fingers or the backs of their hands cause by the friction contact with the teeth and throat when repeatedly sticking their Eating and Sleeping Disorders 2  fingers down their throat to stimulate the gag reflex Associated Psychological Disorders usually anxiety and mood disorders patients with anxiety disorders do not necessarily have elevated rates of eating disorders mood disorders, particularly depression, also commonly co-occur with bulimia one prominent theory suggests that eating disorders are simply a way of expressing depression evidence shows that depression follows bulimia and may be a reaction to it substance abuse commonly accompanies bulimia nervosa Anorexia Nervosa literally means “nervous loss of appetite” they are so successful at losing weight that they put their lives in considerable danger both anorexia and bulimia are characterized by a morbid fear of gaining weight and losing control over eating the major difference seems to be whether the individual is successful at losing weight people with anorexia are proud of their diets and extraordinary control people with bulimia are ashamed of both their eating issues and their lack of control Clinical Description it is less common than bulimia many individuals with bulimia have a history of anorexia; that is, they once used fasting to reduce their body weight below desirable levels the core of the disorder the the intense fear of obesity which causes them to relentlessly pursue thinness decreased body weight is the most notable feature the disorder most commonly begins in an adolescent who is overweight or who perceives themselves to be Eating and Sleeping Disorders 3  they then start a diet that escalates into an obsessive preoccupation with being thing severe, almost punishing exercise is common dramatic weight loss is achieved through severe caloric restriction or by combining caloric restriction and purging specifiers: restricting type → individuals diet to limit calorie intake during the past 3 months eating-purging type → rely on purging during the past 3 months they binge on relatively small amounts of food and purge more consistently, in some cases each time they eat individuals with anorexia are never satisfied with their weight loss staying the same weight from one day to the next or gaining any weight is likely to cause intense panic, anxiety, and depression only continued weight loss everyday for weeks on end is satisfactory they may agree they are underweight and need to gain a few pounds—but they do not really believe it themselves Medical Consequences cessation of menstruation (amenorrhea), which occurs relatively often in bulimia dry skin, brittle hair or nails, and sensitivity to or intolerance of cold temperatures lanugo → downy hair on the limbs and cheeks cardiovascular problems → chronically low blood pressure and heart rate if vomiting is part of anorexia, electrolyte imbalance and resulting cardiac and kidney problems can result Associated Psychological Disorders anxiety disorders and mood disorders are often present in individuals with anorexia one anxiety disorder that seems to co-occur is obsessive-compulsive disorder substance abuse is also common in individuals with anorexia nervosa Eating and Sleeping Disorders 4  Binge-Eating Disorder experience marked distress of binge eating but do not engage in extreme compensatory behaviors greater likelihood of occurring in males and a later age of onset greater likelihood of remission and a better response to treatment compared with other eating disorders about half of individuals with BED try dieting before bingeing and half start with bingeing and then attempt to diet those who begin bingeing first become more severely affected by BED and are more likely to have additional disorders approx. 33% of those with BED binge to alleviate “bad moods” or negative affect Statistics “subthreshold BED” → binge eating occurred at a high enough frequency but some additional criteria, such as “marked distress” regarding the binge eating, were not met the disorder did not meet the diagnostic threshold for BED many cases of anorexia and BED, but not bulimia, begin after age 18 for younger cases of anorexia → age 15 for younger cases of bulimia → age 10 median age of onset for all eating-related disorders → 18-21 years the course of bulimia and anorexia are chronic, but anorexia is not as chronic as bulimia Cross-Cultural Considerations major risk factors for eating disorders in all groups included being overweight, higher social class, and acculturation to the majority anorexia and bulimia are relatively homogeneous, and both—particularly bulimia— were overwhelmingly associated with Western cultures until recently Developmental Considerations majority of cases begin in adolescence Eating and Sleeping Disorders 5  differential patterns of physical development in girls and boys interact with cultural influences to create eating disorders after puberty, girls gain weight primarily in fat tissue, whereas boys develop muscle and lean tissue as the ideal look in Western countries is tall and muscular for men and thing and prepubertal for women, physical development brings boys closer to the ideal and takes girls further away both bulimia and anorexia can occur in later years, particularly after the age of 55 generally, concerns about body image decrease with age Causes of Eating Disorders Social Dimensions anorexia and particularly bulimia are the most culturally specific psychological disorders yet identified for young females in competitive environments, self-worth, happiness, and success are largely determined by body measurements and percentage of body fat, factors that have little or no correlations with personal happiness and success in the long run the risk for developing eating disorders was directly related to the extent to which women internalize or “buy in” to media messages and images glorifying thinness men generally desire to be heavier and more muscular than they are if your friends tend to use extreme dieting or other weight-loss techniques, there is a greater chance that you will, too adolescent girls simply tend to choose friends who already share these attitudes one of the reasons attempts to lose weight may lead to eating disorders is that weight- reduction efforts in adolescent girls are more likely to result in weight gain than weight loss repeated cycles of “dieting” seems to produce stress-related withdrawal symptoms in the brain, much like other addictive substances, resulting in more eating that would have occurred without dieting Eating and Sleeping Disorders 6  reverse anorexia nervosa particularly in male weight lifters men with this syndrome reported they were extremely concerned about looking small, even though they were muscular they avoided beaches, locker rooms, and other places where their bodies might be seen were prone to using anabolic-androgenic steroids to bulk up, risking both the medical and the psychological consequences of taking steroids in adolescence, cultural standards are often experienced as peer pressure and are more influential than reason and fact Dietary Restraint dieting is one factor that can contribute to eating disorders, and, along with dissatisfaction with one’s body, is a primary risk factor for later eating disorders Family Influences the “typical” family of someone with anorexia is successful, hard-driving, concerned about external appearances, and eager to maintain harmony to accomplish these goals, family members often deny or ignore conflicts or negative feelings and tend to attribute their problems to other people at the expense of frank communication among themselves mothers of girls with disordered eating seemed to act as “society’s messengers” in wanting their daughters to be thin whatever the preexisting relationships, after the onset of an eating disorder, particularly anorexia, family relationships can deteriorate quickly Biological Dimensions eating disorders run in families and thus seem to have a genetic component nonspecific personality traits such as emotional instability and, perhaps poor impulse control might be inherited a person might inherit a tendency to be emotionally responsive to stressful life events and, as one consequence, might eat impulsively in an attempt to relieve Eating and Sleeping Disorders 7  stress and anxiety the biological vulnerability of having perfectionist traits, along with negative affect might interact with social and psychological factors to produce an eating disorder low levels of serotonergic activity (system most often associated with eating disorders) are associated with impulsivity generally and binge eating specifically emotional eating behavior (eating relative to stress or anxiety) and binge eating frequencies peaked in the postovulatory phases of the menstrual cycle for all women whether they binged or not during other phases of their cycle high levels of hormones at least partially accounted for these peaks some neurobiological abnormalities do exist in people with eating disorders but they may be a result of semi-starvation or a binge-purge cycle rather than a cause, although they may well contribute to the maintenance of the disorder once it is established Psychological Dimensions young women with eating disorders have a diminished sense of personal control and confidence in their own abilities and talents this may manifest as strikingly low self-esteem they display more perfectionistic attitudes, perhaps learned or inherited from their familities perfectionism alone is only weakly associated with the development of an eating disorder, because individuals must consider themselves overweight and manifest low self-esteem before the trait of perfectionism makes a contribution when perfectionism is directed to distorted perception of body image, a powerful engine to drive eating disorder behavior is in place they feel like impostors in their social groups and experience heightened levels of social anxiety which may explain why they choose social groups with similar attitudes towards eating and body shape rather minor events related to eating may activate fear of gaining weight, further distortions in body image, and corrective schemes such as purging Eating and Sleeping Disorders 8  Treatment of Eating Disorders Drug Treatments there is some evidence that drugs may be useful for some people with bulimia, particularly during the bingeing and purging cycle most effective are antidepressants proven effective for anxiety and mood disorders (Prozac) effectiveness is usually measured by reductions in the frequency of binge eating, as well as by the percentage of patients who stop binge eating and purging altogether SSRIs are helpful in treating bulimia the available evidence suggests that antidepressant drugs alone do not have substantial long-lasting effects on bulimia nervosa medications are likely most useful in conjunction with psychological treatments Psychological Treatments Cognitive-Behavioral Therapy-Enhanced (CBT-E) pioneered by Fairburn CBT directed at causal factors common to all eating disorders are targeted in an integrated way the principal focus of this protocol is on the distorted evaluation of body shape and weight and maladaptive attempts to control weight in the form of strict dieting, possibly accompanied by binge eating, and methods to compensate for overeating Bulimia Nervosa Process: first stage is teaching the patient the ff: physical consequences of binge eating and purging ineffectiveness of vomiting and laxative abuse adverse effects of dieting patients are scheduled to eat small, manageable amounts of food five or six times per day with no more than a 3-hour interval between any planned Eating and Sleeping Disorders 9  meals and snacks, which eliminates the alternating periods of overeating and dietary restriction that are hallmarks of bulimia in later stages, CBT-E focuses on altering dysfunctional thoughts and attitudes about body shape, weight, and eating coping strategies for resisting the impulse to binge and/or purge are also developed, including arranging activities so that the individual will not spend time alone after eating during the early stages of treatment Evaluation: superior efficacy to credible alternative psychological treatments not only for bingeing and purging but also for distorted attitudes and accompanying depression these results seem to last Family Therapy directed at the painful conflicts present in families with an adolescent who has an eating disorder can be helpful integrating family and interpersonal strategies into CBT is a promising new direction Binge-Eating Disorder stopping binge eating is critical to sustaining weight loss in obese patients, a finding consistent with other studies of weight-loss procedures interpersonal therapy (IPT) is every bit as effective as CBT for binge eating the positive results from CBT were reasonably durable at follow up 1 year later self-help procedures CBT delivered as guided self-help was demonstrated to be more effective than a standard behavioral weight-loss program for BED it would seem that a self-help approach should probably be the first treatment offered for BED before engaging in more expensive and time- consuming therapist-led treatments Anorexia Nervosa Eating and Sleeping Disorders 10  the most important initial goal is to restore the patient’s weight to a point that is at least within the low-normal range inpatient treatment is recommended if: body weight is below approx. 75% of the average healthy body weight if weight has been lost rapidly and the individual continues to refuse food restoring weight is probably the easiest part of treatment the gain is often as much as a half-pound a day until weight is within the normal range without attention to the patient’s underlying dysfunctional attitudes about body shape, as well as interpersonal disruptions in their life, they will almost always relapse for restricting type, the focus of treatment must shift to their marked anxiety over becoming obese and losing control of eating, as well as to their undue emphasis on thinness as a determinant of self-worth, happiness, and success extended (1 year) outpatient CBT was found to be significantly better than continued nutritional counseling in preventing relapse after weight restoration Family Therapy the negative and dysfunctional communication in the family regarding food and eating must be eliminated and meals must be made more structured and reinforcing attitudes toward body shape and image distortion are discussed at some length in family sessions Family-Based Treatment parents become intimately involved in the treatment program with a focus on facilitating weight gain Eating and Sleeping Disorders 11  was at least effective and less costly than other forms of family therapy addressing general family processes has the most support from clinical trials for treating adolescents with anorexia Preventing Eating Disorders focusing on eliminating an exaggerated focus on body shape or weight and encouraging acceptance of one’s body stood the best chance of success in preventing eating disorders widespread educational and intervention efforts are clearly preferable than waiting until the disorders develop Obesity BMI 30 or higher Disordered Eating Patterns in Cases of Obesity two forms of maladaptive eating patterns: binge eating night eating syndrome consuming 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, they are not hungry and do not usually eat breakfast they do not binge during their night eating and seldom purge Causes the promotion of an inactive, sedentary lifestyle and the consumption of a high-fat, energy-dense diet is the largest single contributor to the obesity epidemic genetic contributions may constitute a smaller portion of the cause of obesity than cultural factors genes influence the number of fat cells and individual has, the likelihood of fat storage, saiety, and, most likely, activity levels Eating and Sleeping Disorders 12  genes are thought to account for about 30% of the equation in causation of obesity individuals with addictive obese eating behavior (includes less control over eating and feelings of withdrawal if access to food is limited) show similar patterns of reward neurocircuitry in the brain as do individuals with substance use disorders Treatment treatment is usually organized in a series of steps from least intrusive to most intrusive depending on the extent of obesity Self-directed weight-loss program in individuals who buy a popular diet book most usual result is that some individuals may lose some weight in the short term but almost always regain that weight Commercial self-help programs these programs stand a better chance of achieving some success, at least compared with self-directed programs Behavior modification programs most successful programs combination of restricted calorie intake, increased physical activity, and behavior therapy tends to lead to more weight loss than any of these components on their own for individuals who have become more dangerously obese, very low-calorie diets and possibly drugs, combined with behavior modification programs are recommended Bariatric surgery surgical approach to extreme obesity usually more successful than diets, with patients losing approx. 20% to 30% of their body weight postoperatively and maintaining these results over a number of years if the surgery is successful, risk of death from obesity-related diseases such as diabetes is reduced substantially Eating and Sleeping Disorders 13  Sleep-Wake Disorders: The Major Dyssomnias Overview the limbic system may be involved with anxiety as well as our dream sleep, referred to as rapid eye movement (REM) sleep mutual neurobiological connection suggests that anxiety and sleep may be interrelated in important ways Dyssomnias involve difficulties in getting enough sleep, problems with sleeping when you want to, and complaints about the quality of sleep Parasomnias characterized by abnormal behavioral or physiological events that occur during sleep, such as nightmares and sleepwalking Polysomnographic (PSG) Evaluation determines the clearest and most comprehensive picture of your sleep habits patient spends one or more nights sleeping in a sleep laboratory and being monitored on a number of measures: respiration and oxygen desaturation leg movements brain wave activity → electroencephalogram (EEG) eye movements → electrooculogram muscle movements → electromyogram heart activity → electrocardiogram daytime behavior and typical sleep patterns are also noted Actigraph alternative to PSG evaluation Eating and Sleeping Disorders 14  wristwatch-size device that 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 percentage of time actually spent asleep, not just lying in bed trying to sleep calculated by dividing the amount of time sleeping by the amount of time in bed SE = 100% → you fall asleep as soon as your head hits the pillow SE = 50% → you spend half of your time trying to fall asleep Insomnia Disorder Clinical Description insomnia is one of the most common sleep-wake disorders a.k.a. primary insomnia because the sleep problems are not related to other medical or psychiatric problems having trouble both initiating and maintaining sleep others sleep all night but still feel as if they’ve been awake for hours although most people can carry out necessary day-to-day activities, their inability to concentrate can have serious consequences Statistics total sleep time often decreases with depression, substance use disorders, anxiety disorders, and neurocognitive disorder due to Alzheimer’s disease alcohol is often used to initiate sleep in small amounts, it helps make people drowsy, but it also interrupts ongoing sleep interrupted sleep causes anxiety, which often leads to repeated alcohol use and an obviously vicious cycle women report insomnia twice as often as men protective factors: moderate alcohol and caffeine use and following a Mediterranean diet Eating and Sleeping Disorders 15  Causes sometimes insomnia is related to problems with the biological clock and its control of temperature some people who can’t fall asleep at night may have a delayed temperature rhythm their body temperature doesn’t drop, and they don’t become drowsy until later at night people with insomnia seem to have higher body temperature than good sleepers, and their body temperatures seem to vary less people with insomnia may have unrealistic expectations about how much sleep they need and about how disruptive disturbed sleep will be our thoughts alone may disrupt our sleep → role of cognition it is generally accepted that people suffering from sleep problems associate the bedroom and bed with the frustration and anxiety that go with insomnia Hypersomnolence Disorders involve sleeping too much includes not only the excessive sleepiness but also the subjective impression of this problem people with hypersomnolence sleep through the night and appear rested upon awakening but still complain of being excessively tired throughout the day sleep apnea can cause a similar excessive sleepiness they have difficulty breathing at night they often snore loudly, pause between breaths, and wake in the morning with a dry mouth and a headache the clinician must first rule out insomnia, sleep apnea, or other reasons for sleepiness during the day Narcolepsy in addition to daytime sleepiness, some people with narcolepsy experience cataplexy Eating and Sleeping Disorders 16  sudden loss of muscle tone occurs while the person is awake and can range from slight weakness in the facial muscles to complete physical collapse lasts from several seconds to several minutes and is usually preceded by strong emotion such as anger or happiness appears to result from a sudden onset of REM sleep instead of falling asleep normally and going through the four NREM stages that typically precede REM sleep, people with narcolepsy periodically progress right to this dream-sleep stage almost directly from the state of being awake Two other characteristics 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 not only visual aspects but also touch, hearing, and even the sensation of body movement excessive sleepiness usually occurs first, with cataplexy appearing either at the same time or with a delay of up to 30 years the cataplexy, sleep paralysis, and hypnagogic hallucinations often decrease in frequency over time, although sleepiness during the day does not seem to diminish with age sleep paralysis and hypnagogic hallucinations do occur in a portion of people without narcolepsy sleep paralysis commonly co-occurs with anxiety disorders, in which case the condition is termed isolated sleep paralysis Breathing-Related Sleep Disorders 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 of sleep Eating and Sleeping Disorders 17  for all of us, the muscles in the upper airway relax during sleep, constricting the passageway somewhat and making breathing a little more difficult for some, breathing is constricted a great deal and may be labored → hypoventilation in the extreme, there may be short periods (10 to 30 seconds) when they stop breathing altogether → sleep apnea often the affected person is only minimally aware of breathing difficulties and doesn’t attribute sleep problems to the breathing signs of the breathing difficulties: loud snoring frightening episodes of interrupted breathing heavy sweating during the night morning headaches episodes of falling asleep during the day with no resulting feeling of being rested → sleep attacks Three types of apnea: Obstructive Sleep Apnea Hypopnea Syndrome occurs when airflow stops despite continued activity by the respiratory system in some people, the airway is too narrow; in others, some abnormality or damage interferes with the ongoing effort to breathe report snoring at night Central Sleep Apnea involves the complete cessation of respiratory activity for brief periods often associated with certain central nervous system disorders, such as cerebral vascular disease, head trauma, and degenerative disorders they wake up frequently during the night but they tend not to report excessive daytime sleepiness and often are not aware of having a serious breathing problem Sleep-Related Hypoventilation decrease in airflow without a complete pause in breathing Eating and Sleeping Disorders 18  tends to cause an increase in carbon dioxide levels, because insufficient air is exchanged with the environment Circadian Rhythm Sleep Disorder characterized by disturbed sleep (either insomnia or hypersomnolence) brought on by the brain’s inability to synchronize its sleep patters with the current patterns of day and night there are several bodily rhythms that are self-regulated because these rhythms don’t exactly match our 24-hour day, they are called circadian out brains have a mechanism that keeps us in sync with the outside world our biological clock is in the suprachiasmatic nucleus in the hypothalamus connected to the suprachiasmatic nucleus is a pathway that comes from our eyes the light we see in the morning and the decreasing light at night signal the brain to reset the biological clock each day some people have trouble sleeping when they want to because of problems with their circadian rhythms Types: Causes Outside the Person: jet lag type → caused by rapidly crossing multiple time zones usually report difficulty going to sleep at the proper time and feeling fatigued during the day shift work type → associated with work schedules many people work at night or must work irregular hours they may have problems sleeping or experience excessive sleepiness during waking hours working rotating shifts is consistently predictive of poor sleep Causes Within the Person: delayed sleep phase type → extreme night owls, people who stay up late and sleep late Eating and Sleeping Disorders 19  sleep is delayed or there is a later than normal bedtime advanced sleep phase type → “early to bed and early to rise” sleep is advanced or earlier than normal bedtime 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 Melatonin believed to contribute to the setting of our biological clocks that tell us when to sleep produced by the pineal gland in the center of the brain nicknamed the “Dracula hormone” because its production is stimulated by darkness and ceases in daylight Treatment of Sleep Disorders Medical Treatments Insomnia: prescribed one of several benzodiazepine or related medications short-acting drugs → those that cause only brief drowsiness triazolam (Halcion) zaleplon (Sonata) zolpidem (Ambien) long-acting drugs flurazepam (Dalmane) short-acting drugs are preferred, because the long-acting drugs sometimes do not stop working by morning and people report more daytime sleepiness long-acting medications are sometimes preferred when negative effects such as daytime anxiety are observed in people taking the short-acting drugs Eating and Sleeping Disorders 20  newer medications, such as those that work directly with the melatonin system are also being developed drawbacks: benzodiazepine medications can cause excessive sleepiness people can easily become dependent on them and rather easily misuse them, deliberately or not these medications are meant for short-term treatment and are not recommended for use longer than 4 weeks longer use can cause dependence and rebound insomnia they may increase the likelihood of sleep-walking-related problems, such as sleep-related eating disorder Hypersomnolence or Narcolepsy: stimulant such as methylphenidate (Ritalin) or modafinil Cataplexy: can be treated with antidepressant medication as they suppress REM sleep sodium oxybate Breathing-Related Sleep Disorders helping the person breathe during sleep recommending weight loss as people who are obese have soft neck tissue that compresses the airways for obstructive sleep apnea, continuous air pressure (CPAP) machine patients wear a mask that provides slightly pressurized air during sleep and it helps them breathe more normally throughout the night severe breathing problems may require surgery to help remove blockages in parts of the airways didgeridoo → long instrument made from tree limbs hollowed out by termites for mild apnea people who practiced using this wind instrument had less daytime sleepiness Eating and Sleeping Disorders 21  Environmental Treatments general principle for treating circadian rhythm disorders: phase delays (moving bedtime later) are easier than phase advances (moving bedtime earlier) it is easier to stay up several hours later then usual than to force yourself go to sleep several hours earlier people can best readjust their sleep patterns by going to bed several hours later each night until bedtime is at the desired hour drawback: it requires the person to sleep during the day for several days, which is difficult for people with regularly schedules responsibilities phototherapy using bright light to trick the brain into readjusting the biological clock may help people with circadian rhythm problems readjust their sleep patterns several hours of exposure to this bright light have successfully reset the circadian rhythms of many individuals Psychological Treatments relaxation treatments reduce the physical tension that seems to prevent some people from falling asleep at night cognitive treatment may also focus on worries about sleep itself, such as by helping patients to change their assumptions that they can’t function well on little sleep, which can trigger anxiety that disrupts falling asleep for adult sleep problems, stimulus control may be recommended people are instructed to use the bedroom only for sleeping and for sex and not for work or other anxiety-provoking activities progressive relaxation or sleep hygiene (changing daily habits that mat interfere with sleep) alone may not be as effective as stimulus control alone for some people psychological treatment of insomnia takes the form of a “package” of different skills known as cognitive-behavioral therapy for insomnia (CBT-i) Eating and Sleeping Disorders 22  CBT may be more successful treating sleep disorders in older adults than a medical intervention for young children, treatment often includes setting up bedtime routines such as a bath, followed by a parent’s reading a story, to help them sleep at night graduated extinction has been used with some success for bedtime problems, as well as for waking up at night Prevention sleep hygiene changes in lifestyle that is easy to follow and help avoid problems such as insomnia for some people recommendations rely on allowing the brain’s normal drive for sleep to take over, replacing the restrictions we place on our activities that interfere with sleep: setting a regular time to go sleep and awaken each day can help make falling asleep at night easier avoiding the use of caffeine and nicotine—both stimulants—can also help prevent nighttime awakening Parasomnias and Their Treatment these are not problems with sleep itself but abnormal events that occur either during sleep or during that twilight time between sleeping and waking Nightmare Disorder occur during REM sleep these experiences must be so distressful that they impair a person’s ability to carry on normal activities (such as making the person too anxious to try to sleep at night) nightmares vs. bad dreams nightmares → disturbing dreams that awaken the sleeper bad dreams → those that do not awaken the sleeper treatment → psychological intervention and pharmacological intervention (i.e. prazosin) Eating and Sleeping Disorders 23  Disorder of Arousal includes a number of motor movements and behaviors during NREM sleep Sleep terrors most commonly afflict children usually begins with a piercing scream the child is extremely upset, often sweating, and frequently has rapid heartbeat they occur during NREM sleep and therefore are not caused by frightening dreams during episodes, children cannot be easily awakened and comforted and they do not remember sleep terrors treatment usually begins with a recommendation to wait and see if they disappear on their own scheduled awakenings awaken the child briefly approx. 30 minutes before a typical episode (these usually occur around the same time each evening) Sleepwalking a.k.a. somnambulism occurs during NREM sleep, so people are not acting out a dream typically occurs during the first few hours while a person is in the deep stages of sleep DSM-5 requires that the person leave the bed although less active episodes can involve small motor behaviors, such as sitting up in bed and picking at the blanket or gesturing waking someone during an episode is difficult; if the person is wakened, they typically will not remember what has happened mostly, the course of sleepwalking is short, and few people over the age of 15 continue to exhibit this parasomnia factors such as extreme fatigue, previous sleep deprivation, the use of sedative or hypnotic drugs, and stress have been implicated Eating and Sleeping Disorders 24  Nocturnal Eating Syndrome when individuals rise from their beds and eat while they are still asleep vs. Night Eating Syndrome this is considered a part of the eating disorders and this is when people eat a third of their normal food after dinner they do this awake Sexsomnia acting out sexual behaviors such as masturbation and sexual intercourse with no memory of the event Eating and Sleeping Disorders 25