Student Notes Abnormal Psych - Eating and Sleep Dis. PDF Feb 6 2024

SLEEP-WAKE AND FEEDING & EATING DISORDERS ELLEN KLAVER, M.ED PROVISIONAL PSYCHOLOGIST FEBRUARY 06, 2024 @ 6-9 PM ABNORMAL PSYCHOLOGY MACEWAN UNIVERISTY ABOUT YOUR SPEAKER EDUCATION RESEARCH Eating disorders Insomnia Borderline Personality Disorder Anxiety Depression Pedophilia Education, Attitudes,...

SLEEP-WAKE AND FEEDING & EATING DISORDERS ELLEN KLAVER, M.ED PROVISIONAL PSYCHOLOGIST FEBRUARY 06, 2024 @ 6-9 PM ABNORMAL PSYCHOLOGY MACEWAN UNIVERISTY ABOUT YOUR SPEAKER EDUCATION RESEARCH Eating disorders Insomnia Borderline Personality Disorder Anxiety Depression Pedophilia Education, Attitudes, Beliefs sleepbetter.ed.research CLINICAL Emotion dysregulation Individual, group, parent DBT, CBT, EFT ng pi g ee tin Sl Ea Image retrieved from Hoon et al., 2020 AGENDA 1. Sleep: What is it and why do we do it?, etc. 2. Sleep-Wake Disorders: 10 diagnostic categories Diagnostic criteria, prevalence, treatment, etc. Break 3. Feeding & Eating Disorders: 8 diagnostic categories Diagnostic criteria, prevalence, treatment, etc. 4. Broader Relevance to Psychopathology Insomnia as a transdiagnostic factor Eating disorders sequalae SLEEP-WAKE DISORDERS A note about criteria and presentation: SLEEP-WAKE DISORDERS SLEEP: What is it and why do we need it? Types: NREM & REM Stages per cycle: 4 Stages 1, 2, 3 (NREM) Stage 4 (REM) Each cycle can last between 70 to 120 minutes Approx. 4 to 6 cycles/night 1. Brinkman (2023) Image retrieved from SleepFoundation.org SleepFoundation.org SLEEP-WAKEDISORDERS DISORDERS: Sleep – What is it? SLEEP-WAKE Sleep needs vary across the lifespan Humans spent 1/3 of their lives sleeping1,2 "Swiss army knife of health.”2 1. Buysse (2014) 2. Walker (2017) SLEEP-WAKE DISORDERS "...sleep-wake complaints of dissatisfaction regarding the quality, timing, and amount of sleep […] […] resulting daytime distress and impairment are core features shared by all sleep-wake disorders”2 Nighttime Daytime Sleep Wake Disorders 1. Buysse (2014) 2. American Psychological Association, 2013, p. 361 SLEEP-WAKE DISORDERS SLEEP-WAKE DISORDERS: 10 Diagnostic Categories 1. Insomnia Disorder 2. Hypersomnolence Disorder 3. Narcolepsy 4. Breathing-Related Sleep Disorders 5. Circadian Rhythm Sleep-Wake Disorders 6. Non-Rapid Eye Movement (NREM) Sleep Arousal Disorders 7. Nightmare Disorder 8. Rapid Eye Movement (REM) Sleep Behaviour Disorder 9. Restless Leg Syndrome 10. Substance/Medication Induced Sleep Disorder American Psychological Association, 2013 SLEEP-WAKE DISORDERS – Insomnia Disorder 1. Insomnia Disorder* Diagnostic Feature(s): predominant complaint of dissatisfaction with sleep quantity or quality of sleep with one or more of the following: - difficulty falling asleep - difficulty staying asleep, or - difficulty returning back to sleep/waking too early - … and are accompanied with daytime symptoms and dysfunction Frequency & Duration: at least 3 nights/week for at least 3 months Subtypes: primary and secondary American Psychological Association, 2013 SLEEP-WAKE DISORDERS – Insomnia Disorder Risk Factors : female (40% more likely) older adult comorbid health condition Prevalence : 10-15% general population* Assessment: sleep diary semi-structured interview self-report measures Treatment(s) : CBT-Insomnia benzodiazepines over-the counter meds Spielman et al. (1987). *varies across studies based how it is being defined and who is being studied American Psychological Association (2013) SLEEP-WAKE DISORDERS – Insomnia Disorder Prevalence rates of insomnia symptoms across the lifespan in general population American Psychological Association (2013), Calhoun et al. (2014), Dresser et al. (2013), Nunes & Bruni (2015) SLEEP-WAKE DISORDERS – Insomnia Disorder Prevalence rates of insomnia disorder among other health concerns American Psychological Association (2013); Swapna et al (2016) SLEEP-WAKE DISORDERS – Hypersomnolence Disorder 2. Hypersomnolence Disorder Diagnostic Feature(s): despite sleeping at least 7 hours/night, excessive sleepiness causing: - deteriorated quality of wakefulness, and/or - sleep inertia (drunkenness) Frequency & Duration: at least 3 times/week for at least 3 months American Psychological Association (2013) SLEEP-WAKE DISORDERS – Hypersomnolence Disorder Risk Factors: another sleep disorder another medical condition drug abuse nervous system dysfunction Prevalence: 4-6% general population Assessment: polysomnogram test sleep latency tests self-report measures sleep diary Treatment(s): stimulants lifestyle changes Image Retrieved from steinfortrespiratory.com.au/sleep-studies/ American Psychological Association (2013), National Sleep Foundation (2024) SLEEP-WAKE DISORDERS – Narcolepsy 3. Narcolepsy Diagnostic Feature(s): Excessive daytime sleepiness, lapsing into sleep even during activities, involuntary daytime sleep, and presence of at least one of the following: - cataplexy - hypocretin deficiency - abnormal REM results Frequency & Duration: at least 3 times/week for at least 3 months Specifiers: with or without cataplexy American Psychological Association (2013) SLEEP-WAKE DISORDERS – Narcolepsy Risk Factors: genetic predisposition immune system dysfunction hormone changes nervous system dysfunction Prevalence: 0.02-0.04% general population Assessment: polysomnogram test sleep latency tests self-report measures sleep diary hypocretin (orexin) level Treatment(s): anti-depressants stimulants lifestyle changes American Psychological Association (2013) SLEEP-WAKE DISORDERS – Breathing-Related Sleep Disorders 4. Breathing-Related Sleep Disorders Obstructive Sleep Apnea Hypopnea (OSAHS) Diagnostic Feature(s) : Repetitive episodes of airflow reduction (hypopnea) or cessation (apnea) due to upper airway collapse during sleep. Prevalence: 10- 20% of adults Central Sleep Apnea Diagnostic Feature(s) : lack of respiratory effort during cessations of airflow. Prevalence: 1% of adults Sleep-Related Hypoventilation Diagnostic Feature(s) : Breathing that is too slow or shallow during sleep resulting in hypoventilation Prevalence: very uncommon Image retrieved from lighthousedentalcentre.com American Psychological Association (2013) SLEEP-WAKE DISORDERS – Breathing-Related Sleep Disorders Risk Factors: Assessment: polysomnogram test Image retrieved from lighthousedentalcentre.com Treatment(s): continuous positive airway pressure (CPAP) - getting regular exercise, which may decrease symptoms even without weight loss - reducing BMI by losing weight - altering sleeping position to avoid back sleeping - reducing alcohol consumption Image retrieved from health.com American Psychological Association (2013) SLEEP-WAKE DISORDERS – Circadian Rhythm Sleep-Wake Disorders 5. Circadian Rhythm Sleep-Wake Disorders Shared Characteristic: the body's internal clock is out of sync with the environment Types: Delayed Sleep Phase Advanced Sleep Phase Irregular Sleep-Wake Non-24-Hour Sleep-Wake Shift Work American Psychological Association (2013) SLEEP-WAKE DISORDERS – Circadian Rhythm Sleep-Wake Disorders Delayed Sleep Phase (DSP) Type Diagnostic Feature(s): sleep delayed (2 or more hours) from conventional sleep pattern, resulting in later sleep onset and waking Frequency & Duration: at least 3 times/week for at least 3 months Prevalence : 0.17% in adults; 7-16% in adolescents Advanced Sleep Phase (ASP) Type Diagnostic Feature(s) : early sleep-wake (2 or more hours) from conventional sleep pattern, resulting in early sleep onset and waking Frequency & Duration : at least 3 times/week for at least 3 months Adapted from Barion & Zee (2007) Prevalence : Approx. 1% middle-aged adults, higher in older adults American Psychological Association (2013) SLEEP-WAKE DISORDERS – Circadian Rhythm Sleep-Wake Disorders Irregular Sleep-Wake Diagnostic Feature(s): No major sleep period, sleep fragmented into at least 3 periods during 24-hour day Prevalence: Unknown Non-24-Hour Sleep-Wake Diagnostic Feature(s): circadian rhythm is not aligned to 24-hour environmental clock; clock not respondent to light and darkness. Prevalence: 0.3% in sighted; up to 70% in people with blindness Shift Work Diagnostic Feature(s) : history of working outside normal daytime work window (8 am-6 pm) on regularly scheduled basis; excessive sleepiness at work and impaired sleep at home on a persistent basis Prevalence: up to 20% of people working nontraditional (i.e. night) shift work American Psychological Association (2013) SLEEP-WAKE DISORDERS – Circadian Rhythm Sleep-Wake Disorders Assessment polysomnogram test sleep diary medical/diagnostic tests (melatonin, cortisol) Treatment(s) Morning-bright light exposure Evening light restriction Melatonin Lifestyle & sleep hygiene Barion & Zee (2007) SLEEP-WAKE DISORDERS – Parasomnias - NREM 6. Non-Rapid Eye (NREM) Sleep Arousal Disorders Shared Characteristics: recurrent episodes of incomplete awakening from sleep, usually occurring during non-REM stage three (N3; slow wave) sleep, accompanied by either sleepwalking and/or night terrors, with no memory of event in the morning. Types: Sleep-Walking Type recurrent episodes of rising from bed blank, staring face relatively unresponsive Night Terror Type recurrent episodes of abrupt terror arousals from sleep signs of autonomic arousal (e.g., tachycardia) relatively unresponsive Risk Factors: genetics, sleep deprivation, some medications (sedatives), fever, stress, other sleep disorders Prevalence: unknown, more common in children Assessment: clinical interview, self-report measures, polysomnogram, video data Treatment(s): eliminate risk factors (if possible), treat underlying causes, anticipated awakening American Psychological Association (2013), Sleep Foundation (2023) SLEEP-WAKE DISORDERS – Parasomnias – Nightmare Disorder 7. Nightmare Disorder Diagnostic Feature(s): repeated occurrences of extended, extremely distressing, and well-remembered dreams that usually involving efforts to avoid threats of survival, security, or physical integrity Frequency: less than 1 episode/week (mild) 1-2 episodes/week (moderate) nightly (severe) Duration: 1 month or less (acute) 6 or more months (persistent) Risk Factors: trauma, genetic/family history, medication Prevalence: varies Assessment: physical exams, self-repot, polysomnogram Treatment(s): medications and psychotherapies (imagery rehearsal therapy, systematic desensitization, exposure) American Psychological Association (2013), Nadorff et al. 2014 SLEEP-WAKE DISORDERS – Parasomnias – REM Sleep Behaviour Disorder 8. Rapid Eye Movement Sleep Behaviour Disorder Diagnostic Feature(s): physically act out vivid, often unpleasant dreams with vocal sounds and sudden, often violent arm and leg movements during REM sleep - sometimes called dream-enacting behavior - able to recall the dream upon awaken during the episode. Risk Factors: associated with other neurological conditions, such as Lewy body dementia or Parkinson's disease male, over 50 years old alcohol, medications, or withdrawal from drugs or alcohol narcolepsy Prevalence: 0.5-1% of adults in general population Assessment: in-laboratory video polysomnography, physical and neurological exam Treatment: combination of lifestyle changes, medication, and injury prevention techniques. American Psychological Association (2013), Sleep Foundation (2023) SLEEP-WAKE DISORDERS – Parasomnias - RLS 9. Restless Leg Syndrome Diagnostic Feature(s): urge to move legs in response to uncomfortable sensations, particularly when relaxing or lying down and trying to fall asleep. Frequency & Duration: at least 3 times/week for at least 3 months Risk Factors: family history female advanced age disturbance in dopaminergic system & iron metabolism Prevalence: 2-7% of adults Assessment: polysomnogram Treatment: sleep hygiene, exercise, massage, hot bath, medication (e.g., gabapentin) Image retrieved from Medicover Hospitals American Psychological Association (2013) SLEEP-WAKE DISORDERS – Parasomnias – Substance/Medication-Induced 10. Substance/Medication-Induced Sleep Disorder Diagnostic Feature(s): severe disturbance in sleeping patterns primarily caused by effects of substance (based on evidence from history, physical exam, or lab results) Frequency & Duration: symptoms persist for substantial period of time (i.e., 1 month) after cessation of acute withdrawal or intoxication Specifiers: onset during intoxication and onset during discontinuation/withdrawal Risk Factors: substance use/dependence or medication Prevalence: varies Assessment: history, physical exam, lab results Treatment: CBT-I, over-the-counter medications and dietary supplements, prescription medications without known abuse potential American Psychological Association (2013) Substance Abuse and Mental Health Services Administration (SAMHA, 2014) Break FEEDING & EATING DISORDERS FEEDING & EATING DISORDERS Eating: What is it ? FEEDING & EATING DISORDERS: Eating – What is it? Figure 1. Social and environmental influences at multiple levels on food choice and diet-related behaviours Image retrieved from Monterrosa Edward et al (2020) FEEDING & EATING DISORDERS Feeding & Eating Disorders: What are they? "Feeding and eating disorders are persistent disturbance of eating or eating-related behaviour that results in the altered consumption or absorption of food and that significantly impairs physical health or psychosocial functioning." (APA, 2013, p. 329) About the food and not about the food FEEDING & EATING DISORDERS: What are they? Biologically-based, neuro-metabolic disorders Altered reward and punishment procession Altered balance of reward and inhibitory control Differences in inhibitory control, decision making, reinforcement learning, and interoception Wierenga (2023) FEEDING & EATING DISORDERS: What are they? Highest mortality rate of any other mental disorder Every 63 minutes, someone in USA dies as direct result of an eating disorder 2 to 11 times more likely to attempt suicide than those without eating disorders Co-morbidities is the rule rather than the exception Academy of Eating Disorders, 2014; Archelus et a1., 2013; Cheney et al., 2011 FEEDING & EATING DISORDERS FEEDING & EATING DISORDERS: 8 Diagnostic Categories 1. Pica 2. Rumination Disorder 3. Avoidant/Restrictive Food Intake Disorder 4. Anorexia Nervosa 5. Bulimia Nervosa 6. Binge Eating Disorder 7. Other Specified Feeding or Eating Disorder 8. Unspecified Feeding or Eating Disorder American Psychological Association, 2013 FEEDING & EATING DISORDERS - Pica 1. Pica (PIKE-ah) Diagnostic Feature(s): compulsively eating nonfood items - inappropriate to developmental level - not part of cultural or normative practices - and, if symptoms occur in context of other mental or physical disorder, it is sufficiently severe to warrant clinical attention Frequency & Duration: persistent, at least 1 month Examples: ice chips, dirt, soap, coins, cleaners American Psychological Association, 2013 FEEDING & EATING DISORDERS - Pica Risk Factors: neglect developmental delay pregnancy autism Prevalence: unknown Assessment: intake, lab tests mental development, rule out cultural factors and other health conditions, ECG, X-ray Treatment(s): mainly therapy (mild aversive therapy, behavioural therapy, differential reinforcement) Pleasurable stimulus Maintain or increase desire to eat non-food Aversive stimulus Decrease desire to eat non-food Eat non-food American Psychological Association, 2013 FEEDING & EATING DISORDERS – Rumination Disorder 2. Rumination Disorder Diagnostic Feature(s): repeated regurgitation of food (may be re-chewed, re-swallowed, or spit out) - does not occur exclusively during AN, BN, BED, or ARFID - not due to gastrointestinal problem Frequency & Duration: persistent, at least 1 month Risk Factors: lack of stimulation neglect problems with parent-child relationship Prevalence: unknown but higher in individuals with intellectual disability Assessment: medical history, tests (e.g. endoscopy, colonoscopy, to rule out other causes) Treatment(s): medication (anxiety, abdominal contractions) psychotherapy (habit-reversal behaviour therapy, biofeedback, parent-child therapy) American Psychological Association, 2013 FEEDING & EATING DISORDERS - ARFID 3. Avoidant/Restrictive Food Intake Disorder Diagnostic Feature(s) : persistent failure to meet nutritional and/or energy/needs associated with 1+ of the following : - significant weight loss - significant nutritional deficiency - dependence of enteral feeding/oral supplements - marked interference w/ psychosocial functioning - not due to lack of available food or culturally sanctioned practice - does not occur exclusively during another eating disorder Frequency & Duration : sufficiently severe to cause above features Risk Factors : temperament, early food-experience, neglect, abuse Prevalence : unclear Assessment: semi-structured interview, dietary intake, lab tests, physical exam Treatment(s) : CBT-AR, TBD American Psychological Association (2013), Thomas et al. (2017) FEEDING & EATING DISORDERS - AN 4. Anorexia Nervosa Diagnostic Feature(s): significantly low body weight (as defined and based on normative growth charts and BMI ) - intense fear of gaining weight, behaviours interfere - disturbed perception, self-evaluation, lack of recognition of seriousness Frequency & Duration: at least 3 months Subtypes: restricting and binge-eating/purge Specifiers: mild, moderate, severe, extreme (based on BMI) Risk Factors: family history of AN and obesity, temperament, perfectionism, low self-esteem, emotional intolerance, other psychological disorders, history of dieting, culture Prevalence: 12-month prevalence 0.4% among young females lifetime prevalence 4% females and 0.3% among males Assessment: physical exam, semi-structured interview, intake assessment Treatment(s): refeeding, meal program, medication, psychotherapy American Psychological Association (2013); van Eeden (2021) FEEDING & EATING DISORDERS - BN 5. Bulimia Nervosa Diagnostic Feature(s): recurrent episodes of binge eating* + inappropriate compensatory behaviour** - self-evaluation is unduly influenced by body shape and weight Frequency & Duration: 1 binge-purge episode/week for at least 3 months Specifiers: mild, moderate, severe, extreme (based on episodes of compensatory behaviours) Risk Factors: family or personal history of obesity, temperament, perfectionism, low self-esteem, emotional intolerance, other psychological disorders, history of dieting, early pubertal maturation, childhood sexual abuse Prevalence: 12-month prevalence 1-1.5% among young females lifetime prevalence 3% among females and 1% males Assessment: semi-structured interview, self-report, physical exam Treatment(s): psycho-education, meal program, medication, psychotherapy American Psychological Association (2013); van Eeden (2021) FEEDING & EATING DISORDERS - BED 6. Binge Eating Disorder Diagnostic Feature(s) : recurrent episodes of binge eating* associated with 3+ of the following: - eating more rapidly than normal - eating until uncomfortably full - large amount when not physically hungry - eating alone because of embarrassment of quantity - disgusted with self …. and NOT associated with inappropriate compensatory behaviour Frequency & Duration : 1 binge-episode /week for at least 3 months Specifiers : mild, moderate, severe, extreme (based on binge-eating episodes ) Risk Factors : genetics, life stage, low self-esteem, emotional intolerance, history of dieting, cultural factors Prevalence : 12-month prevalence 1.6 % among females and 0.8% among males; lifetime prevalence 2.8% Assessment: semi-structured interview, self-report, physical exam Treatment(s) : psycho-education, medication, psychotherapy American Psychological Association (2013) FEEDING & EATING DISORDERS - OSFED 7. Other Specified Feeding or Eating Disorder Diagnostic Feature(s): do not meet full criteria for any other feeding or eating disorder and clinician chooses to communicate specific reason (e.g. atypical AN, purging disorder) Prevalence: varies 8. Unspecified Feeding or Eating Disorder Diagnostic Feature(s): do not meet full criteria for any other feeding or eating disorder and clinician chooses NOT to specify reason, usually due to insufficient information Prevalence: varies American Psychological Association (2013) FEEDING & EATING DISORDERS Clinically Relevant: Diagnostic Drifting Up to 40% of eating disorder presentations do not fit into the prescribed categories (Castellini et al., 2011; Garke et al., 2019; Grave, 2011) High degree of drifting between diagnostic categories due to shared underlying features (Keel & Brown, 2010; Stice et al., 2013) FEEDING & EATING DISORDERS Shared Underlying Features HIGH VALUE ON ONE DOMAIN EMOTIONAL INTOLERANCE LOW SELF-ESTEEM MALADAPTIVE PERFECTIONISM INABILITY TO FEED ONESELF EGOSYNTONIC Modified from Transdiagnostic Theory of Eating Disorder (Fairburn et al., 2003) PSYCHOLIGICAL DISORDERS Insomnia, Eating Disorders, and Psychological Disorders PSYCHOLIGICAL DISORDERS Insomnia and Psychological Disorders Insomnia is identified as a risk factor and symptom of most psychological disorders. Insomnia = transdiagnostic factor Treating insomnia with CBT-I can result in a clinically significant decrease in insomnia symptoms and symptoms of co-occurring psychological disorders. 50% Baglioni et al (2019); Baglioni & Riemann (2022); Jansson-Fröjmark & Norell-Clarke (2016); Harvey et al. (2011) FEEDING PSYCHOLIGICAL & EATINGDISORDERS DISORDERS Eating Disorders and Psychological Disorders Recent rapid review results of eating disorder: 60% have psychiatric comorbidity 42% have medical co-morbidity Hambleton et al. (2022); Treasure & Schmidt, 2010 FEEDING PSYCHOLIGICAL & EATINGDISORDERS DISORDERS Eating disorders and Sleep Disturbance Thank you! 50% [email protected] sleepbetter.ed.research Want to learn more? Here are some evidence –based references and resources: American Psychiatric Association. (2017). Older Adults and Insomnia Resource Guide Retrieved from http://www.apa.org/pi/aging/resources/guides/insomnia.aspx November 21, 2017 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5(5th ed.). Arlington, VA: American Psychiatric Association. Bastien, C. H., Vallieres, A., & Morin, C. M. (2004). Precipitating Factors of Insomnia. Behavioral Sleep Medicine, 2(1), 50-62. Bhaskar, Swapna1,; Hemavathy, D.2; Prasad, Shankar3. Prevalence of chronic insomnia in adult patients and its correlation with medical comorbidities. Journal of Family Medicine and Primary Care 5(4):p 780-784, Oct–Dec 2016. | DOI: 10.4103/2249-4863.201153 Bonnet, M., & Arand, D. (2022, April 15). Risk factors, comorbidities, and consequences of insomnia in adults. In R. Benca (Ed.). Brinkman JE, Reddy V, Sharma S. Physiology of Sleep. [Updated 2023 Apr 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482512/ Buysse, D. J., Ancoli-Isreal, S., Edinger, J. D., Lichenstein, K. L., & Morin, C. M. (2006). Recommendations for a Standard Research Assessment of Insomnia. Sleep, 29(9), 1155–1173. Buysse, D. J. (2014). Sleep health: Can we define it? Does it matter? Sleep, 37(1), 9-17 Calhoun, S. L., Fernandez-Mendoza, J., Vgontzas, A. N., Liao, D., & Bixler, E. O. (2014). Prevalence of insomnia symptoms in a general population sample of young children and preadolescents: Gender effects. Sleep Medicine, 15, 91–95. Dopheide, JA PharmD, BCPP, FASHP, Insomnia Overview: Epidemiology, Pathophysiology, Diagnosis and Monitoring, and Nonpharmacologic Therapy, Am J Manag Care. 2020;26:S76-S84. https://doi.org/10.37765/ajmc.2020.42769 Dresler, M., Spoormaker, V. I., Beitinger, M. C., Kimura, M., Steiger, A., & Holsboer, F. (2013). Neuroscience-driven discovery and development of sleep therapeutics. Pharmacology & Therapeutics. 10(12), 1-35. Harvey, A. G. (2002). A cognitive model of insomnia. Behavioural Restorative Therapy. 40(8):869-93. Harvey AG, Murray G, Chandler RA, Soehner A. Sleep disturbance as transdiagnostic: consideration of neurobiological mechanisms. Clin Psychol Rev. 2011 Mar;31(2):225-35. doi: 10.1016/j.cpr.2010.04.003. Epub 2010 Apr 24. PMID: 20471738; PMCID: PMC2954256. Jaussent,I., Dauvilliers,Y., Ancelin,M., Dartigues,J., Tavernier, B., Touchon,J., Ritchie,K., & Besset, A. (2011). Insomnia symptoms in older adults: associated factors and gender differences American Journal of Jansson-Fröjmark M, NorellClarke A. Cognitive Behavioural Therapy for Insomnia in Psychiatric Disorders. Curr Sleep Med Rep. 2016;2(4):233-240. doi: 10.1007/s40675-016-0055-y. Epub 2016 Oct 20. PMID: 28003955; PMCID: PMC5127887. Geriatric Psychiatry, 19(1),88–97.doi:10.1097/JGP.0b013e3181e049b6 Khurshid, A. M. (2015). A review of changes in DSM-5 Sleep-Wake Disorders. Psychiatric Times, published September 20, 2015. Merikangas, K. R., Zhang, J., Emsellem, H., Swanson, S. A., Vgontzas, A., Belouad, F., … Mignot, E. (2014). The structured Diagnostic Interview for Sleep Patterns and Disorders: Rationale and initial evaluation. Sleep Medicine, 15, 530–535. Morin, C. M., LeBlanc, M., Belanger, L., Ivers, H., Merette, C., & Savard, J. (2011). Prevalence of insomnia and its treatment in Canada. The Canadian Journal of Psychiatry, 56(9) Morin, M., Drake, C. L., Harvey, A. G., Krystal, A D., Manbe, R., Riemann, D., & Spiegelhalder, K. (2015). Insomnia disorder. Nature Reviews Disease Primers, 1. doi:10.1038/nrdp.2015.26Neubauer, D.N. (2009) Current and new thinking in the management of comorbid insomnia. American Journal of Management Care, 15, S24–S32. Nunes, M. L., & Bruni, O. (2015). Insomnia in childhood and adolescence: Clinical aspects, diagnosis, and therapeutic approach. Journal de Pediatria, 91(6), S26–S35. Roth, T. (2007). Insomnia: Definition, prevalence, etiology, and consequences. Journal of Clinical Sleep Medicine, 3(5), S7–S10. Roth, T. (2009) Comorbid insomnia: current diagnosis and future challenges. American Journal Management Care,15, S6–S13. Sivertsena,B., Krokstadb,S., Øverlandd, S., & Mykletund, A. (2009). The epidemiology of insomnia: Associations with physical and mental health. The HUNT-2 study, Journal of Psychosomatic Research 67, 109–116. Substance Abuse and Mental Health Services Administration (SAMHA) 2014, 8, 2 https://store.samhsa.gov/sites/default/files/sma14-4859.pdf Teodorescu, M. (2014). Sleep disruptions and insomnia in older adults. Consultant, 54(3),166-173. van Eeden AE, van Hoeken D, Hoek HW. Incidence, prevalence and mortality of anorexia nervosa and bulimia nervosa. Curr Opin Psychiatry. 2021 Nov 1;34(6):515-524. doi: 10.1097/YCO.0000000000000739. PMID: 34419970; PMCID: PMC8500372. Yong Hoon KimYong Hoon KimMitchell A LazarMitchell A Lazar Transcriptional Control of Circadian Rhythms and Metabolism: A Matter of Time and Space May 2020Endocrine Reviews 41(5) DOI: 10.1210/endrev/bnaa014 On sleep and insomnia: National Institute of Neurological Disorders and Stroke. July 2023. Brain Basics: Understanding Sleep Retrieved January 28, 2024. https://www.ninds.nih.gov/health-information/public-education/brain-basics/brain-basics-understanding-sleep On Insomnia and Eating Disorders https://www.sleepfoundation.org/mental-health/eating-disorders-and-sleep