This is a powerpoint presentattion in abnormal psychology

1. Chapter 8
Eating and Sleep-Wake
Disorders

2. Outline
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Types of eating disorders
Causes of eating disorders
Treatment of eating
disorders Obesity
Sleep-Wake disorders
Treatment of sleep-wake
disorders

3. Focus
Questions
What are the features of anorexia nervosa,
bulimia nervosa and binge eating disorder?
What factors contribute to the development
of eating disorders?
What are some treatments for eating
disorders? What are causes and treatment for
obesity?
What are the features and treatment for sleep-
wake disorders?

4. Eating Disorders: An
Overview
• Major types of DSM-5 eating disorders
▪ Anorexia nervosa and bulimia nervosa
• Severe disruptions in eating behavior
• Weight and shape have
disproportionate influence on self-
concept
• Extreme fear and apprehension
about gaining weight
• Strong sociocultural origins – driven
by Western emphasis on thinness

5. Eating Disorders: An
Overview
• Additional DSM-5 eating disorder: Binge
eating disorder
▪ Involves disordered eating behavior (binges)
▪ May involve fewer cognitive distortions
about weight and shape

6. Eating Disorders: An
Overview
• Obesity – considered a symptom of some
eating disorders but not a disorder in and of
itself
▪ Rates are increasing
▪ 70% of U.S. adults overweight, 35% are
obese
▪ Presents serious health risks (e.g.,
cardiovascular strain, increased risk of
early death)
▪ Determined by BMI

7. Bulimia Nervosa: Overview
and Defining Features
• Binge eating – hallmark of bulimia nervosa
and binge eating disorder
▪ Eating excess amounts of food in a
discrete period of time
▪ Eating is perceived as uncontrollable
▪ May be associated with guilt, shame or regret
▪ May hide behavior from family members
▪ Foods consumed are often high in sugar, fat
or carbohydrates

8. Bulimia Nervosa: Overview and
Defining Features
• Compensatory behaviors – designed to “make
up for” binge eating
▪ Most common: Purging
• Most common purging method: Self-
induced vomiting
• May also include use of diuretics or laxatives
▪ Excessive exercise
▪ Fasting or food restriction

9. DSM-5 Criteria for Bulimia
Nervosa
A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of
the following:
1. Eating, in a discrete period of time (e.g. within any 2-hour period), an amount of food
that is definitely larger than what most individuals would eat in a similar period of
time under similar circumstances.
2. A sense of lack of control over eating during the episode (e.g. feeling that one cannot
stop eating or control what or how much one is eating)
B. Recurrent inappropriate compensatory behaviors in order to prevent weight gain, such
as self-induced vomiting, misuse of laxatives, diuretics, or other medications, fasting, or
excessive exercise
C. The binge eating and inappropriate compensatory behaviors both occur on average at least
once a week for 3 months.
D. Self-evaluation is unduly influenced by body shape and weight
E. The disturbance does not occur exclusively during episodes of anorexia nervosa
Specifiers: Partial Remission-after full criteria was met, some but not all of the criteria have
been met for a sustained period of time; Full Remission-after full criteria was met, none of
the criteria have been met for a sustained period of time. Mild (1-3 episodes/week);
Moderate (4-7 episodes/week); Severe (8-13 episodes/day); Extreme (14+ episodes/week)

10. Bulimia Nervosa:
Associated
Features
• Associated medical features
▪ Most are within 10% of normal body weight
▪ Purging methods can result in severe
medical problems
• Erosion of dental enamel,
electrolyte imbalance
• Kidney failure, cardiac arrhythmia,
seizures, intestinal problems, permanent
colon damage

11. Bulimia Nervosa:
Associated
Features
• Associated psychological features
▪ Most are overly concerned with body shape
▪ Fear of gaining weight
▪ Most have comorbid psychological disorders
• 20% meet criteria for a mood disorder
• 50-70% have met criteria for a mood
disorder at some point
• 80% have met criteria for an anxiety
disorder at some point
• Nearly 2 in 5 abuse substances

12. Anorexia Nervosa: Overview and
Defining Features
• Extreme weight loss – hallmark of anorexia
▪ Restriction of calorie intake below energy
requirements (Sometimes defined as 15% below
expected weight)
▪ Intense fear of weight gain
▪ Often begins with dieting
▪ Subtypes:
• Restricting: Diet to limit calorie intake
• Binge-eating-purging: Purge to limit calorie
intake

13. DSM-5 Criteria for Anorexia
Nervosa
A. Restriction of energy intake relative to requirements, leading to a significantly low body weight in
the context of age, sex, developmental trajectory, and physical health. Significantly low weight is
defined as weight that is less than minimally normal or, for children and adolescents, less than that
minimally expected.
B. Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with
weight gain, even though at a significantly low weight.
C. Disturbance in the way in which one’s body weight or shape is experienced, undue in-fluence of
body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the
current low body weight.
D. Types
A. Restricting Type: During the last 3 months, the individual has not engaged in recurrent
episodes of binge eating or purging behavior. Weight loss is accomplished primarily through
dieting, fasting, and/or excessive exercise.
B. Binge-eating/Purging Type: During the last 3 months, the individual has engaged in
recurrent episodes of binge eating or purging (vomiting, laxatives, diuretics, enemas).
E. Specifier
A. Partial Remission: Criteria were previously met but criterion A has not been met for a
sustained period but criterion B or C is still met
B. Full Remission: Criteria were previously met but none of the criteria or currently met
C. Mild-Extreme: Based on BMI

14. Anorexia Nervosa: Overview and
Defining Features
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•
Most show marked disturbance in body
image Most have comorbid psychological
disorders
▪ 70% are depressed at some point
▪ Higher than average rates of substance
abuse and OCD
Starving body borrows energy from internal
organs, leading to organ damage including
cardiac damage > can cause heart attack
•

15. Anorexia
Nervosa
• Medical consequences
▪ Amenorrhea (loss of periods in women)
▪ Dry skin
▪ Brittle hair and nails
▪ Sensitivity to cold temps
▪ Lanugo
▪ Cardiovascular problems
▪ Electrolyte imbalance
Most deadly mental disorder due to organ
damage
•

16. Bulimia and Anorexia: Facts and
Statistics
• Bulimia
▪ Majority are female – 90%+
▪ Male sufferers are more likely to be gay
or bisexual
▪ Lifetime prevalence is about 1.1% for females,
0.1% for males
▪ 6-7% of college women suffer from bulimia at
some point
▪ Onset typically in adolescence
▪ Tends to be chronic if left untreated

17. Bulimia and Anorexia: Facts and
Statistics (continued)
• Anorexia
▪ Majority are female and white
▪ From middle- to upper-middle-class families
▪ Usually develops around early adolescence
▪More chronic and resistant than bulimia
Lifetime prevalence approximately 1%
Cross-cultural factors
▪ Develop in non-Western women after moving
to Western countries
▪ Rare in African-American women
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18. Binge Eating Disorder:
Overview and Defining
Features
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•
New disorder in DSM-5
Binge eating without associated
compensatory behaviors
Associated with distress and/or functional
impairment (e.g., health risk, feelings of
guilt)
Excessive concern with weight or shape may
or may not be present
•
•

19. Binge-Eating Disorder: Associated
Features
• Approximately 20% of individuals in weight-
control programs suffer from BED
Approximately half of candidates for
bariatric surgery suffer from BED
Better response to treatment than other
eating disorders
Tend to be older than sufferers of anorexia
and bulimia
Higher rates of psychopathology than
non- bingeing obese individuals
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•
•

20. DSM-5 Binge Eating Disorder
A. Recurrent episodes of binge eating characterized by both of the following:
A. Eating, in a discrete period of time, an amount of food that is definitely larger than what
most people would eat in a similar period of time under similar circumstances.
B. A sense of lack of control over eating during the episode
B. The binge-eating episodes are associated with 3+ of the following:
A. Eating much more rapidly than normal
B. Eating until feeling uncomfortably full
C. Eating large amounts of food when not feeling physically hungry
D. Eating alone because of feeling embarrassed by how much one is eating
E. Feeling disgusted with oneself, depressed, or very guilty afterward
C. Marked distress regarding binge eating
D. The binge eating occurs, on average, at least once/week for 3 months
E. The binge eating is not associated with the recurrent use of inappropriate compensatory behavior
as in bulimia nervosa and does not occur exclusively during the course of bulimia nervosa or
anorexia nervosa
F. Specifiers: Partial remission; Full remission
G. Specifiers: Mild-Extreme (same criteria for bulimia)

21. Causes of Eating
Disorders
• Social dimensions
▪ Cultural factors
▪ Dietary restraint
▪Family influences
Biological
dimensions
Psychological and behavioral
dimensions
•
•

22. Causes of Eating Disorders: Social
Factors
• Media and cultural considerations
▪ Media portrayals: thinness linked to
success, happiness
▪ Cultural emphasis on dieting
▪ Standards of ideal body size
• Frequently changing and difficult to
achieve

23. Causes of Eating Disorders: Social
Factors
• Dieting and dietary restraint
▪ Adolescent dieting leads to an 8x greater risk
of developing an eating disorder
▪ Adolescents tend to internalize the standards
of friendship groups (e.g., a teenager is more
likely to diet if her friends also diet)
▪ May paradoxically cause weight gain
• Produces stress and withdrawal
symptoms that increase cravings for food

24. Causes of Eating Disorders: Social
Factors
• Dieting and dietary restraint
▪ During periods of restricted food intake,
people become preoccupied with food and
eating
• Classic study conducted during WWII:
Volunteers placed on strict diets started
thinking, writing and reading more
about food

25. Causes of Eating Disorders: Family
Influences
• Parents with distorted perception of food and
eating may restrict children’s intake too (e.g.,
put chubby toddlers on unnecessary diets)
Families of individuals with anorexia are often:
▪ High achieving
▪ Concerned with external appearances
▪ Overly motivated to maintain harmony > leads
to poor communication and denial of problems
Disordered eating also strains family relationships
▪ Causes parental guilt and frustration
•
•

26. Causes of Eating Disorders: Biological
Factors
• Some genetic component
▪ Relatives of people with eating disorders are 4-
5x more likely to develop an eating disorder
Not clear what is inherited
▪ May be nonspecific traits like emotional
instability or impulsivity
Low levels of serotonergic activity often found
in eating disorders
▪ Not clear whether this is a cause or
consequence, but likely to contribute to
maintenance of eating disorders
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•

27. Causes of Eating Disorders:
Psychological Dimensions
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Low sense of personal control and self-
confidence Perfectionistic attitudes
Distorted body image
Preoccupation with food
Mood intolerance

28. Treatments for Eating
Disorders
• Drugs – primarily antidepressants
▪Generally ineffective for anorexia nervosa
Psychological treatments – usually
cognitive behavioral therapy
▪ Emphasis on core pathological
mechanism: Distorted body imge
•

29. Medical and Psychological Treatment
of Bulimia Nervosa
• Cognitive-behavioral therapy (CBT)
▪ Treatment of choice
▪ Basic components of CBT: Identifying
maladaptive thinking patterns and behavioral
habits, then gradual practice of new habits
Medical and drug treatments
▪ Antidepressants
• Can help reduce binging and purging
behavior
• Usually not efficacious in the long-term
•

30. Medical and Psychological Treatment
of Binge Eating Disorder
• Previously used medications for obesity are now
not recommended
Psychological treatment
▪ CBT
• Similar to that used for bulimia
• Appears efficacious
▪ Interpersonal
psychotherapy
• Equally as effective as CBT
▪ Self-help techniques
• Also appear effective
•

31. Psychological Treatment of Anorexia
Nervosa
• General goals and strategies
▪ Weight restoration
• First and easiest goal to achieve
▪ Psychoeducation
▪ Behavioral and cognitive interventions
• Target food, weight, body image, thought
and emotion
▪ Treatment often involves the family
▪ Long-term prognosis for anorexia is poorer
than for bulimia

32. Preventing Eating
Disorders
• Often focuses on promoting body acceptance
in adolescent girls
Identify specific targets
▪Early weight concerns
Screening for at-risk
groups Provide education
▪ Normal weight limits
▪ Effects of calorie restriction
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33. Obesity: Background and
Overview
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Considered BMI of 30+
Not DSM disorder, but may be a
consequence Statistics
▪ In 2008, 33.8% of adults in the United
States were obese; 37.5% in 2010
▪ Mortality rates
• Close to those associated with smoking
▪ Increasing more rapidly in children/teens
▪ Obesity also growing rapidly in
developing countries

34. Obesity and Disordered Eating
Patterns
• Obesity and night eating syndrome
▪ Occurs in 7-19% of treatment seekers
▪ Occurs in 55% of individuals seeking
bariatric surgery
▪ Consume 1/3+ of daily calories after dinner
▪ Get up during the night to eat
▪ Patients are wide awake and do not binge
eat
▪ Often not hungry, skip breakfast the
next morning

35. DSM-5 Criteria for Night
Eating Syndrome
Recurrent episodes of night eating, as manifested by eating
after awakening from sleep or by excessive food
consumption after the evening meal. There is awareness
and recall of the eating. The night eating is not better
explained by external influences such as changes in the
individual’s sleep/wake cycle or by local social norms. The
night eating causes significant distress and/or impairment in
functioning. The disordered pattern of eating is not better
explained by binge- eating disorder or another mental
disorder, including substance use, and is not attributable to
another medial disorder or an effect of medication.

36. Obesity and Disordered Eating
Patterns
• Causes
▪ Obesity is related to technological
advancement
• Promotes inactive, sedentary lifestyle
▪ Genetics account for about 30% of
obesity cases
▪ Psychosocial factors contribute as well
• More likely to be obese if people in
close social circles are also obese

37. Obesity
Treatment
• Efficacy
▪ Moderate success with adults
▪ Greater success with children and
adolescents
Treatment progression – from least to
most intrusive options
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38. Obesity
Treatment
• First step
▪Self-directed weight loss programs
Second step
▪Commercial self-help programs
Third step
▪Behavior modification programs
Last step
▪ Bariatric surgery
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•

39. Introduction to Sleep-Wake
Disorders: The Importance of Sleep
• Just a few hours’ sleep deprivation
decreases immune functioning
Sleep deprivation affects all aspects of
daily functioning – energy, mood,
memory, concentration, attention
Sleep loss may bring on feelings of depression
in non-depressed individuals
▪ Paradoxically, can have antidepressant effects
in depressed individuals
•
•

40. Sleep-Wake Disorders: An
Overview
• Polysomnographic (PSG) evaluation of sleep:
▪ Electroencephalograph (EEG) – brain waves
▪ Electrooculograph (EOG) – eye movements
▪ Electromyography (EMG) – muscle movements
▪ Detailed history, assessment of sleep
hygiene and sleep efficiency
Actigraph
▪ Portable wearable device sensitive to movement
– can detect different stages
of wakefulness/sleep
•

41. Sleep Disorders: An
Overview
• Two major types of sleep disorders
▪ Dyssomnias
• Difficulties in amount, quality, or timing
of sleep
▪ Parasomnias
• Abnormal behavioral and
physiological events during sleep

42. The Dyssomnias: Overview and
Defining Features of Insomnia
• Insomnia disorder
▪ One of the most common sleep disorders
▪ Microsleeps
▪ Problems initiating/maintaining sleep
(e.g., trouble falling asleep, waking during
night, waking too early in the morning)
▪ 35% of adults report daytime sleepiness
▪ Only diagnosed as a sleep disorder if it is not
better explained by a different condition
(e.g., generalized anxiety disorder

43. DSM-5 Criteria for Insomnia
Disorder
A. The predominant complaint of dissatisfaction with sleep quantity or quality, associated with one
or more of the following:
A. Difficulty initiating sleep (in children, may be in absence of caregiver)
B. Difficulty maintaining sleep, with frequent awakenings or problems returning to sleep
after awakenings
C. Early morning awakening with inability to return to sleep
B. The sleep disturbance causes clinically significant distress or impairment in social,
occupational, education, academic, behavioral, or other important areas of functioning
C. The sleep difficulty occurs at least 3 nights/week
D. The sleep difficulty is present for at least 3 months
E. The sleep difficulty occurs despite adequate opportunity for sleep
F. The insomnia is not better explained by and does not occur exclusively during the course of
another sleep-wake disorder
G. The insomnia is not attributable to the physiological effects of a substance
H. Coexisting mental disorders and medical conditions do not adequately explain the
predominant complaint of insomnia
I. Specifiers: With non-sleep disorder mental comorbidity; with other medical comorbidity; with
other sleep disorder
J. Specifiers: Episodic (1 month but less than 3); Persistent (3 months or longer); Recurrent (2+
episodes within 1 year)

44. The Dyssomnias:
Insomnia
• Facts and statistics
▪ Often associated with medical
and/or psychological conditions
• Anxiety, depression, substance use
▪Affects females twice as often as males
Associated features
▪ Unrealistic expectations about sleep
▪ Believe lack of sleep will be more
disruptive than it usually is
•

45. Causes of Insomnia
Disorder
•
•
Pain, physical discomfort
Delayed temperature rhythm (body
temperature doesn’t drop until later, leading to
delayed drowsiness)
Light, noise, temperature influence ability to
sleep Other sleep disorders cause secondary
insomnia
▪ Apnea
▪Periodic limb movement disorder
Stress and anxiety
•
•
•

46. Causes of Insomnia
Disorder
• Parental effects on children’s sleep
▪ Parents’ negative beliefs about sleep linked
to more infant waking during the night
▪ Some kids learn to fall asleep only with a
parent present

47. Overview and Defining Features of
Hypersomnolence Disorder
• Hypersomnolence Disorder
▪ Sleeping too much or excessive sleep
• May manifest as long nights of sleep
or frequent napping
▪ Experience excessive sleepiness as a
problem

48. DSM-5 Criteria for
Hypersomnolence Disorder
A. Self-reported excessive sleepiness despite a main sleep period lasting at least 7 hours, with at
least one of the following symptoms:
A. Recurrent periods of sleep or lapses in sleep within the same day
B. A prolonged main sleep episode of more than 9 hours within the same day
C. Difficulty being fully awake after abrupt awakenings
B. The hypersomnolence occurs at least 3 times/week for at least 3 months
C. The hypersomnolence is accompanied by significant distress or impairment in cognitive,
social, occupational, or other important areas of functioning
D. The hypersomnolence is not better explained by and does not occur exclusively during the course
of another sleep disorder
E. The hypersomnolence is not attributable to the physiological effects of a substance
F. Specifier: With mental disorder, with medical condition, with another sleep disorder
G. Specifier: Acute (duration less than 1 month); Subacute (duration 1-3 months); Persistent
(duration more than 3 months)
H. Specifier: Mild (difficulty maintaining daytime alertness 1-2 days/week); Moderate (difficulty
maintaining daytime alertness 3-4 days/week); Severe (difficulty maintaining daytime alertness 5-
7 days/week)

49. Overview and Defining Features of
Hypersomnolence Disorder
• Causes are not well understood due to
limited research
Often associated with other medical
and/or psychological conditions
Only diagnosed if other conditions don’t
adequately explain hypersomnia, which should
be the primary complaint
Associated features
▪ Complain of sleepiness throughout the day
▪ Able to sleep through the night
•
•
•

50. The Dyssomnias: Overview and
Defining Features of Narcolepsy
• Narcolepsy
▪ Principal symptom: Recurrent intense need
for sleep, lapses into sleep or napping
▪ Also accompanied by at least one:
• Cataplexy
• Hypocretin deficiency
• Going into REM sleep abnormally fast
(<15 min), as evidenced by
polysomnographic measures

51. DSM-5 Criteria for
Narcolepsy
A. Recurrent episodes of an irrepressible need for sleep, lapsing into sleep, or napping occurring
within the same day. These must have been occurring at least 3 times/week for the past 3 months
B. The presence of at least one of the following
A. Episodes of cataplexy, defined as either (a) or (b), occurring at least a few times per month:
A. In individuals with long-standing disease, brief (seconds or minutes) episodes of
sudden bilateral loss of muscle tone with maintained consciousness that are
precipitated by laughter or joking
B. In children or in individuals within 6 months of onset, spontaneous grimaces or
jaw- opening episodes with tongue thrusting or a global hypotonia, without any
obvious emotional triggers.
B. Hypocretin deficiency, as measured by CSF
C. Nocturnal sleep polysomnography showing REM sleep latency less than or equal to 15
minutes or a multiple sleep latency test showing a mean sleep latency less than or equal to 8
minutes and two or more sleep-onset REM periods.
D. Specifier: Mild (infrequent cataplexy of <once/week, need for naps only 1-2/day, and
less disturbed nocturnal sleep), Moderate (cataplexy once daily or every few days,
disturbed nocturnal sleep, and need for multiple naps daily), Severe (drug-resistant
cataplexy with multiple attacks daily, nearly constant sleepiness, and disturbed
nocturnal sleep

52. The Dyssomnias: Overview and
Defining Features of Narcolepsy
• Facts and statistics – rare condition
▪ Affects about .03% to .16% of the population
▪ Equally distributed between males and
females
▪ Onset during adolescence
▪ Typically improves over time

53. The Dyssomnias: Overview of
Breathing-Related Sleep
Disorders
• Include 3 different disorders previously
classified as parts of the same disorder:
▪ Obstructive sleep apnea hypopnea
• Airflow stops, but respiratory system works
▪ Central sleep apnea (CSA)
• Respiratory systems stops for brief periods
▪ Sleep-related hypoventilation: Decreased
breathing during sleep not better explained
by another sleep disorder

54. DSM-5 Criteria for Obstructive
Sleep Apnea Hopopnea
A. Either (1) or (2
A. Evidence by polysomnography of 15 or more obstructive apneas
and/or hypopneas per hour of sleep regardless of
accompanying symptoms
B. Evidence of polysomnography of at least 5 obstructive apneas
or hypopneas per hour of sleep and either of the following
sleep symptoms:
A. Nocturnal breathing disturbances: snoring,
snorting/gasping, or breathing pauses during sleep
B. Daytime sleepiness, fatigue, or unrefreshing sleep despite
sufficient opportunities to sleep that is not better explained
by another mental disorder and is not attributable to another
medical condition
C. Specifiers: Mild, Moderate, Severe (based on hypopnea index)

55. Facts and Features Associated
With Breathing-Related Sleep
Disorders
• Obstructive sleep apnea occurs in 10-20%
of population
More common in males
Associated with obesity and increasing age
•
•

56. Facts and Features Associated
With Breathing-Related Sleep
Disorders
• Persons are usually minimally aware of
apnea problem
Often snore, sweat during sleep, wake
frequently May have morning headaches
May experience episodes of falling asleep
during the day (due to poor sleep quality at
night)
•
•
•

57. Circadian Rhythm Sleep-Wake
Disorders
• Disturbed sleep (e.g., either insomnia or
excessive sleepiness) leading to distress and/or
functional impairment (e.g. significantly
decreased productivity at work)
Specifically due to brain’s inability to
synchronize day and night
•

58. DSM-5 Circadian Rhythm Sleep-
Wake Disorders
A. Persistent or recurrent pattern of sleep disruption that is primarily
due to an alteration of the circadian system or to a misalignment
between the endogenous circadian rhythm and the sleep-wake
schedule required by an individual’s physical environment or social
or professional schedule
B. The sleep disruption leads to excessive sleepiness or insomnia,
or both
C. The sleep disturbance causes clinically significant distress or
impairment in social, occupational, and other important areas
of functioning.
D. Subtype for shift work among others
E. Specifiers: Episodic (symptoms last at least 1 month but less than 3);
Persistent (symptoms last 3+ months); Recurrent (2+ episodes
within one year)

59. Circadian Rhythm Sleep-Wake
Disorder
• Affects suprachiasmatic nucleus, which
stimulates melatonin and regulates sense of
night and day
Examples
▪ Shift work type – job leads to irregular hours
▪ Familial type – associated with family history
of dysregulated rhythms
▪ Delayed or advanced sleep phase type –
person’s biological clock is naturally
“set” earlier or later than a normal
bedtime
•

60. Treatments for Sleep
Disorders
• Insomnia
▪ Benzodiazepines and over-the-counter
sleep medications
▪ Prolonged use
• Can cause rebound insomnia, dependence
▪Best as short-term solution
Hypersomnia and
narcolepsy
▪ Stimulants (i.e., Ritalin)
▪ Cataplexy usually treated with
•

61. Treatments for Sleep
Disorders
• Breathing-related sleep disorders
▪ May include medications, weight loss,
or mechanical devices
Circadian rhythm sleep-wake disorders
▪ Phase delays
• Moving bedtime later (best approach)
▪ Phase advances
• Moving bedtime earlier (more difficult)
▪ Use of very bright light
• Trick the brain’s biological clock
•

62. Treatments for Sleep
Disorders
• Cognitive behavioral therapy for insomnia (CBT-
I)
▪ Psychoeducation about sleep
▪ Changing beliefs about sleep
▪ Extensive monitoring using sleep diary
▪ Practicing better sleep-related habits

63. Psychological Treatments for Sleep
Disorders
• Relaxation and stress reduction
▪ Reduces stress and assists with sleep
▪Modify unrealistic expectations about sleep
Stimulus control procedures
▪ Improved sleep hygiene – bedroom is a
place for sleep
▪ For children – setting a regular bedtime
routine
•

64. Preventing Sleep
Disorders
• Best approach: Practice healthy “sleep hygiene”
(behaviors that lead to adequate quality and
quantity of sleep)
Also helpful to educate parents about good sleep
habits for children
•

65. Good Sleep
Hygiene
•Try to go to bed at the same time every night.
•Avoid naps.
•Create a pre-sleep ritual such as baths or relaxation.
•Use your bed only for sleep.
•If you cannot fall asleep after 15 minutes, get up for a brief period of time and perform
a non-stimulating task (e.g. watch TV, read, fold laundry, etc.).
•Increase your body temperature before bedtime (e.g. take a bath).
•Keep your room temperature consistent. A colder room is more conducive to sleep.
•Eliminate distracting stimuli.
•Avoid caffeine 4-6 hours before bedtime and nicotine.
•Avoid alcohol before bed.
•If hungry before bed, eat a small snack.
•Avoid stimulating activity before bed.

66. The Parasomnias: Nature and General
Overview
• Nature of parasomnias
▪ The problem is not with sleep itself
▪ Problem is abnormal events during sleep,
or shortly after waking
Two classes of parasomnias
▪ Those that occur during REM (i.e., dream) sleep
▪ Those that occur during non-REM (i.e.,
non- dream) sleep
•

67. The Parasomnias: Non-REM Sleep
Arousal Disorders
•
•
New DSM-5 Diagnosis
Recurrent episodes of
either/or:
▪ Sleep terrors
• Recurrent episodes of panic-like
symptoms during non-REM sleep
▪ Sleepwalking
Individual has no memory of the episodes
•

68. DSM-5
Parasomnias
• Sleepwalking: repeated episodes of rising from bed during sleep and
walking about. While sleepwalking, the individual 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
Sleep Terrors: Recurrent episodes of abrupt terror arousals from
sleep, ususally beginning with a panicky scream. There is intense fear
and signs of autonomic arousal, such as mydriasis, tachycardia, rapid
breathing, and sweating, during each episode. There is relative
unresponsiveness to efforts of others to comfort the individual during
the episodes.
For both conditions, little or no dream imagery is
recalled and there is amnesia for the event.
Sleep eating and sleep-related sexual behavior
(sexsomnia)
•
•
•

69. More about Sleep
Terrors
• Facts and associated features
▪ More common in children (~6%) than
adults
▪ Child cannot be easily awakened during
the episode
▪ Child has little memory of it the next day

70. More about Sleep
Walking
• Sleep walking disorder – somnambulism
▪ Occurs during non-REM sleep
▪ Usually during first few hours of deep sleep
▪Person must leave the bed Facts
and associated features
▪ More common in children than adults
▪ Problem usually resolves on its own without
treatment
▪ Seems to run in families
▪ May be accompanied by nocturnal eating
•

71. The Parasomnias: Overview of
Nightmare Disorder
• Repeated episodes of extended, extremely
dysphoric dreams leading to distress
and/or impairment in daily life
Not adequately explained by other
conditions
•

72. DSM-5 Nightmare
Disorder
A. 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.
B. On awakening from the dysphoric dreams, the individual rapidly
becomes oriented and alert.
C. The sleep disturbance causes clinically significant distress or impairment
in social, occupational, and other important areas of functioning
D. The nightmare symptoms are not attributable to the physiological effects of
a substance
E. Coexisting mental and medical disorders do not adequately explain
the predominant complaint of dysphoric dreams.
F. Specifiers: with associated non-sleep disorder; with associated other medical
condition; with associated other sleep disorder
G. Specifier: Mild (less than one episode/week); Moderate (one or
more episodes/week but less than nightly); Severe (nightly)

73. The Parasomnias: Overview of
Nightmare Disorder
• Facts and associated features
▪ 10%-50% of children and 1% of adults
have nightmares
▪ Occurs during REM sleep
▪ Dreams often awaken the sleeper
▪ Problem is more common in children
than adults

74. REM Sleep Behavior
Disorder
•
•
New diagnosis in DSM-5
Repeated episodes of arousal during sleep
associated with vocalization and/or
complex motor behaviors
Causes impairment or distress
▪ Often, major problem is injury to self
or sleeping partner
•

75. Treatment for
Parasomnias
•
•
Parasomnias may go away on their
own Reducing nightmares
▪ Cognitive behavioral therapy
▪ Drugs such as prazosin may help
▪Relaxation may help
Reducing sleep
terrors
▪ Scheduled awakenings: Wake child up
before sleep terror usually occurs, then
fade out awakenings over time
•

76. DSM-5 REM Sleep Behavior
Disorder
A. Repeated episodes of arousal during sleep associated with vocalization and/or
complex motor behaviors
B. These behaviors arise during REM sleep and therefore usually occur more than 90
minutes after sleep onset, are more frequent during the later portions of the
sleep period, and uncommonly occur during daytime naps
C. Upon awakening from these episodes, the individual is completely awake, alert, and
not confused or disoriented
D. Either of the following:
A. REM sleep without atonia or polysomnographic recording
B. A history suggestive of REM behavior disorder and an
establishment synucleinopathy diagnosis (Parkinson's, MSA)
E. The behaviors cause clinically significant impairment or distress in social,
occupational, or other important areas of functioning (may include injury to bed
partner or self)
F. The disturbance is not attributable to the physiological effects of a substance
G. Coexisting medical or mental disorders do not explain the episodes

77. Summary of Eating and Sleep
Disorders
• All eating disorders share
▪ Gross deviations in eating behavior
▪ Heavily influenced by social, cultural,
and psychological factors
▪ Most are driven by distorted thinking related
to shape and weight

78. Summary of Eating and Sleep
Disorders
• All sleep-wake disorders share
▪ Interference with normal process of sleep
▪ Interference results in problems during
waking
▪ Heavily influenced by psychological
and behavioral factors
Incidence of eating and sleep disorders
is increasing
More effective treatments for eating and
sleep- wake disorders are needed
•
•