Eat, Sleep, and Elimination Disorders- AP Psych
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AP psychology Eating, sleeping and elimination disorders lecture
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Eat, Sleep, and Elimination Disorders- AP Psych
- 2. gEnEral trEnDs • Increasing in prevalence – Changing norms regarding size and shape of women ModelModel AnorexiaAnorexia TV StarTV Star
- 5. gEnEral trEnDs • Increasing in prevalence – Changing norms regarding size and shape of women • Mostly female – Male cases of AN tend to be associated with homosexuality • Most often occurs just after puberty or upon entering college – Decreases after mid 20s
- 6. BarBiE Mattel formed in 1945 • 1957—owner thought of 3-D adult- like doll – Based on German doll “Lili” that was sold as a sex toy for men • Life-size Barbie would be 5’6”, 110 lbs., 39 inch bust, 18 inch waist, 33 inch hips
- 8. Eating DisorDErs: risk Factors • Teasing by peers • Lack effective ways of resolving conflict • Maternal preoccupation with weight • Athletic competition • Chronic disease
- 9. common thEmEs at onsEt • Break up of first relationship/ dating • Loss/separation • Menarche/growth • Comments about weight (+ or -) • Family conflict • Increased pressure to achieve • Competition with peers
- 10. co-morBiD DisorDErs • Depression: 60% • Anxiety: 60% • OCD: 40% • Trauma: 25-60% • Personality Disorders
- 11. Bmi • BMI=kg of weight / height2 (meters) – Normal 18.5-25 – Overweight 25-30 – Class I Obesity 30-34.99 – Class II Obesity 35-39.99 – Class III Obesity >40 (Morbid obesity)
- 12. Bulimia nErvosa • Involves a sense of lack of control related to recurrent episodes of eating large quantities of food (binge eating) and subsequent compensating behavior – Two types: • Purging type and non-purging type
- 13. Binging anD Purging • Frequency, amount, and duration of binges vary – Once or twice a week to several times a day • Type of purging varies – 70% vomit – 30% laxatives
- 14. sEvErity • The minimum level of severity is based on the frequency of inappropriate compensatory behaviors – Mild: Average of 1-3 episodes a week – Moderate: Average of 4-7 episodes a week – Severe: Average of 8-13 episodes a week – Extreme: Average of 14+ episodes a week
- 15. coursE & Prognosis • More common than AN (1.5% of females) • Onset is usually 5 years later than AN – Duration of the disorder is longer (about 8.3 years) • Usually precipitated by dieting and weight loss • Prognosis after 10 years: – 50% recovered – 20-30% still meet full criteria – 20-30% wax and wane
- 16. Physiological EFFEcts • Binging – stomach rupture • Purging – heart failure, organ damage, burst blood vessels in the eye, dental erosion, stomach tears • Psychological effects – agitation, irritability, cold intolerance, fatigue
- 17. anorExia nErvosa • Requirements: – Restricted caloric intake insufficient to maintain normal body weight • Based on what is minimally normal in adults and minimally expected in children – Intense fear of gaining weight – Disturbance in perception of body size
- 18. anorExia nErvosa
- 19. AnorexiA nervosA • Food and weight become obsessions • Strange eating rituals or refuse to eat in front of others • Denial of the seriousness of the current low body weight • Amenorrhea – No longer a requirement • Eventually, about half of those with anorexia will develop bulimia
- 20. severity • The minimum level of severity is based, for adults, on current body mass index (BMI), or for children and adolescents, on BMI percentile. – Mild: BMI >17 kg/m2 – Moderate: BMI 16 – 16.99 kg/m2 – Severe: BMI 15 – 15.99 kg/m2 – Extreme: BMI 15 kg/m˂ 2
- 21. specificAtions • Restricting Type: Diets, fasts, or exercises excessively • Binge-Eating/Purging Type: Regularly engages in binge-eating but compensates with purging behavior
- 22. What’s the difference between anorexia and bulimia?
- 23. physiologicAl effects • Mild anemia • Swollen joints • Reduced muscle mass • Dizziness • Brittle bones • Heart failure • Dry, yellow skin • Excessive thirst • Irregular heart rhythms • Brain shrinkage – Personality changes • Starvation • Death
- 24. DeAth in AnorexiA nervosA • Occurs in 1/10 for people with AN • Mortality rate of 5% per decade – Highest of all mental disorders • Results from starvation, suicide, cardiac arrest, or electrolyte imbalance
- 25. Binge eAting DisorDer • Episodic uncontrolled consumption, without compensatory activities – Eating rapidly – Eating until feeling uncomfortably full – Eating when not hungry – Eating alone because of embarrassment – Feeling disgusted, depressed or guilty after overeating • Binges occur at least once a week for 3 months and marked with distress
- 26. physiologicAl effects • Prone to the serious medical problems associated with obesity – High cholesterol – High blood pressure – Diabetes – Gallbladder disease – Heart disease – Cancer
- 27. AN BN BED Excessive weight loss in short period of time X Continuation of dieting although bone-thin X Belief that body is fat, even though underweight X Loss of monthly menstrual periods (amenorrhea) X X Unusual interest in food; development of strange eating rituals X X Eating in secret X X X Obsession with exercise X X Serious depression X X X Binging X X Vomiting or use of drugs to stimulate vomiting, bowel movements, and urination X X Binging but no noticeable weight gain X Disappearance into bathroom for long periods of time to induce vomiting X X Abuse of drugs or alcohol X X X
- 28. treAtment of eAting DisorDers • Physical exam– rule out medical condition • Determine if in immediate medical danger – May require hospitalization • Psychotherapy – Treat comorbid mental disorders and medical complications
- 29. treAtment of AnorexiA nervosA • Family therapy if early onset • Supportive therapy if late onset • No drug has been found to promote weight gain for these patients • Inpatient treatment
- 30. treAtment of BulimiA nervosA • Cognitive-behavioral therapy – Proactive Scheduling – Distracting – Alternative Behaviors – Delaying – Modify beliefs about body image • Antidepressants
- 31. efficAcy of treAtment • Outcome in bulimia is generally more favorable than in anorexia • Even after recovery, women with anorexia often retain an impaired sense of body shape
- 32. other eAting DisorDers • Avoidant/Restrictive Food Intake Disorder – How is this different from AN? • Pica • Rumination Disorder
- 33. oBesity • Obesity rates doubled from1980-2000 – 35% US population is obese • 1998 labeled an EPIDEMIC by World Health Organization • 65% of population lives in countries where obesity kills more than underweight complications • Not currently defined as a mental disorder
- 34. ultimAte costs • Direct link between obesity and lost years of life (Fontaine, 2003) • Young adults with morbid obesity had 22% reduction in life • Obesity-related illness accounts for 300,000 deaths yearly in U.S. • Obesity leads to cardiovascular death – Over 800,000 deaths annually
- 37. Normal Sleep • Sleep nearly 3,000 hours/year – Approximately 1/3 of life • Ideal amount of sleep varies by person – 5 to 6 hours for some – 8+ for others • Amount of sleep needed decreases with age
- 38. maiN TypeS of Sleep • NREM sleep (75-80% of sleep) – Stages 1-4 • REM sleep (20-25% of sleep) – Majority dreams occur • REM and NREM alternate every 80-100 minutes • Sleep patterns vary across the lifespan – Must take into account when diagnosing sleep-wake disorders
- 39. maiN TypeS of Sleep • NREM is 75% of all sleep time – Stage 1-5% of the night – Stage 2-48% of the night – Stage 3 -7% of the night – Stage 4-15% of the night – REM Sleep—25% • Muscles move during NREM, metabolic functions slow down & 20% of dreams Delta (deepest)Delta (deepest) sleepsleep
- 40. rem Sleep • During REM, you have muscle paralysis, erections and much more vivid dreams • Newborns dream 80% of time • By age 2, REM sleep is 33% of total sleep time, approaching adolescent levels
- 41. STageS of Sleep
- 42. BraiN paTTerNS DuriNg Sleep EEG—electroencephelogram (brain waves)EEG—electroencephelogram (brain waves) EOG—electrooculogram (eye-movements)EOG—electrooculogram (eye-movements) EMG—electromyogram (muscle activity)EMG—electromyogram (muscle activity)
- 43. amouNT per STage
- 44. lack of Sleep • What happens when not enough sleep? – health problems – hospitalizations – immune function – Death!
- 45. DeaTh from lack of Sleep
- 46. DeaTh from lack ofDeaTh from lack of SleepSleep
- 47. SuBTypeS of Sleep- Wake DiSorDerS • Dyssomnias: abnormalities in the amount, quality, or timing of sleep • Parasomnias: abnormal behavioral or physiological events during sleep – In DSM-5, the distinctions are no longer central to organization of sleep-wake disorders, but are helpful in describing them
- 49. iNSomNia • Difficulty initiating or maintaining sleep, or nonrestorative sleep – Significant distress or impairment – Must persist for at least 3 months, occurring 3 nights a week • Cannot be due to general medical condition, the effects of a substance, or another mental disorder
- 50. iNSomNia • Prevalence – Up to 10% (women > men) – Up to 25% in the elderly • Course – Begins in young adulthood or middle age – Acute onset with stress – Problems persist after factors resolve – Chronic for 1 year or more in 50-75% • Heightened arousal and negative conditioning
- 51. hyperSomNia • Excessive sleepiness despite receiving 7 hours of sleep during main sleep period – Duration: Acute, Subacute, Persistent – Severity: Mild, Moderate, Severe • Prevelance– 8% • Course – Begins ages 15 – 30 – Usually chronic
- 52. NarcolepSy • Irresistible attacks of refreshing sleep 3 time a week for 3+ months • Requires either – Cataplexy (loss of muscle tone) – Hypocretin deficiency – 15 min or less of REM sleep • REM sleep intrusion • Hallucinations • Sleep paralysis
- 53. BreaThiNg-relaTeD Sleep DiSorDerS • Sleep apnea – restricted airflow or cessation of breathing – Most common obese individuals- soft tissues in neck block airways • Hypopnea- unusually slow or shallow breathing • Hypoventilation: abnormal blood levels of oxygen and carbon dioxide due to shallow breathing
- 54. circaDiaN rhyThm Sleep DiSorDer • Sleep disruption due to an inability to synchronize sleep patterns with current patterns of the day and night • Subtypes – Delayed sleep phase type – Advanced sleep phase type – Shift work type – Irregular sleep-wake type – Non-24-Hour Sleep-Wake Type
- 56. nrem sleeP arousal disorders • Involve incomplete awakening from sleep, accompanied by sleepwalking or sleep terrors. – Sleepwalking – Night terrors • Individuals do not remember the event the next morning
- 57. sleePWalking disorder • Repeated episodes sleepwalking • Blank, stare, unresponsive to others, difficult to awaken • Short period of confusion or disorientation resolves quickly • Sleep violence or eating – 2% of the population enacting some form of violence during sleep
- 58. sleeP terror disorder • Recurrent episodes of abrupt awakening from sleep with a panicky scream • Intense fear and signs of autonomic arousal • Unresponsive to comforting efforts
- 59. rem sleeP Behavior disorder • Complex motor activity that occurs during REM sleep – Associated with vivid dreaming – Normally, skeletal muscles are paralyzed during REM sleep • Prevalence- 0.5% – May precede or accompany development of neurodegenerative conditions
- 60. other sleeP disorders• Nightmare Disorder – Repeated awakenings with detailed recall of frightening dreams • Restless Legs Syndrome – Frequent urges to move legs to relieve unpleasant sensations • Substance/Medication-Induced – Dysfunctions caused by substance use, intoxication, or withdrawal – Risk: Take multiple medications
- 61. assessment • Polysomnographic evaluation – Respiration rate and air flow – Leg movements – Brain activity (EEG) – Eye movement (EOG) – Muscle movements (EMG) – Heart activity (ECG)
- 62. medical interventions • Insomnia: Benzodiazepines or Melatonin – Not recommended long term (excessive sleepiness, dependence, rebound insomnia) • Hypersomnia and narcolepsy: stimulants or amphetamines • Circadian rhythm disorder: melatonin • Breathing-related disorders: weight loss, medications to improve breathing, or mechanical devices • REM Sleep Behavior: Benzodiazepines
- 63. Psychosocial treatments • Relaxation treatment • Confront unrealistic expectations about sleep • Better sleep hygiene • Circadian rhythm disorder – Move bedtime earlier or later – Bright light to trick brain into readjusting biological clock – Zeitgeiber
- 65. sleeP hygiene • Behavioral Principles: – Use the bed only for sleeping/sex – Awake same time/go to bed same time • Only when sleepy – If awake 20 minutes after retiring, relax in another room and return to bed only when tired • Similar if wake up and can’t get back to sleep
- 66. sleeP hygiene • 60-65 degrees Fahrenheit in bedroom (cool) • Avoid daytime naps • Avoid use of caffeine and nicotine • Eat a balanced diet • Reduce noise, stimulation, and temperature in the bedroom • Early afternoon or evening exercise • Light snacks (hunger aggravates sleep) • Avoid extra wink in the morning • Imagine a tranquil place and calming sounds
- 67. hoW to Become an insomniac • Keep unrealistic sleep goal • Catastrophize about not meeting goal • Nap in daytime/spend more time in bed • Spend all of the desperate hours fighting to get to sleep in bed (stimulus for upset) • Make bed center for activity • Start taking sleep medications (REM rebound)
- 69. elimination disorders • Encopresis – repeated passage of feces into inappropriate places – At least 4 years old – Occur once a month for 3+ months • Enuresis – repeated voiding of urine into inappropriate places – At least 5 years old – Occur twice a week for 3+ months – Subtypes: nocturnal, diurnal, or both
- 70. elimination disorders • If events are voluntary or intentional, the disorder may be associated with conduct disorder or oppositional defiant disorder • Must be distinguished from developmentally- appropriate deficiencies in toileting abilities or a general medical condition
- 71. elimination disorders • Prevalence – Encopresis: 1% of 5-year-olds – Enuresis: 10% among 5-year-olds • Treatment – Encopresis: high fiber diets, laxatives, relaxation training – Enuresis: antidepressants, desmopressin, bell and pad method
Notas do Editor
- Mary Kate Olsen and Nicole Richie- anorexia Ask what they see- bone prominence, flappy skin, lack of muscle… ect.
- Eating disorders are increasing in prevalence over the last couple of years, due primarily to change in body image and what is portrayed in the media Curvy used to be in Though I believe they are not increasing as dramatically as they were…
- Over the years, expectation of what weight is considered “attractive” has decreased…
- While the actual weight of the general population has increased. See a greater disparity between what is “ideal” and what is currently happening, which can push people to take extreme actions. Tends to happen more in young girls in western civilizations who are white- why? Standard of beauty in the culture- Culture is huge!
- Increase has slowed since 1984 though Talk about male model video- became obsessed with exercise (different than women)
- Focus on the cultural signals that are around us- ideals we can’t reach Average girl: 118-148 (130); Bust: 34-36; waist: 26-28; hips: 36-38
- Funny comic about how their beauty helped all their problems go away or the double standards for men. CULTURE
- There are certain people who are more at risk though… Conflict- particularly with parents Certain athletes, especially those involved in aesthetic performance (such as figure skating or gymnastics) or those emphasizing a specific weight (such as judo or wrestling) are at higher risk for eating disorders. Anorexia nervosa runs in families, and concordance rates are higher in MZ than DZ twins. Bulimia has some heritability, but not as strong as AN
- Trying to assert independence by refusing to eat- key underlying motivation to AN
- Less optimistic, to worry more, deny negative issues when solving problems, more difficult time dealing with stress than other women Many patients with bulimia have obsessive-compulsive behavior as severe as that seen in patients diagnosed with OCD Break to talk Current trends in weight status and views of appropriate weight The effect culture has Risk factors/onset
- Measure of body fatness- important to understand before defining disorders Could overestimate those with more muscle and underestimate those with less muscle Normal until about 18.5
- Binging: Eating an amount of food that is larger than most people would eat during a similar period of time and under similar circumstances
- Eating binges prior to purging are about 1,000-2,000, but intake during a binge can be as high as 20,000 or as low as 100 calories It usually includes high-calorie foods such as cookies, cakes, and ice cream Binge eating usually takes place rapidly, in secret, and continues until the individual becomes uncomfortably full. Those who use drugs to stimulate vomiting, bowel movements, or urination may be in considerable danger, as this practice increases the risk of heart failure
- Question: Is BN related to SES? Interesting no- think so because of resources available to you, but it’s actually not. The female-to-male ratio is 10:1.
- heart failure due to loss of vital minerals, such as potassium. Break to discuss what is BN, types of purging, and severity?
- Defined as inability to maintain a sufficient body weight Lifetime prevalence rates now appear to be about 0.9% for females and 0.3% for males. Got rid of a specific number cut off (categories), but “inability to keep sufficient weight” is usually between 17 and 18.5 BMI
- Example of how an individual with anorexia views themselves—VERY difficult to overcome this altered view of self, no matter how serious condition gets. This is why there is a lack of realistic knowledge about seriousness of condition. This is the disturbance in body image example
- Think about food a lot- collect recipes But strict control is seen as an accomplishment and source of pride. Assert independence Adhere to strict exercise routines to keep off weight Men with anorexia often become impotent SHOW VIDEO and ask about it
- Restricting type eat very little (as few as 4 to 600 calories per day); only lettuce could be on the menu Binge and purging using diuretics, enemas, self-induced vomiting Binge is less common Many who begin with the restricting type of the disorder shift to binge eating/purging type within the first 5 years. Both often isolate themselves and become awkward socially
- Difference between bulimia and anorexia? Same: fear of gaining weight, dissatisfied with body, and self-evaluation is based on weight Different: bulimia is lack of control while anorexia is maintaining control. Anorexia, you have to have the insufficient weight.
- Loss of calcium effects bones In some patients, the brain shrinks, causing personality changes. Fortunately, this condition can be reversed when normal weight is reestablished Dehydration (like fingers get pruney), so increase in volume with water and hydration, but very small change
- Heart develops dangerous rhythms, blood flow is reduced, blood pressure drops, heart muscle starves—BAD Break for discussion Three requirements for AN How does BMI factor into requirements and severity? What are the two different types of AN? How is it different from BN?
- Binge: Recurrent episodes of binge eating associated with both a sense of lack of control and rapid consumption Not accompanied by compensatory behaviors Often associated with depression, anxiety, and negative self-image More men than other eating disorders Was a provisional diagnosis in DSM-4
- Bulimia vs. Binge Eating Lack of compensatory behaviors
- Break here?
- getting--and keeping--people with these disorders into treatment can be extremely difficult comprehensive treatment plan, involving a variety of experts and approaches. Ideally, the treatment team includes an internist, a nutritionist, an individual psychotherapist, and a psychopharmacologist--someone who is knowledgeable about psychoactive medications useful in treating these disorders most successfully treated when diagnosed early, but often resistant to treatment Experts advise 10 to 12 weeks for full nutritional recovery, however insurance companies in the U.S. rarely cover more than 15 days Most studies on adults with bulimia and BED, not adolescents or AN A sizable proportion of those with eating disorders have limited response to treatment (less than ½ fully recover from AN) Medication for Bulimia, but not AN
- Elicit parents’ aid in getting patient to eat Gradually return control of eating to patient Family helps deal with developmental challenges of adolescence The addition of medication does not add to outcome, and at present, there is no specific role for pharmacology in the treatment of anorexia nervosa Antidepressants not helpful unless added after patient has already returned to normal weight Inpatient treatment, which allows for close monitoring, nutritional counseling, and specific behavioral contingencies, can be effective in restoring body weight
- CBT is therapy of choice Engage in pleasant activities Distracting- Changing the cognitive channel some reduction in the frequency of binge eating and purging with antidepressants, but not as great as CBT
- Someone you know/love exhibits symptoms of an eating disorder Most likely will: Deny Not want treatment Supportive Get them help before gets too serious Break to discuss key considerations before diagnosing, effective are medications, and who has a better prognosis
- Avoidant: do not eat enough food to meet their energy or nutritional needs. Unlike anorexia nervosa, the lack of appetite or avoidance of food does not involve body shape or image. This new DSM-5 diagnosis replaced the DSM-IV condition “feeding disorder of infancy or early childhood,” which required childhood onset. Pica essentially involves the persistent (for at least a month) eating of non-nutritive substances such as soil, paint, cloth, string, insects and pebbles. In rumination disorder, individuals repeatedly regurgitate their food, and either discard it or, more commonly, re-chew it. Rumination disorder usually occurs in infants, with onset before 1 year of age These have been moved from conditions first diagnosed in infancy, childhood, or adolescence
- One more quick eating-related condition—OBESITY Possibility that no countries have reduced their obesity rates in 33 years Rates are still increasing, though Not a disorder- why? Not affecting cognitive/psych functioning and further stigmatize those who are obese; weight not issue, the thought process (why binge eating would be a disorder); more effect of things than cause (obesity comes from multiple medical disorders).
- Most medical problems today are behavioral in nature- obesity is preventable Inactivity doubles risk of CVD Women are more likely than men to be sedentary and the higher your income the more inactive you are Physical activity and physical fitness are two independent risk factors for heart disease. You need both!! Break Here? Discuss: Differences between bulimia and anorexia Differences in treatment Obesity- not a mental disorder
- Sleep disorders weren’t classified until the DSM-4 and they have been reworked in DSM-5 to be more beneficial to mental health and general practitioners
- If I am going to be doing something for one-third of my life, I want to be doing it right! Average for infant is up to 16 hours Average for college age is 7 to 8 hours Elderly 6 or below
- Explain that they don’t need to know percentages—this is just to give them an idea Stage 1: occupies about 5% of time spent asleep in healthy adults Stage 2: 50% of time spent asleep 3 & 4: deepest levels of sleep and occupy about 20% of sleep time- where you repair During REM sleep muscles from neck down enter into a paralyzed state so don’t go cruising all over the place. We will talk more about what happens when this isn’t in place later. Repair: BP drops, breathing slows, sympathetic NS, muscles relax, tissue growth and repair, energy restores, hormones released (growth hormones)
- REM interesting- not sure why so important but it is (will die without it)! Not restorative (that’s deep sleep, REM looks like you are awake) and when sleep deprived, you do REM rebound
- Say stages three and four are where the body rests and repairs itself.
- Brain, eye, muscle
- Fatal familial insomnia where the total lack of sleep results in degeneration of brain tissue and eventual death.
- For the death part, explain the rat study how had an EEG so every time could tell rat went to sleep the floor moved. Lack of sleep-> hypothalamus went crazy- couldn’t regulate body temperature or eating behavior (never felt full)-> lost weight and died (essentially from lack of sleep)
- disorders of initiating or maintaining sleep or of excessive sleepiness; characterized by a disturbance in the amount, quality, or timing of sleep
- Unrelated to other med or psych problems It can be specified as being comorbid with non-sleep mental disorders, other medical disorders, or other sleep disorders Usually a combination of difficulty falling asleep (early insomnia) and intermittent wakefulness during sleep (middle insomnia)
- Young adults more often complain of difficulty falling asleep, whereas midlife and elderly adults are more likely to have difficulty with maintaining sleep and early morning awakening A fairly sudden onset at a time of psychological, social, or medical Stress (most common). Insomnia often persists long after the original causative factors resolve, due to the development of heightened arousal and negative conditioning If the disruption continues, the person becomes frustrated, anxious, and concerned about his or her inability to sleep, increasing the emotional arousal and further interfering with sleep Individuals often attempt to force sleep by remaining in bed longer, but that serves to associate the bed with arousal and wakefulness (negative conditioning)
- Acute (less than 1 month), subacute (1-3 months) or persistent (3+ months) Severity can be mild (1-2 days/week), moderate (3-4 days/week) and severe (5-7 days/week) In one type of recurrent hypersomnolence disorder (called Kline-Levin syndrome), individuals may spend as much as 20 hours per day in bed. Sleep for 9+ hours or take naps and not restorative or refreshing Incidence- 1% As many as 10% of individuals presenting at sleep clinics complain of hypersomnolence
- Cataplexy (i.e., brief episodes of sudden bilateral loss of muscle tone, often precipitated by strong emotions such as anger, laughter, or surprise) Cataplexy can range from subtle signs that may not be obvious to others (such as drooping eyelids or a sagging jaw) to dropping items and falling to the ground Full consciousness is maintained during the episode, which typically lasts only a few seconds or minutes Hypocretin- hypothalamic NT associated with arousal Recurrent intrusions of elements of rapid eye movement (REM) sleep into the transition between sleep and wakefulness, as manifested by either hypnopompic (waking up) or hypnagogic (going to sleep) hallucinations or sleep paralysis at the beginning or end of sleep episodes loss of muscle inhibition Hals – vivid and terrifyingly realistic sensory experiences at sleep onset Experience sleepiness daily Prevalence – rare (0.04%) May be slightly more common in males Course Onset in adolescence to young adult Chronic However, hypnagogic and hypnopompic hallucinations occur in about 15% of the general population, and up to 50% have experienced sleep paralysis, making these REM-related symptoms not unique to narcolepsy. DOG VIDEO
- Sleep disruption due to a sleep-related breathing condition Sleep disruption, leading to excessive sleepiness or insomnia, that is judged to be due to a sleep-related breathing condition (e.g., obstructive or central sleep apnea syndrome or central alveolar hypoventilation syndrome). Person doesn't’t realize breathing problems but loud snoring and heavy sweating morning headaches, sleep drunkenness or sleep inertia (difficulty wakening, confusion, and inappropriate behavior) and episodes of falling asleep during the day are signs
- Sleep disruption leading to excessive sleepiness or insomnia that is due to a mismatch between the sleep-wake schedule required by a person's environment and his or her circadian sleep- wake pattern Circadian rhythms are self regulated and don’t match our 24-hour day clock Delayed Sleep Phase Type: a persistent pattern of late sleep onset and late awakening times, with an inability to fall asleep and awaken at a desired earlier time. Can’t shift cycle forward Advanced sleep phase: experience earlier sleep onset and awakening Shift Work Type: insomnia during the major sleep period or excessive sleepiness during the major awake period associated family or work related disturbances during sleep times Irregular: lack discernable sleep-wake rhythm- sleep is fragmented into at least different periods during the day Non: Sleep-phase gradually increases and drifts our of 24 hour alignment, so sleep moves into daytime hours
- Abnormal events occurring during sleep or twilight time between sleeping and waking
- Repeated episodes of rising from bed during sleep and walking about, usually occurring during the first third of the major sleep episode. Story of man hurting his wife Violent activity more often in men, eating more often in women
- Recurrent episodes of abrupt awakening from sleep, usually occurring during the first third of the major sleep episode and beginning with a panicky scream. Signs of autonomic arousal, such as tachycardia, rapid breathing, and sweating, during each episode Prevalence – 5% children; 1% adults Male adults > female adults Violent activity more often in men, eating more often in women Course Onset in childhood (before 12 years) Usually disappears spontaneously during early adolescence Adults: Sleep terror is related to high incidences of PTSD, mood, anxiety, and personality disorders
- The condition may precede or accompany the development of some neurodegenerative conditions, including Parkinson’s disease, and it may be more likely in children with autism. It can be induced by a variety of medications, including antidepressants. However, its causes remain uncertain. Neurodegenerative- relationship between movement. Brain stem is disinhibited, there is no GABA inhibition, and so have movement problems, like Parkinson’s disease Dan and Larson
- Nightmare: Most dreams last 10 minutes and happen during REM sleep; Most common in children who are exposed to psychosocial stressors; Actual prevalence unknown Restless legs syndrome was also elevated to a parasomnia from provisional status in the DSM-IV. It involves frequent urges to move the legs, especially when resting, in order to relieve unpleasant sensations such as itching, burning, or tingling. Symptoms must occur three times per week for 3 months to qualify for the diagnosis. The incidence increases up to about age 60, and the disorder is more prevalent in females, especially during pregnancy. Prevalence: 2-7% Substance: Women seem more susceptible to substance/medication-induced sleep problems than men, given the same amount and duration of consumption.
- Monitored in a sleep lab
- Melatonin has been shown to improve sleep in chronic insomniacs with few side effects and no withdrawal symptoms after discontinuation Melatonin (reset biological clock; produced by pineal gland in response to darkness) Usually not primary treatment Mechanical devices to reposition tongue or jaw during sleep melatonin (reset biological clock; produced by pineal gland in response to darkness)
- Greater than 2,3000 lux (normal household light is 250 lux) Reduce tension related to sleep
- Desmopressin (a synthetic urine suppressor) Bell and Pad- based on Pavlovian conditioning model. Urination is an automatic reflex response to an enlarged bladder. Most children as they grow older learn to inhibit this reflexive response while sleeping and make the response at the correct time and place. So for nocturnal enuresis, you condition the response of awakening to the stimulus of a full bladder Sleep on pad that when urinated on completes electric circuit and causes bell to sound and awakening the child and pretty soon the CR is paired with the CS- relieving your bladder