EATING AND SLEEP–WAKE

DISORDERS
MAJOR TYPES OF EATING DISORDERS

• In bulimia nervosa, out of control eating episodes, or binges, are

followed by self-induced vomiting, excessive use of laxatives, or
other attempts to purge (get rid of) the food.
• In anorexia nervosa, the person eats nothing beyond minimal
amounts of food, so body weight sometimes drops dangerously.
• In binge-eating disorder, individuals may binge repeatedly and
find it distressing, but they do not attempt to purge the food.
• Obesity is not considered an official disorder in the DSM, but we
consider it here because it is thought to be one of the most
dangerous epidemics confronting public health authorities around
the world today. The latest surveys indicate that close to 70% of
adults in the United States are overweight, and more than 35%
meet criteria for obesity (Flegal, Carroll, Kit, & Ogden, 2012)
SLEEP–WAKE DISORDERS: THE MAJOR DYSSOMNIAS

• We spend about one third of our lives asleep. That means most of
us sleep nearly 3,000 hours per year. For many of us, sleep is
energizing, both mentally and physically. Unfortunately, most
people do not get enough sleep, and 28% of people in the United
States report feeling excessively sleepy during the day (Ohayon,
Dauvilliers, & Reynolds, 2012).
SLEEP–WAKE DISORDERS ARE DIVIDED INTO TWO MAJOR
CATEGORIES:

1. Dyssomnias involve difficulties in getting enough sleep, problems

with sleeping when you want to (not being able to fall asleep until 2
a.m. when you have a 9 a.m. class), and complaints about the quality
of sleep, such as not feeling refreshed even though you have slept
the whole night.
2. Parasomnias are characterized by abnormal behavioral or
physiological events that occur during sleep, such as nightmarescand
sleepwalking.
• The clearest and most comprehensive picture
of your sleep habits can be determined only
by a polysomnographic (PSG) evaluation
(Morin, Savard, & Ouellet, 2012). The patient
spends one or more nights sleeping in a sleep
laboratory and being monitored on a number
of measures, including respiration and
oxygen desaturation (a measure of airflow);
leg movements; brain wave activity,
measured by an electroencephalogram; eye
movements, measured by an
electrooculogram; muscle movements,
measured by an electromyogram; and heart
activity, measured by an electrocardiogram.
HYPERSOMNOLENCE DISORDERS

• Insomnia disorder involves not getting enough sleep (the

prefix in means “lacking” or “without”), and
hypersomnolence disorders involve sleeping too much
(hyper means “in great amount” or “abnormal excess”).
Many people who sleep all night find themselves falling
asleep several times the next day.
• Another sleep problem that can cause a similar excessive
sleepiness is a breathing-related sleep disorder called sleep apnea.
People with this problem have difficulty breathing at night. They
often snore loudly, pause between breaths, and wake in the
morning with a dry mouth and headache.
• cataplexy, a sudden loss of muscle tone. Cataplexy occurs while
the person is awake and can range from slight weakness in the
facial muscles to complete physical collapse. Cataplexy lasts from
several seconds to several minutes; it is usually preceded by strong
emotion such as anger or happiness. Imagine that while cheering
for your favorite team, you suddenly fall asleep; while arguing with
a friend, you collapse to the floor in a sound sleep.
• Sleep terrors, which most commonly afflict children,
usually begin with a piercing scream. The child is
extremely upset, often sweating, and frequently has a
rapid heartbeat.

• During sleep terrors, children cannot be easily awakened

and comforted, as they can during a nightmare. Children
do not remember sleep terrors, despite their often
dramatic effect on the observer.
• One approach to reducing chronic sleep terrors is the use of
scheduled awakenings. In the first controlled study of its kind,
Durand and Mindell (1999) instructed parents of children who
were experiencing almost nightly sleep terrors to awaken their
child briefly approximately 30 minutes before a typical episode
(these usually occur around the same time each evening). This
technique, which was faded out over several weeks, was
successful in almost eliminating these disturbing events.
• It might surprise you to learn that sleepwalking (also called
somnambulism) occurs during NREM sleep (Shatkin &
Ivanenko,2009). This means that when people walk in their sleep,
they are probably not acting out a dream. This parasomnia
typically occurs during the first few hours while a person is in the
deep stages of sleep.