Feeding/Eating and

Sleep-Wake Disorders
Alyson Morgan, MS3
Ross University School of Medicine
Feeding and Eating Disorders
Anorexia Nervosa

▪ Restriction of food intake leading to significantly low BMI w/ intense

fear of gaining weight, compensatory effort to prevent weight gain
▪ Sxs: thin habitus, amenorrhea, hypothermia, hypotension,
bradycardia, arrhythmia, ACS, cardiomyopathy, MVP, alopecia,
edema, dehydration, seizures, osteoporosis, Russell’s sign, petechiae
▪ Restricting type vs. Binge-Purging type
▪ Main Concerns: hyponatremia, hypochloremic hypokalemic alkalosis,
arrhythmia (pQT), anemia, hypoglycemia
▪ Tx: FOOD!, CBT, family therapy, supervised weight-gain programs
Refeeding Syndrome

▪ Electrolyte and fluid shifts when severely malnourished pts are refed
– Fluid retention, decreased phosphorus, magnesium, and calcium

▪ Complications: arrhythmias, respiratory failure, delirium, seizures

▪ Tx: replace electrolytes and slow feedings
Bulimia Nervosa

▪ Restriction of food intake w/ normal to increased BMI, intense fear of

gaining weight, compensatory effort to prevent weight gain
▪ Similar sxs and presentation as anorexia
– Salivary gland enlargement, dental erosions/caries, Russell’s sign, petechiae,
peripheral edema, aspiration

▪ Main Concerns: hyponatremia, hypochloremic hypokalemic alkalosis,

arrhythmia (pQT), anemia, hypoglycemia
▪ Tx: antidepressants + therapy (SSRIs first-line, namely fluoxetine)
– Therapy: CBT, interpersonal psychotherapy, group therapy, family therapy
Binge-Eating Disorder

▪ Emotional distress, not preoccupation with weight, drives need to

binge eat
– Bingeing episode with at least 3 of following: eating very fast, until uncomfortably
full, large amounts when not hungry, alone due to embarrassment, and feelings of
disgust/guilt/depression after eating

▪ At least once a week for 3 months

▪ NOT associated w/ compensatory behaviors (vomiting, laxatives, etc.)
▪ Tx: CBT or interpersonal psychotherapy w/ strict diet and exercise
program
– Pharmacotherapy MAY help: stimulants, topiramate, zonisimide orlistat
Sleep-Wake Disorders
Normal Sleep-Wake Cycle

▪ REM and NREM stages (90 minutes)

▪ NREM
– Stages 1-3

▪ REM
– Waking = vivid dream recall
Sleep Disorders

▪ Dyssomnias
– Insufficient, excessive, or altered timing of sleep

▪ Parasomnias
– Unusual sleep-related behaviors

▪ Hx: be sure to ask about Activities prior to bedtime, Bed partner hx,
Consequence on waking function/quality of life, Drug regimen,
Exacerbating/relieving factors, Frequency/duration, Genetic
factor/FHx, Habits (alcohol, caffeine, nicotine, illicit substances,
hypnotics)
Dyssomnias

▪ Insomnia disorder
– Acute (<3 months) or chronic (>3 months
– Change in duration and/or quality of sleep
▪ Sleep-onset, Sleep-maintenance insomnia or Non-restorative sleep
– Tx: sleep hygiene, CBT, pharmacotherapy
▪ BZs, non-BZs (ambien, lunesta, sonata), antidepressants (trazodone, amitriptyline,
doxepin)

▪ Hypersomnolence disorder
– Excessive quantity of sleep, reduced wakefulness, and sleep drunkenness
– Tx: life-long therapy w/ modafinil or stimulants (atomoxetine second-line) and
scheduled napping
Dyssomnias

▪ Obstructive sleep apnea hypopnea

– Repetitive collapse of upper airway during sleep
– Sxs of excessive daytime sleepiness, apneic episodes, sleep fragmentation,
snoring, frequent awakenings w/ gasping/choking, unrest, morning HA, HTN
▪ Associated w/ obesity, increased neck circumference, airway narrowing
– Tx: CPAP or BiPAP, lifestyle modifications, possible surgery

▪ Central sleep apnea

– Idiopathic, Cheyne-Stokes subtype (pts w/ dec. EF, acute stroke), due to opioids
– Tx: CPAP/BiPAP, supp O2, medications (acetazolamide, theophylline, sedative
hypnotics), treat underlying condition
Dyssomnias

▪ Sleep-related hypoventilation
– Decreased respiration w/ increased CO2
– Sxs: frequent arousals, morning HA, insomnia, excessive daytime sleepiness
– Tx: CPAP/BiPAP, breathing promoters (bronchodilators, theophylline), treat
underlying condition

▪ Narcolepsy
– Recurrent need to sleep, lapsing into sleep, or daytime napping ≥3 times/wk for
≥3 months w/ one of following: cataplexy, hypocretin deficiency, reduced REM
– Associated w/ hypnagogic and hypnopompic hallucinations
– Tx: sleep hygiene, scheduled naps, avoidance of shift work, supportive
▪ Daytime sleepiness (stimulants), cataplexy (SSRIs/SNRIs)
Dyssomnias

▪ Circadian rhythm sleep-wake disorders

– Delayed sleep phase disorder
▪ Recurrent delay in sleep onset and awakening times w/ preserved sleep quality
– Advanced sleep phase disorder
▪ Normal duration and quality, but awakening earlier than desired
– Shift-work disorder
▪ Sleep deprivation and misalignment of CR due to work hours
– Jet lag disorder
▪ Sleep deprivation and misalignment of CR due to travel
Parasomnias

▪ Abnormal behaviors or events occurring during sleep or sleep-wake

transitions
– NREM sleep arousal disorders
▪ Sleepwalking
– Difficulty arousing during episode w/o memory of event
▪ Sleep terrors
– Difficulty arousing during episode w/o memory of event
▪ Nightmare disorder
– Easy arousal w/ vivid memory of dreams, causing significant distress and impairment
– REM sleep behavior disorder
▪ Dream enacting behaviors/vocalization, often violent behaviors during sleep
– Restless leg syndrome
– Urge to move legs w/ unpleasant sensation relieved by movement