Eating Disorders and Insomnia Essay Paper

 Eating Disorders and Insomnia Essay Paper

Sleep problems are often characterized as trouble falling asleep, staying asleep, difficulty waking from sleep, feeling sleepy or tired during the daytime, or experiencing abnormal sleep behavior (e.g., sleep-walking). Sleep problems can also lead to sleep deprivation or insufficient sleep. Sometimes these problems cluster together, such as difficulty falling asleep, staying asleep, and waking from sleep, which are the symptoms of sleep disorder insomnia. Eating Disorders and Insomnia Essay Paper(1) Sleep problems like those experienced with insomnia or other sleep disorders (e.g., hypersomnolence or sleeping too much, circadian rhythm sleep-wake disorder) are diagnosed when the problems persists for at least one month.(1) Usually researchers evaluate sleep problems over the past month;(2) however experimental studies often look at the effects of more short-term sleep deprivation (e.g., less than a week) on both physical and psychological health.(3)

What do we know about sleep and eating disorders?

Sleep problems have been studied in eating disorders, including anorexia nervosa (AN), bulimia nervosa (BN), binge-eating disorder (BED), and night eating syndrome (NES; see below for comprehensive reviews).(4, 5, 6) For example, Kim et al.(7) found approximately half of female patients with AN or BN were currently experiencing sleep problems, including about 33% having trouble falling asleep and about 18% waking up throughout the night. Eating Disorders and Insomnia Essay Paper As for BED, Vardar et al.(8) reported that patients with BED and obesity had more sleep problems, such as poor sleep quality and shorter sleep duration, compared to patients who were obese but did not have BED and compared to normal weight individuals. NES, which involves nighttime consumption of at least 25% of daily food intake after the evening meal, has an established overlap with sleep problems such as insomnia.(4) More broadly, sleep problems have been associated with binge eating in studies of female twins,(9, 10) and sleep problems have also been associated with binge eating and purging behaviors in studies of college men and women.(11-16)

What explains this connection?

Clearly, research supports a connection between sleep problems and eating disorders, but we don’t have an explanation for the connection, although several theories have been proposed.(4, 5, 6) Allison et al.(4) review this research and highlight weight fluctuations (gain and loss) and disruption of appetite-regulating hormones as one possibility. In fact, studies have suggested that sleep deprivation contributes to weight gain and obesity(17) and can cause disruption of appetite-regulating hormones, resulting in increased hunger.(17, 18) This is supported by the fact that individuals with eating disorders are known to have disruptions in appetite-regulating hormones as well as weight fluctuations.(19) Eating Disorders and Insomnia Essay Paper

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Depressed mood may also explain the connection between sleep problems and eating disorders. Sleep problems, particularly sleep deprivation, increase risk for depression,(1) and frequent insomnia or daytime fatigue are actually criteria for the diagnosis of depression.(20) Supporting this is the high overlap between eating disorders and depression; with lifetime co-morbidity (overlap) with AN, BN, and BED of 39%, 50%, and 32%, respectively.(21) These factors and possibly others (e.g., personality traits, genetic predisposition, reward sensitivity) may contribute to the connection between sleep problems and eating disorders.

Why is this important?

Understanding the connection between sleep problems and eating disorders may inform future prevention and intervention programs and treatments. Indeed, bright light therapy, which is also used to effectively treat seasonal affective disorder(22) and various sleep disorders, has shown promising results in treating BN(23, 24, 25) and NES(26) in pilot studies. It remains unclear which comes first—sleep problems or the eating disorder. Most likely, both paths are possible. Allison et al.(4) review assessment tools, including self-report questionnaires and actigraph watches, that can be used both clinically and in research. Eating Disorders and Insomnia Essay Paper All of this is particularly noteworthy as sleep deprivation has continuously increased in the general population over the last few decades.(18) Further and more detailed studies of the nature of the relationship between sleep and eating disturbances are relevant not only for individuals with eating disorders, but also for the general population.

Breaking the Cycle of Eating Disorders, Insomnia and Trauma

Insomnia affects about 24% of Americans1, but the incidence is higher for individuals who have experienced a traumatic event. Fully 70% of individuals with PTSD have recurring sleep disturbances2, and the majority of PTSD-diagnosed patients cite falling asleep or remaining asleep as their chief complaint.3 There’s a similarly high correlation between eating disorders and sleep disturbances. Anorexics and bulimics often complain of sleep onset insomnia and disrupted sleep,4 and restrictive eating can also reduce sleep quality.5

Over the past decade, Mirasol has witnessed a steady increase in the percentage of clients admitting with serious trauma, and has consequently developed specialized protocols for the treatment of eating disorders with co-occurring complex trauma and PTSD. Given the complex interactions between trauma, depression and eating disorders, it’s not surprising that a high percentage of Mirasol clients also suffer from recurring sleep disturbances. Eating Disorders and Insomnia Essay Paper

“We estimate that 75% of our clients have one or more of the sleep disturbances that characterize insomnia, such as difficulty falling asleep, frequent waking during the night, and waking earlier than is desired,” says Mirasol Executive Director Diane Ryan. “Lack of sleep impacts not only their ability to function, but it can also make it more difficult for them to succeed in eating disorder treatment.”

To respond to this critical need, Mirasol has developed new treatment protocols for sleep disturbances. All clients are now screened for insomnia, and if they score in the moderate to severe range, they receive additional treatment modalities that target the cognitive, behavioral, neurologic and physiologic aspects of the disorder.

The intervention combines mindfulness and education with cognitive behavioral components, and includes objective sleep measures. It may or may not include medication, since research indicates that medication has only temporary utility in treating insomnia. For example, a study comparing zolpidem (Ambien) cognitive behavioral therapy (CBT), those who received a combination of CBT and medication improved faster, but in the second, longer-term phase of the study, benefits of drug therapy faded.6

According Ryan, “medication management may be a goal of our insomnia treatment protocol, but it is not necessary to discontinue these medications for the treatment to be effective.”

Alleviating symptoms of insomnia could have far-reaching consequences, since recent research indicates that sleep disturbances not only result from, but also contribute to, the development of PTSD.7

“We are committed to providing state-of-the-art treatment for eating disorders and co-occurring conditions including trauma,” says Ryan. Eating Disorders and Insomnia Essay Paper “That means we must also intervene in clients’ struggles with insomnia to increase treatment effectiveness as well as to prevent re-dramatization.

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Sleep-Related Eating Disorders

Sleep-related eating disorders are characterized by abnormal eating patterns during the night.

Although it is not as common as sleepwalking, nocturnal sleep-related eating disorder (NS-RED) can occur during sleepwalking. People with this disorder eat while they are asleep. They often walk into the kitchen and prepare food without a recollection for having done so. If NS-RED occurs often enough, a person can experience weight gain and increase their risk of developing type 2 diabetes.

A closely related disorder, known as night eating syndrome (NES), is diagnosed when a person eats during the night with full awareness and may be unable to fall asleep again unless he/she eats.

Symptoms of NES include the following and often persist for at least two months: Eating Disorders and Insomnia Essay Paper

Sleep disturbances in anorexia nervosa

In clinical practice, insomnia is a common feature in anorexia nervosa (AN). Sleep self-reports in AN suggest that these patients report poor sleep quality and reduced total sleep time. Weight loss, starvation and malnutrition can all affect sleep. Patients with eating disorders who have sleep disturbances have more severe symptomatology. The authors intend to review sleep disturbances observed in AN, describe possible pathophysiological mechanisms and evaluate the clinical impact of sleep disturbances on the treatment and prognosis of the disease. Eating Disorders and Insomnia Essay Paper In this study, a non-systematic search of published literature from January 1970 and August 2015 was carried out, through PubMed, using the following key words: ‘sleep’, ‘anorexia nervosa’ and ‘insomnia’. These patients subjectively report having poor sleep quality, with difficulty falling asleep, interrupted sleep, early morning waking or reduced total sleep time. Sleep disturbances found in AN using polysomnography are: reduction in total sleep time, decrease in slow wave sleep, slow wave activity and reduced sleep efficiency. Privation of adequate and restful sleep has a negative impact on the quality of life of patients, may contribute to the appearance of comorbidities, such as depression and anxiety, and to a poor prognosis for AN. Eating Disorders and Insomnia Essay Paper

 

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