Chapter 8: Eating and Sleep–Wake Disorders

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Hey everyone and welcome back for another Deep Dive.

You know, we love to take a look at some interesting psychology stuff and today we're going to be focusing on eating and sleepwalk

It's a really fascinating area.

You know, we often think of these as kind of individual struggles, but you know, they're actually incredibly common and really deeply connected to our culture in the society that we live in.

That's exactly what we're going to be talking about today.

We're looking at a really interesting chapter in a psych textbook and I was so excited to get into this with you.

It's a real eye -opener.

We're breaking down, you know, what these disorders are, how their cause, what the treatments are, and the really surprising ways that they reflect these larger societal forces.

Yeah, these are really fundamental parts of our lives, eating and sleeping, and when they go wrong, the impact can be huge.

Absolutely, and the chapter really starts out by, you know, highlighting just how prevalent eating disorders are.

It's interesting to note that they kind of started to become more common back in the 1950s and 60s and then they really took off in western countries, specifically between 1960 and 1995.

And what's really concerning is how serious disorders can be.

You know, anorexia, for example, has a shockingly high mortality rate.

Up to 20 % of individuals with anorexia actually die from it, and over 5 % within just 10 years.

Wow, 20%.

That's a really stark reminder that we're not talking about, you know, just superficial concerns here.

This is really serious stuff.

Absolutely.

It's really crucial to understand the different types of eating disorders because they each have their own, you know, unique characteristics.

Let's break it down a little bit.

So first up, we've got bulimia nervosa.

So this is kind of a cycle of out -of -control binges followed by these purging behaviors, so things like vomiting, using laxatives.

The textbook gives this example of Phoebe, you know, a seemingly perfect high school student who's struggling with this cycle, and it's important to note that purging is not actually an effective way to lose weight.

Right, and then there's anorexia nervosa, which is where individuals severely restrict their food intake, and that's driven by an intense fear of weight gain and a really distorted body image.

So they give an example of Julie in the textbook, and she's like a high achiever who becomes totally consumed by counting calories and exercising, and unlike those with bulimia,

individuals with anorexia often take pride in their control over their eating.

And then there's binge eating disorder, so this is where we see recurring binges, but without the purging behaviors, and it causes significant distress.

So this is actually a relatively new diagnosis.

It was added to the DSM -5 in 2013, and it's important to emphasize this isn't just overeating.

You know, we're talking about real emotional and psychological distress that's associated with these episodes.

And looking at the bigger picture, there's some really striking statistics about the prevalence in gender differences.

The median age of onset for all eating disorders is between 18 and 21, but what's really striking is that 90 to 95 percent of individuals diagnosed with bulimia are women.

That's a huge gender gap.

Why do you think we see such a stark difference between men and women when it comes to eating disorders?

You know, it's a complex issue, but a big part of it really relates back to this culture of thinness that we see, you know, particularly in Western society.

So there's this constant bombardment of media images, especially aimed at women,

that idealize a very specific and often unrealistic body type.

It's not even just the images, it's the advertising too, right?

We're constantly bombarded with ads for this readily available, highly processed food that definitely doesn't encourage healthy eating habits.

And the study that they mentioned, the chapter about Fiji, really drives this point home.

Oh yeah, tell me about that one.

So they looked at what happened after Western television was introduced in Fiji in 1995, and there was a huge increase in binge eating and purging behaviors among Fijian girls.

Wow, that's a really powerful illustration of how cultural influences can really impact our behavior.

You know, we're immersed in this environment that promotes these unrealistic beauty standards while at the same time making it so easy to, you know, engage in unhealthy eating patterns.

The chapter also talks about the really high rates of eating disorders among ballet dancers.

So in one study, 25 % of the young women, they looked at developed eating disorders in just two years, which is pretty alarming.

It is, it really makes you think about how these messages about body image and thinness, you know, how they affect our own habits and how we see ourselves.

Absolutely.

So we've talked about the types of eating disorders and some of the cultural factors that contribute to them, but what about the underlying causes of these disorders?

What's going on there?

Well, it's not a simple answer.

There's no single cause, but the biopsychosocial model really helps to explain how these different factors kind of interplay and work together.

So there's definitely a biological component.

You know, research shows that you're four to five times more likely to develop an eating disorder if you have a close relative with one.

So there's a genetic predisposition, but it's not the whole story.

Right.

There's also a psychological aspect.

You know, many people with eating disorders experience low self -esteem.

They have a really distorted body image and they struggle with perfectionism.

And then of course you have the social factors that we talked about, the influence of culture and peers.

And the chapter mentions the study where researchers basically artificially raise perfectionistic standards in a group of women.

And they found it led them to restrict their eating more.

Which really highlights how all of these things work together.

The biological, the psychological and the social, they all come together to create this vulnerability to these disorders.

So knowing all this, what are the treatment options out there?

Are medications effective?

Unfortunately, medications have limited effectiveness for eating disorders.

Antidepressants may be helpful for bulimia, but they haven't shown much promise for anorexia.

What about therapy?

Cognitive behavioral therapy or CBT is showing some really promising results, especially a newer transdiagnostic version called CBTE.

And research indicates that CBTE is actually more effective than traditional psychoanalytic therapy in treating bulimia.

That's really good to hear.

What role does family therapy play in all of this?

Family therapy is really crucial, especially for adolescents with anorexia.

So the focus there is on changing unhealthy communication patterns around food and addressing body image issues within the family dynamic.

It seems like a really multifaceted approach is essential.

But given how difficult these disorders can be to treat,

what about prevention?

Prevention is definitely key.

There are programs like Healthy Weight and online student bodies program that promote body acceptance and healthy eating habits.

That online component is interesting.

Are internet -based interventions a viable option these days?

It's a growing field and it has a lot of potential.

They can reach a much wider audience and they offer more accessibility, which is crucial for people who might not have access to traditional therapy.

Now let's shift gears a bit and talk about obesity.

So it's not technically a DSM disorder, but it is a major health concern in our society.

Absolutely.

In the U .S., around 70 % of adults are overweight and over 35 % are obese.

So it's a global issue, some really serious health implications.

What are some of the maladaptive eating patterns that are associated with obesity?

Well, one is binge eating disorder, which we talked about earlier.

And another is night eating syndrome, which is where individuals consume a large portion of their daily calories after dinner,

often involving these late night trips to the fridge while they're asleep.

They're asleep.

That's fascinating.

It is.

And it's different from sleepwalking with night eating syndrome.

People are awake during those nighttime eating episodes, but they may not have full awareness or memory of it later.

That sounds like a really challenging condition to address what causes these patterns and what are the treatment options.

The causes are multifaceted.

It's a combination of biological and lifestyle factors.

So we have genetic predispositions that affect things like our metabolism, the number of fat cells we have.

But our modern environment also plays a significant role.

Just like with eating disorders, we kind of face this toxic environment that promotes a sedentary lifestyle and easy access to these high calorie, low nutrition foods.

So what can be done to make our diets effective?

Well, diets often lead to short term weight loss, but most people end up regaining the weight.

So professionally directed programs that combine diet and exercise with behavior modification tend to be more successful.

And it's also really vital to involve parents in these programs, especially for children and adolescents.

What about medication or surgery?

Medications for obesity have limited effectiveness and potential side effects.

Bariatric surgery is an option, but it's typically a last resort reserved for severe cases where obesity poses a significant health risk.

And even with surgery, long term success depends on major lifestyle changes.

It seems like a combination of approaches is really needed.

It makes you think about how our environment and our habits contribute to this complex issue.

Okay, so let's move on now to the world of sleep wake disorders, just like with eating, you know, sleep is so fundamental to our being, but so many of us experience disruptions.

It's true.

And just like with those eating disorders, a lot of times these disorders are more than just bad habits or a lack of willpower.

Right.

We've all had those nights where we toss and turn, but when does it actually cross the line from just having a bad night's sleep to an actual diagnosable disorder?

Well, that's where the diagnostic process comes in.

There's this tool called a polysomnographic evaluation or a sleep study, and it measures things like airflow, brain waves, muscle movements during sleep.

And one key factor they look at is something called sleep efficiency, which is the percentage of time that you're actually asleep.

So it's not just about the number of hours that you're in bed.

It's about how much of that time you're actually sleeping soundly.

Exactly.

And sleep wake disorders can fall into two main categories.

You have dyssomnias and parasomnias.

So dyssomnias involve problems with the amount or the quality or the timing of sleep.

Parasomnias are these abnormal behaviors that occur during sleep.

Like sleep talking.

Exactly.

But let's start with dyssomnias first.

Insomnia is one that's incredibly relatable.

The textbook says that about a third of people experience insomnia symptoms in any given year.

And it's important to remember that insomnia doesn't always mean no sleep at all.

So there are different ways that insomnia can actually manifest.

Yeah.

It can involve difficulty falling asleep, waking up frequently throughout the night, or even waking up feeling unrefreshed, even though you've gotten a seemingly adequate amount of sleep.

The chapter mentions these microsloops, which are these brief involuntary sleep episodes that can happen when someone is severely sleep deprived.

Wow.

So it's like your brain is trying to sneak in sleep any way it can.

Chapter also talks about hypersomnolence disorder, which is kind of like the opposite of insomnia.

Right.

Hypersomnolence is characterized by excessive sleepiness even after a full night's sleep.

They use an example of Anne in the textbook, who's a college student who just can't stay awake class no matter what she does, which highlights how disruptive this can actually be.

It's not just about feeling tired.

It can have really serious academic and social consequences.

And it's important to distinguish hypersomnolence from narcolepsy.

Narcolepsy involves sudden uncontrollable episodes of REM sleep, and they're often triggered by strong emotions.

So REM sleep, that's the dream stage of sleep, right?

Exactly.

And as high point people with narcolepsy may experience things like cataplexy, which is a sudden loss of muscle control, or even hypnagogic hallucinations, which are these really vivid and often frightening experiences that happen right at the onset of sleep.

That sounds so disorienting.

It can be.

And then you have these breathing -related sleep disorders like sleep apnea, where breathing repeatedly stops and starts during sleep.

I've heard that untreated sleep apnea can be really dangerous.

Yeah, it's true.

It's linked to a lot of health problems, including heart disease and stroke.

So the most common treatment is a CPAP machine, which helps to keep the airway open during sleep.

And then there's circadian rhythm sleep disorders, which I think we've all experienced in some form or another, whether it's jet lag or adjusting to a new work schedule.

Our internal clocks can get thrown off by things like travel or shift work, making it really hard to sleep at night and feel alert during the day.

So many different ways our sleep can go haywire.

What about those strange happenings in the night, those parasomnias?

All right, let's start with nightmares.

You know, most of us have had a bad dream or two, but nightmares are more intense, more disturbing, often waking the person up in a state of fear.

And they're more common than you might think.

The textbook says that college students report an average of 10 nightmares per year.

Wow,

that's more than I would have guessed.

What about sleep terrors?

Sleep terrors are different from nightmares in that they occur during non -REM sleep, so the person isn't actually dreaming.

These episodes involve intense fear, often accompanied by screaming, sweating, a racing heart.

But the person usually has no memory of the event afterward.

That must be really frightening for anyone who witnesses it, especially if it's a child.

Yeah, it can be.

And then there's sleepwalking, which can be potentially dangerous, especially if the person wanders outside or tries to do something that could cause harm.

There have even been controversial cases of violence that occur during sleepwalking episodes, which raises some interesting legal and ethical questions.

The chapter also mentions nocturnal eating syndrome.

So this is where people eat while they're fully asleep, often with no memory of it afterward.

It's different from night eating syndrome, which we discussed earlier in the context of obesity.

It's amazing our sleep can be just as complex and fascinating and sometimes troubling as our waking lives.

It's really amazing how much we're still learning about the brain, especially when it comes to things like eating and sleeping, these really basic functions.

It is fascinating.

For so long, these disorders were seen as purely medical issues or even failings.

But now we're really starting to understand these complex connections between our minds and our bodies when it comes to eating and sleepwalking disorders.

It's a good reminder that we're not just bodies.

We're complex beings with thoughts and feelings and behaviors, and it's all kind of intertwined.

Right.

And we can't forget those social and cultural influences that we talked about.

They play such a huge role.

It really highlights the need for a more holistic approach to treatment, one that takes all these different aspects into account.

So let's circle back to treatments for sleepwalk disorders.

Specifically, we talked about insomnia earlier.

What are some of the options beyond sleeping pills?

One of the most promising approaches is cognitive behavioral therapy for insomnia or CBTI, and it really helps to target both those behaviors and the thought patterns that contribute to insomnia.

The textbook mentioned a student named Sanja who successfully overcame her sleep problems using CBT.

Can you break down what her treatment actually looked like?

Sure.

So Sanja was dealing with really severe insomnia, only getting about four hours of sleep a night.

And her therapist used a technique called sleep restriction,

which might sound a little strange at first.

Sleep restriction.

So you mean making her sleep even less.

Yeah.

It seems counterintuitive, but it's all about improving sleep efficiency.

She was told to limit her time in bed to just those four hours, even though it felt like she needed way more rest.

Okay.

I'm intrigued.

How does that actually work?

Well, by limiting her time in bed to the actual amount she was sleeping, it kind of increased her sleep drive.

So she started falling asleep faster and sleeping more soundly during those four hours.

It helps to retrain your body to associate bed with sleep and not with, you know, tossing and turning or worrying.

So you're basically resetting that sleepwalk cycle.

Exactly.

And along with sleep restriction, her therapist also used something called stimulus control.

So she was told to avoid doing anything in bed besides sleeping, no studying, no TV, no phone.

And if she couldn't fall asleep after 15 minutes, she was supposed to get out of bed and do something relaxing until she felt tired again.

Sounds like a pretty strict regimen.

It can be challenging,

but the goal is to create this really strong mental association between bed and sleep.

And then the other key component of CBTI is cognitive therapy.

So this part helps people to challenge those negative thoughts and beliefs about sleep.

And it helps them to manage the anxiety that might be interfering with their sleep.

So it's a three -pronged approach.

You're changing your sleep habits.

You're controlling your sleep environment and you're addressing the thoughts that are getting in the way of good sleep.

What about treatments for some of the other sleepwalk disorders?

Well, for narcolepsy medication is often the primary treatment.

Simulants can be really helpful in managing that excessive daytime sleepiness.

And for those breathing related sleep disorders like sleep apnea, those CPAP machines we talked about are the go -to treatment.

They deliver continuous positive airway pressure, which helps to keep the airway open and prevents those pauses in breathing.

And for those circadian rhythm disorders where the body's natural sleep -wake cycle is out of whack.

Treatment often focuses on resetting that internal clock.

So it might involve things like adjusting sleep schedules using bright light therapy or taking melatonin supplements.

It's incredible how many different approaches there are.

And of course, there's a lot we can do ourselves to promote good sleep hygiene.

Absolutely simple things like sticking to a consistent sleep schedule, even on the weekends, having a relaxing bedtime routine, avoiding caffeine and alcohol before bed.

Those can make a huge difference.

Well, this deep dive has been so eye -opening.

We've covered a lot of ground today from the types of eating and sleep -wake disorders to their causes and treatments.

What are some of the big takeaways you want our listeners to walk away with?

I think one of the biggest is that these disorders are so much more common than we often think.

And they often stem from a combination of things, our biology, our psychology, and even the social world around us.

It's not about willpower or some kind of personal failing.

These are real conditions, and they need to be treated with understanding and evidence -based approaches.

It's been so interesting to really explore how our culture, especially those pressures around body image and thinness, contribute to these disorders.

And that brings us to a really important question.

How do we, as individuals and as a society, perpetuate these pressures?

Do we buy into unrealistic beauty standards?

Do we put looks above health?

Do we create environments that make it hard for people to develop healthy habits around food and sleep?

Those are all things to think about.

They really are.

And we hope this deep dive has given you some new insights and maybe even sparked some ideas about how we can create a healthier and more supportive environment for everyone.

If you have any questions or thoughts you want to share, don't hesitate to reach out.

Thanks for joining us.