Eating disorders

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Patients with eating disorders may have a variety of sleep complaints, and some studies have documented objective sleep abnormalities. (36> Those with anorexia nervosa may report excess energy and symptoms of insomnia, particularly during periods of weight loss, whereas those with bulimia nervosa may experience hypersomnia, typically following eating binges. Comorbid depression is not uncommon in patients with eating disorders, and polysomnographic investigations of sleep patterns were motivated at least in part to determine if common biological markers could be identified in patients with depression and eating disorders. One of the major problems with this work has been the age of the subjects studied; patients with eating disorders are typically young. A number of investigations have failed to document significant sleep changes in subjects with eating disorders, (3Z,38 and3§) but this is also true for most sleep parameters in young depressives. (D In studies that have documented sleep abnormalities, patterns of sleep disturbance have generally been similar to those seen in depression: sleep continuity disruption, loss of SWS, and reduced REM sleep latency. (4 .41>

Sleep-related eating disorders have been increasingly recognized, both in patients with known eating disorders as well as in individuals with no apparent histories of daytime eating abnormalities, although the latter is probably less common. Bulimics frequently binge late in the evening or during the night, and up to a third have episodes of binge-eating which occur during sleep. (42> In sleep-related eating, the individual may partially arouse sometime after sleep onset and consume a large amount of high-calorie food; sometimes the foods consumed during these episodes is not typical of what is eaten during the daytime, and patients may be unusually sloppy or careless while eating. There may be little or no recollection of the eating episode the following day. Many of these patients have prior histories of sleepwalking, and polysomnographic studies have documented SWS parasomnias in half or more of patients studied. (43,44> Sleep-related eating has also been reported in association with other sleep disorders (e.g. periodic limb movements, narcolepsy, and obstructive sleep apnoea), substance abuse (e.g. benzodiazepine and alcohol abuse) and other psychiatric disorders (mood and anxiety disorders). (43,45> (See also CMpieL4J,0...,3,.)

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