January 18, 2017
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.
"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. "That means we must also intervene in clients' struggles with insomnia to increase treatment effectiveness as well as to prevent re-traumatization.
1The American Insomnia Survey (AIS) (Kessler, 2011).
2Straus, L. D., Drummond, S. P., Nappi, C. M., Jenkins, M. M., & Norman, S. B. (2015)."Sleep Variability in Military-Related PTSD: A Comparison to Primary Insomnia and Healthy Controls", Journal of Traumatic Stress, 28(1), 8-16. doi:10.1002/jts.21982.
3Pigeon, W. R., Heffner, K. L., Crean, H., Gallegos, A. M., Walsh, P., Seehuus, M., & Cerulli, C. (2015), "Responding to the need for sleep among survivors of interpersonal violence: A randomized controlled trial of a cognitive-behavioral insomnia intervention followed by PTSD treatment." Contemporary Clinical Trials, 45, 252-260. doi:10.1016/j.cct.2015.08.019.
4"Correlation Between Eating Disorders and Sleep Disturbances", Eiber R, Friedman S, Encephale Sep-Cot 2001.
5"Severity of insomnia, disordered eating symptoms, and depression in female university students", Lombard, Battagliese, Baglioni, David, Violani and Riemann, Clinical Psychologist 18 (2014) 108-115.
6"Overcoming Insomnia", Harvard Mental Health Letter, February 2011.
7"Sleep Disturbance in Pediatric PTSD: Current Findings and Future Directions", Journal of Clinical Sleep Medicine, 2013 May 15; 9(5): 501-510.