Department of Psychology, University of Kansas, Lawrence, Kansas, USA.
Department of Anesthesiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
Int J Eat Disord. 2021 May;54(5):701-707. doi: 10.1002/eat.23498. Epub 2021 Mar 4.
Many people with eating disorders (EDs) report symptoms of insomnia (i.e., frequent difficulty falling asleep, staying asleep, and/or early morning wakening) and sleep problems have been linked to alterations in eating behaviors; however, mechanisms of these bidirectional associations remain poorly understood and under researched. This is a problem because higher insomnia symptom severity is a risk factor for the onset and perpetuation of anxiety, mood, trauma, and substance use disorders and, potentially, ED symptoms. Furthermore, insomnia symptoms may hinder recovery and increase relapse rates following successful psychotherapy. In this article, we describe potential mechanisms underlying bidirectional associations between insomnia and eating psychopathology that may contribute to the etiology and maintenance of both disorders. We suggest novel directions for future research to characterize the association between dysregulated sleep and ED symptoms and to evaluate impacts of insomnia symptoms on relapse and recovery for people with co-occurring pathology. Finally, we discuss options for testing the incorporation of existing evidence-based treatments for insomnia disorder (e.g., Cognitive-Behavioral Therapy for Insomnia) with ED care. Overall, insomnia symptoms present a promising intervention point for ED treatment that has not been systematically tested, yet would be highly feasible to address in routine clinical care.
许多饮食障碍（ED）患者报告有失眠（即频繁入睡困难、睡眠保持困难和/或清晨早醒）症状，而睡眠问题与饮食行为的改变有关；然而，这些双向关联的机制仍知之甚少，研究也不足。这是一个问题，因为更高的失眠症状严重程度是焦虑、情绪、创伤和物质使用障碍以及潜在的 ED 症状发病和持续的风险因素。此外，失眠症状可能会阻碍成功心理治疗后的康复并增加复发率。在本文中，我们描述了失眠和饮食心理病理学之间双向关联的潜在机制，这些机制可能有助于两种疾病的病因和维持。我们为未来研究提供了新的方向，以描述睡眠失调与 ED 症状之间的关联，并评估失眠症状对共病患者复发和康复的影响。最后，我们讨论了测试将现有的失眠障碍循证治疗（例如失眠认知行为疗法）与 ED 护理相结合的选择。总的来说，失眠症状是 ED 治疗的一个很有前途的干预点，尚未得到系统测试，但在常规临床护理中解决这个问题是非常可行的。
