When a body standard tightens around food, and what anorexia nervosa looks like

How much a person eats, and how, bears directly on body shape. Many people try to regulate eating both to keep their health and to meet an appearance standard. When intake is excessive the body enlarges and collides with the ‘ideal figure’ a society asks for, so a tendency to eat less appears. A slim build is treated as a symbol of self-management and draws a positive social judgment. This shows itself strongly in women, tied to the standard a contemporary society holds for a woman’s appearance. In the past a healthy, ample figure was accepted as the ideal of beauty; now a slim body has taken that place, and media, the fashion industry, and social platforms continually idealize a thin figure and pass on the message that it should be followed. Many women suppress appetite to meet an outer standard, and even fall into pathological eating, which can lead to an eating disorder. Eating is not a mere personal choice; it is tightly bound to sociocultural pressure.

Anorexia nervosa is an eating disorder in which, from an extreme fear of weight gain, a person refuses food or markedly reduces intake. At its core are a distorted body image and an excessive preoccupation with weight. Even in an underweight state the person still sees herself as fat, and thoroughly controls intake or expels food by vomiting to prevent a gain. The body then falls into severe malnutrition, and physiological abnormalities appear: menstruation stops, fatigue, dizziness, low blood pressure, and reduced heart function. Mood swings may worsen, and depression, anxiety, and social withdrawal may accompany them. It is not a mere refusal of meals, but a mental illness in which a distorted recognition of one’s own body and a compulsive need for control act together. The most representative behavior is restriction of intake. People may avoid meals with family or friends, or pretend to eat and secretly throw food away. They also tend toward excessive exercise: one anecdote is of deliberately going up and down stairs, or getting off a stop early and walking. After eating, some induce vomiting themselves, or use laxatives or diuretics — physically dangerous methods. The behavior not only damages the body; mentally it also strengthens anxiety and guilt, and a vicious cycle is made. Generally, a loss of 15 percent or more of normal weight, or a body-mass index of 17 or below, is medically assessed as underweight. If the state continues, physiological function drops sharply: amenorrhea, low blood pressure, a slow pulse, constipation, a low body temperature, fatigue, and a reduced tolerance of cold. In some patients, fine downy body hair grows as it becomes hard to keep body heat. When vomiting is repeated, enamel is damaged by gastric acid, and cuts may appear on the back of the hand when fingers are used to induce it. A long-term state of starvation can bring reduced heart function, an electrolyte imbalance, kidney impairment, and osteoporosis, and in severe cases the mortality rate can reach 10 percent or more —, without

The causes of anorexia nervosa are not single; several psychological and sociocultural factors act together. A psychoanalytic view sees the disorder as an unconscious fear and repression of sexual maturity. Freud interpreted a refusal of food as a symbolic act meant to suppress sexual desire, and Bruch saw it as an attempt at control in order to gain a sense of self-efficacy — an expression of autonomy, a sense of regulating one’s own body and life. A family-therapy view saw unclear, overly entangled boundaries between parent and child as a root: when, at the time an adolescent tries to become independent, a parent’s controlling attitude is strengthened, resistance appears in the form of starving. A behaviorist position holds that, in an environment where a society rewards ‘thinness’ and punishes ‘obesity,’ a fear of weight gain is learned and reinforced. A cognitive view explains a distorted perception of the body, seeing it as larger than it is, as a core factor. Patients depend excessively, for both self-esteem and others’ evaluation, on body image. They believe a slim body is the key to success and love, and they interpret others’ reactions in a distorted way, taking even a positive word as meaning they are ‘still not slim enough,’ so that even praise or worry becomes a motive for further loss. Body and self are identified, and weight becomes a measure of self-worth.

On a biological theory, anorexia nervosa is related to genetic factors and to an abnormality of brain function, among them a dysfunction of the hypothalamus, which regulates hunger and satiety. If that function is damaged, appetite decreases abnormally and the internal standard for keeping weight is lowered. An auto-addictive model also explains a process in which endorphins secreted after fasting or excessive exercise induce a positive feeling, and the patient comes to depend on that emotion. As the brain’s reward system is distorted, the act of starving is reinforced as a psychological reward, and a vicious cycle is made. Genetic studies have also shown a high concordance in monozygotic twins, supporting a genetic predisposition — Treatment needs an integrated approach that deals together with physical recovery, a restructuring of cognition, and a change in family dynamics. When hospital care is needed, securing a recovery of weight and of nutrition in a safe setting comes first. Positive behavior is reinforced and fasting is punished, on behaviorist principles. Cognitive-behavioral therapy is then used to revise irrational beliefs and negative automatic thoughts about a distorted body image. Family therapy should be combined to deal with problems of communication and a controlling style of parenting, and medication is combined when a secondary psychopathology such as depression is present. Treatment needs a long course, and because the chance of relapse is high it is important to plan ongoing outpatient care and a possible return to hospital together.

Binge eating and night eating, how treatment is set out, and when sleep and waking come apart

Binge-eating disorder is an eating disorder in which, in a short time, a person eats an uncontrollably large amount of food and afterward feels guilt or disgust. People with the disorder tend to try to ease feelings such as anxiety, depression, and stress through food. It may look similar to bulimia nervosa, but the largest difference is that there is no compensatory behavior: after eating they do not vomit, exercise, or use medicine to regulate weight. As a result, patients often gradually gain weight and become overweight or obese. A study also found that about 30 percent of obese participants in a diet program had binge-eating disorder — left undated. First, binge eating of a much larger amount than usual, in a short time, appears repeatedly. Second, the binge appears together with three or more of the following: eating even when not hungry, eating uncomfortably much, eating alone in secret, and feeling disgust or depression after eating. Third, the person feels severe distress in daily life. Fourth, the behavior should have continued at least once a week for three months or more. Last, there should be no compensatory behavior such as vomiting or using medicine. When negative feelings — depression, stress, anger, loneliness — are many, binge eating is provoked; sometimes it becomes an act of comforting oneself. Yet self-esteem falls further, and self-reproach and regret after the binge repeat, and a vicious cycle is entered. Physical health can worsen, and relationships and daily life are affected. The disorder appears often in adults in their thirties and forties, and relatively evenly in both women and men. The outlook is said to be relatively better than that of other eating disorders, but if it is not found and treated early it can continue chronically. Cognitive-behavioral therapy is set out as the most effective treatment, including skills for handling emotion, self-understanding, and a restructuring of eating habits; medication may be combined. It is not a problem that arises because the will is weak. A shortage of skill in regulating emotion, a lack of self-esteem, and difficulty in coping with stress are, rather, among the causes.

Night-eating disorder is an eating disorder in which a substantial portion of a day’s whole intake is eaten late at night or at dawn, repeatedly. People with the disorder have almost no appetite in the morning, eat little during the day, and at night feel a strong appetite and take in a large amount. The rhythm of appetite and of sleep has been broken by an imbalance of the biological rhythm, by stress, or by a sleep disorder. Unlike a mere late-night snack habit, it is a pathological state in which the night eating, repeated, brings psychological and physical trouble. At its core is a ‘distortion of time.’ Most of the day’s meals shift to after evening, and it often happens that a person wakes after falling asleep and rummages in the refrigerator. The behavior is hard to control, and regret and self-reproach follow. Rather than eating explosively in a short time, as in binge-eating disorder, there is a tendency to eat steadily over several occasions. It is also closely tied to a sleep disorder: often a person cannot sleep, or wakes in the middle, eats, and falls asleep again. The disorder is deeply related to obesity. Food taken at night is easily stored without an expenditure of energy, so weight rises easily, and the risk of chronic conditions such as high blood pressure, diabetes, and high blood lipids also grows. The quality of sleep falls, fatigue lasts into the next day, and the vitality of life as a whole can decrease. It often appears in people whose skill in regulating emotion and managing stress is low, and it is often accompanied by depression. Some people hold back all day and then eat at night as if in ‘reward.’ Treatment should be centered, above all, on recovering regularity in meal times and in sleep times. Cognitive-behavioral therapy, education in sleep hygiene, stress management, and, when needed, medication can be combined. When a sleep disorder comes with it, collaboration with a sleep specialist is a help. People themselves often feel they ‘want to fix it,’ but it is hard to resolve by will alone, because the biological rhythm, the regulation of emotion, and sleep are intertwined.

Eating disorders include anorexia nervosa, bulimia nervosa, binge-eating disorder, night-eating disorder, pica, and rumination disorder, and because symptoms and causes differ, the method of treatment should also differ. When, as in anorexia nervosa, weight has fallen severely and life is threatened, hospital care and a recovery of nutrition come first. By contrast, binge-eating disorder or bulimia nervosa that arise from a problem of feeling are focused, through cognitive-behavioral therapy, on correcting distorted thoughts and behaviors. When conflict with the family is a main factor, family therapy is sometimes combined. Medication can be effective when depression, anxiety, or a problem of impulse control is also present; antidepressants of the SSRI class help in reducing binge symptoms. In night-eating disorder, because a problem of sleep and a broken meal rhythm are at the core, education in sleep hygiene and an improvement of daily habits are important, and a sleep aid or an antidepressant is used together when needed. In cases such as pica or rumination disorder that appear in young children, education of the parents, the forming of an emotional relationship, and behavior therapy are needed. A fuller account of bulimia nervosa itself is not filled out beyond this in the essay.

An arousal disorder, is a state in which the biological rhythm of falling asleep and waking naturally is disturbed, and daytime activity is greatly hindered. In DSM-5-TR the disorders are classified as insomnia disorder, hypersomnolence disorder, narcolepsy, breathing-related sleep disorders, circadian-rhythm sleep-wake disorders, and others. As the textbook put it, it is not merely a problem of ‘not sleeping well,’ but a psychophysiological problem in which the time when sleep is needed and the time when one should be awake do not match. Sleep is divided into non-REM and REM sleep, and in each stage the body and the brain take turns resting and recovering. That process must repeat normally if sufficient arousal is to be kept in the day. When the quality or the rhythm of sleep is abnormal, daytime sleepiness, a sense of lethargy, and a drop in concentration appear. Sleep is not mere rest; it carries out important functions such as the recovery of the brain and the body, emotional stability, and the organizing of memory. Sleep itself is a time of recovery for body and mind, and an arousal disorder means that this cycle of recovery has collapsed. Among the kinds of insomnia, the essay sets out sleep-maintenance insomnia as a state in which a person wakes several times while asleep and finds it hard to fall asleep again. Restless-legs syndrome is a state in which, mainly at night or during rest, an unpleasant sensation arises in the legs and one feels an urge to move them. Insomnia disorder is a condition that persists in which a person wants to sleep but sleep does not come, or wakes often while asleep, or wakes too early and cannot fall asleep again. Hypersomnolence disorder is a state in which, even after taking sufficient sleep, excessive sleepiness comes on in the daytime and ordinary daily life becomes difficult. Sleep-wake disorders also appear in particular occupations: nurses who often work through the night, firefighters who must keep a twenty-four-hour standby, and international flight attendants who find jet lag hard are liable to chronic sleep trouble, short of both hours and quality. A contemporary society also fosters a cultural pressure that one succeeds by cutting sleep. Even adolescents struggle with chronic shortage under academic stress and smartphone use, and there is a report that Korean high-school students are among those with the shortest sleep among OECD countries —, without When shortage of sleep is repeated, attention drops, short-term memory is impaired, and impulse control suffers. As one case, traffic accidents from drowsy driving on a highway mostly stem from shortage of sleep. A U.S. study also found that shift workers had more than twice the accident risk of regular workers — left undated — because shift work breaks a normal sleep-wake cycle and chronically disturbs the biological rhythm. Sleep trouble, then, is a serious issue that goes beyond a person’s condition and ties directly to social safety. The same Korean report, at fuller length, is on CampusDown.

Sources

1. How much a person eats, and how, bears directly on body shape. Many people try to regulate eating both to keep their health and to meet an appearance standard. When intake is excessive the body enlarges and collides with the ‘ideal figure’ a society asks for, so a tendency to eat less appears. The reason is that a slim build is treated as a symbol of self-management and receives a positive social judgment. The physiological phenomenon above shows itself strongly in women. The reason is deeply related to the standard a contemporary society has for a woman’s appearance. In the past a healthy, ample female figure was accepted as the ideal standard of beauty, but at present a slim body has taken its place as the standard of beauty. And it is further strengthened today through media, the fashion industry, social platforms, and the like, because those media continually idealize a thin figure and pass on the message that it should be followed. Many women suppress appetite to meet an outer standard, and even come to a pathological level of eating behavior, and this can lead to an eating disorder. In this way, the act of eating is not a mere personal choice, but is tightly connected to sociocultural pressure. In fact, when a shortage of sleep is repeated, a drop in attention, impairment of short-term memory, problems of impulse control, and the like occur, and they lead to practical losses in daily life. As one case, traffic accidents from drowsy driving while driving on a highway mostly stem from a shortage of sleep. In a U.S. study a result also came out that shift workers had more than twice the accident risk of regular workers. The reason is that, because of shift work, a normal sleep-wake cycle is broken and the biological rhythm is chronically disturbed. In this way a sleep problem is a serious issue that goes beyond a person’s condition and is directly tied to social safety. Also, sleep-wake disorders appear in particular occupational groups or social settings: nurses who often work through the night, firefighters who must keep a twenty-four-hour standby system, international flight attendants who find adjustment to a time difference difficult, and the like, easily suffer from a chronic sleep disorder. It is because sleep hours are short and the quality of sleep also falls. Moreover, a contemporary society also fosters a cultural pressure that ‘one succeeds by cutting sleep.’ Even adolescents are suffering from a chronic shortage of sleep from academic stress and smartphone use, and in fact there is also a report that Korean high-school students are among those with the shortest sleep hours among OECD countries. Anorexia nervosa is an eating disorder in which, from an extreme fear of weight gain, a person refuses food or markedly reduces the amount of intake. The core of this disorder comes from a distorted body image and an excessive preoccupation with weight. In fact, even in an underweight state, the person still recognizes herself as fat, and thoroughly controls food intake to prevent a gain in weight, or also expels eaten food by vomiting. As a result the body falls into a state of severe malnutrition, and physiological abnormalities such as a stopping of menstruation, fatigue, dizziness, low blood pressure, and a drop in heart function appear. Mood swings also become severe, and depression, anxiety, social withdrawal, and the like are sometimes accompanied. Anorexia nervosa is not a mere refusal of meals, but a mental illness in which a distorted recognition of one’s own body and a compulsive desire for control act together in a complex way. Patients feel an extreme anxiety about a gain in weight, and they perform behaviors in order to avoid those feelings. The most representative behavior is a restriction of food intake. They also show deceptive behaviors such as avoiding a seat at a meal with family or friends, or pretending to eat and secretly throwing food away. Also, a tendency to do excessive exercise in order to reduce weight appears. As one anecdote, they repeat unnecessary activity such as deliberately going up and down stairs, or getting off early at a stop and walking. Going further, they also sometimes choose physically dangerous methods such as vomiting by themselves after intake of food, or using a laxative (a diarrheal medicine) or a diuretic. Such behavior not only brings physical damage; mentally it also makes a vicious cycle that strengthens anxiety and a sense of guilt. Generally, when 15 percent or more of normal weight is lost, or the body-mass index (BMI) falls to 17 or below, it is medically assessed as an underweight state. If this state continues, physiological function drops sharply, and symptoms such as amenorrhea, low blood pressure, bradycardia, constipation, hypothermia, a feeling of fatigue, and a drop in tolerance of cold appear. In some patients, fine hair (body hair in the form of down) also grows on the body as it becomes hard to maintain body temperature. If vomiting is repeated, the enamel of the teeth is damaged by gastric acid, and when fingers are used to induce vomiting a wound is also sometimes made on the back of the hand. A long-term state of starvation can bring a drop in heart function, an electrolyte imbalance, kidney impairment, and osteoporosis, and in a severe case the mortality rate reaches 10 percent or more. The causes of anorexia nervosa are not single, and are the result of several psychological and sociocultural factors acting together in a complex way. In a psychoanalytic perspective this disorder is seen as an unconscious fear and repression of sexual maturity. Freud interpreted a refusal of food as a symbolic act meant to suppress sexual desire, and Bruch saw it as an attempt at control in order to obtain a sense of self-efficacy. It is a kind of expression of autonomy, in order to secure a sense of regulating one’s own body and life by oneself. In a family-therapy perspective, a family structure in which the boundary between parent and child is unclear and overly entangled was seen as becoming the root of the problem. It is an interpretation that, at the time an adolescent tries independence, if a parent’s controlling attitude is strengthened, resistance to it appears in the form of ‘starving.’ In a behaviorist position, it is held that, in an environment in which a society rewards ‘thinness’ and punishes ‘obesity,’ a fear of weight gain is learned and reinforced. In a cognitive perspective, a distorted perception of body image, recognizing one’s own body as more enlarged than it actually is, is explained as a core factor. Patients with anorexia nervosa have a seriously distorted recognition of their own figure. It does not come from dissatisfaction with appearance, but from a cognitive characteristic of depending excessively, for both self-esteem and others’ evaluation, on body image. They recognize themselves as much fatter than their actual figure, and believe that a slim body is the key to obtaining success and love. They also interpret others’ reactions in a distorted way, receive even a positive word as meaning they are ‘still not slim enough,’ and continue to attempt a reduction of weight. Thus even praise or worry from outside comes to act as a motive for a reduction of weight. It is because a distorted cognitive structure has been formed in which body and self are identified, and weight becomes a measure of the worth of the self. According to a biological theory, anorexia nervosa is related to genetic factors and to an abnormality of brain function, among them a dysfunction of the hypothalamus. The hypothalamus plays a role in regulating hunger and satiety, and if that function is damaged, appetite decreases abnormally and the internal standard that tries to maintain weight is lowered. Also, an auto-addictive model explains a process in which endorphins secreted after fasting or excessive exercise induce a positive emotion, and the patient comes to depend on this feeling. In this way, as the brain’s reward system is distorted, a vicious cycle is made in which the behavior of starving is reinforced as a psychological reward. In genetic research as well, a high concordance rate in monozygotic twins has appeared, supporting a genetic predisposition. The treatment of anorexia nervosa needs an integrated approach that deals together with physical recovery, a restructuring of cognition, and a change in family dynamics. When hospital treatment is needed, securing a recovery of weight and an intake of nutrition first, in a safe environment, has priority. At that time a behaviorist principle is applied that reinforces positive behavior and punishes fasting behavior. Afterward, through cognitive-behavioral therapy for a distortion of body image, irrational beliefs and negative automatic thoughts are revised. Also, family therapy to deal with problems of communication between family members and a controlling attitude of parenting should be carried out together, and when a secondary psychopathology such as depression is accompanied, medication is also combined. Treatment requires a long-term process, and because the possibility of relapse is high, it is important to set up ongoing outpatient management and a plan for rehospitalization together. Binge-eating disorder (Binge Eating Disorder) is an eating disorder in which, in a short period, a person eats an uncontrollably large amount of food and afterward feels a sense of guilt or disgust. It is because people who have this disorder have a tendency to try to resolve feelings such as anxiety, depression, and stress through food. It looks similar to bulimia nervosa, but the largest difference is the point that there is no compensatory behavior. In other words, after eating they do not regulate weight by vomiting, by exercising, or by using medicine. As a result, patients with binge-eating disorder in many cases gradually gain weight and become overweight or obese. In fact there is also a study that about 30 percent of obese participants who took part in a diet program had binge-eating disorder. First, a binge-eating behavior of eating a much larger amount of food than an ordinary person, in a short time, appears repeatedly. Second, this binge eating appears together with three or more of the following behaviors: eating even when the stomach is not hungry, eating uncomfortably much, eating alone in secret, feeling a sense of disgust or depression after eating, and the like. Third, because of this, severe distress is felt in daily life. Fourth, this behavior should have continued at least once a week for three months or more. Last, there should be no compensatory behavior such as vomiting or using medicine. When there are many negative feelings such as a depressive feeling, stress, anger, and loneliness, a binge-eating behavior is provoked. At times it is not eating without any reason, but becomes a behavior for comforting oneself. However, because of this, self-esteem rather falls further, and as self-deprecation and regret after binge eating are repeated, a person falls into a vicious cycle. Physically as well, health can worsen, and it affects even interpersonal relations and daily life. Binge-eating disorder appears often mainly in adults in their thirties and forties, and appears relatively evenly in both men and women. The prognosis is known to be relatively better than that of other eating disorders, but if it is not found and treated early it can continue chronically. As a method of treatment, cognitive-behavioral therapy is the most effective, and skills for dealing with emotion, self-understanding, a restructuring of eating habits, and the like are included. Medication can also be combined. Binge-eating disorder is not a problem that arises because the will is weak. Rather, a shortage of ability in regulating emotion, a deficit of self-esteem, difficulty in coping with stress, and the like are the causes. Night-eating disorder is an eating disorder in which eating a substantial portion of a day’s whole intake late at night or at dawn is repeated. People who have this disorder have almost no appetite in the morning, and the amount they eat during the day is also small, whereas when night comes they feel a strong appetite and come to take in a large amount of food. It is because, in these people, the rhythm of appetite and of sleep has been broken by an imbalance of the biological rhythm, by stress, or by a sleep disorder. Unlike a mere late-night snack habit, night-eating disorder is a pathological state in which the behavior of eating at night, being repeated, provokes psychological and physical problems. The core of night-eating disorder is a ‘distortion of time.’ Most of a day’s meals are concentrated after evening, and it even frequently occurs that a person wakes after falling asleep and rummages in the refrigerator. This behavior is hard to control even for the person, and after eating, regret and a sense of self-reproach follow. However, rather than eating explosively in a short time as in binge-eating disorder, they have a tendency to eat steadily over several occasions. Another characteristic is that it is closely connected to a sleep disorder. There are many cases in which a pattern is repeated of sleep not coming, or of waking in the middle, eating, and falling asleep again. Night-eating disorder is deeply related to obesity, and can cause various problems for health. Food taken in at night is easily stored without an expenditure of energy, so weight increases easily, and the risk of chronic diseases such as high blood pressure, diabetes, and hyperlipidemia also grows. Also, the quality of sleep falls, fatigue continues into the next day, and the overall vitality of life can decrease. This disorder frequently occurs in people whose ability to regulate emotion and to manage stress is low, and there are also many cases in which it is accompanied by depression. Some people also eat food at night as if in ‘reward,’ after holding back all day. The treatment of night-eating disorder should, above all, have as its center a recovery of regularity in meal times and in sleep times. Cognitive-behavioral therapy, education in sleep hygiene, stress management, and, when necessary, medication can be carried out together. When it comes together with a sleep disorder, a joint consultation with a sleep specialist is a help. With night-eating disorder, a person feels for herself that she ‘wants to fix it,’ but it is hard to resolve by will alone. It is because complex elements such as the biological rhythm, the regulation of emotion, and sleep are entangled. Among eating disorders there are anorexia nervosa, bulimia nervosa, binge-eating disorder, night-eating disorder, pica, rumination disorder, and the like, and because each disorder has different symptoms and causes, the method of treatment should also differ. In a case such as anorexia nervosa, where weight has been severely reduced and life is threatened, hospital treatment and a recovery of nutrition have priority. On the other hand, binge-eating disorder or bulimia nervosa that arise from a problem of emotion are focused, through cognitive-behavioral therapy (CBT), on correcting distorted thoughts and behaviors. When conflict with the family is a main factor, family therapy is also sometimes carried out together. Also, medication can be effective when a depressive feeling, anxiety, or a problem of impulse control is present together. Antidepressants of the SSRI class are a help in reducing binge-eating symptoms. In the case of night-eating disorder, because a problem of sleep and a broken meal rhythm are the core, education in sleep hygiene and an improvement of living habits are important, and if necessary a sleep aid or an antidepressant is used together. In a case that appears in a young child, such as pica or rumination disorder, education of the parents, the forming of an emotional relationship, and behavior therapy are needed. An arousal disorder refers to a state in which the biological rhythm by which a person naturally falls asleep and wakes is disturbed, and a great hindrance is received in activity during the day. In DSM-5-TR this disorder is classified as insomnia disorder, hypersomnolence disorder, narcolepsy, breathing-related sleep disorders, circadian-rhythm sleep-wake disorders, and the like. As the textbook said, it is not a problem of ‘not being able to sleep well,’ but a psychophysiological problem in which the period when sleep is needed and the period when one should be awake come not to match. Sleep is divided into non-REM and REM sleep, and in each stage the body and the brain perform a function of taking turns resting and recovering. Only when this process repeats normally can sufficient arousal be maintained in the day. That is why, if an abnormality arises in the quality or the rhythm of sleep, problems such as sleepiness during the day, a feeling of lethargy, and a drop in concentration appear. Why are sleep-wake disorders important? The reason is that sleep is not mere ‘rest,’ but performs important functions such as the recovery of the brain and the body, emotional stability, and the organizing of memory. Sleep is a time of recovery for the body and the mind, and an arousal disorder means that this cycle of recovery has collapsed. The second is sleep-maintenance insomnia, and it refers to a state in which a person wakes several times in the course of sleeping and finds it difficult to fall asleep again. Restless-legs syndrome refers to a state in which, mainly at night or during rest, an unpleasant sensation arises in the legs and one comes to feel an impulse to move the legs. A sleep problem is a serious issue that goes beyond a person’s condition and is directly tied to social safety. Insomnia disorder is a disease in which a state persists of wanting to sleep but sleep not coming, or of frequently waking while asleep, or of waking too early and being unable to fall asleep again. Hypersomnolence disorder is a state in which, even though sufficient sleep has been taken, excessive sleepiness comes on during the day and a normal daily life becomes difficult.

Last updated: 14 November 2026