Sleep eating is a sleep-related disorder, although some specialists consider it to be a combination of a sleep and an eating disorder. It is a relatively rare and little known condition that is gaining recognition in sleep medicine. Other names for sleep eating are sleep-related eating (disorder), nocturnal sleep-related eating disorder (NS-RED), and sleep-eating syndrome.
Sleep eating is characterized by sleepwalking and excessive nocturnal overeating (compulsive hyperphagia). Sleep eaters are comparable to sleepwalkers in many ways: they are at risk for self-injury during an episode, they may (or may not) experience excessive daytime sleepiness, and they are usually emotionally distressed, tired, angry, or anxious. Sleep eaters are also at risk for the same health complications as compulsive overeaters, with the added dangers of sleepwalking. Common concerns include excessive weight gain, daytime sleepiness, choking while eating, sleep disruption, and injury from cooking or preparing food such as from knives, utensils, or hot cooking surfaces. There is also the potential for starting a fire.
As with sleepwalkers, sleep eaters are unaware and unconscious of their behavior. If there is any memory of the episode, it is usually sketchy. A sleep eater will roam the house, particularly the kitchen, and may eat large quantities of food (as well as non-food items). In the morning, sleep eaters have no recollection of the episode. However, in many cases there are clues to their behavior. One woman woke up with a stomachache and chocolate smeared on her face and hands. Candy wrappers littered the kitchen floor. The next morning her husband informed her that she had been eating during the night. She was shocked and distressed because she had no recollection of the event.
As in the case described above, food consumed by sleep eaters tends to be either high sugar or high fat. Odd combinations of foods, such as potato chips dipped in peanut butter or butter smeared on hotdogs, as well as non-food items, have been reported. Oddly, one person was discovered cutting a bar of soap into slices and then eating it as if it were a slice of cheese!
Sleep eating is classified as a parasomnia. It is a rare version of sleepwalking, which is an arousal disorder. In 1968, Roger Broughton published a paper in Science (159: 1070-1078) that outlined the major features of arousal disorders. They are:
•Abnormal behavior that occurs during an arousal from slow wave sleep;
•The absence of awareness during the episode;
•Automatic and repetitive motor activity;
•Slow reaction time and reduced sensitivity to environment;
•Difficulty in waking despite vigorous attempts;
•No memory of the episode in the morning (retrograde amnesia); and
•No or little dream recall associated with the event.
How Common is Sleep Eating?
The actual number of sleep-eating sufferers is unknown; however, it is estimated that 1 to 3 percent of the population is affected by sleep eating. A higher percentage of persons with eating disorders, as many as 10 to 15 percent, are affected. For this reason, sleep eating is more common in younger women. Symptoms typically begin in the late 20s. Episodes may reoccur, in combination with a stressful situation, or an episode may occur only once or twice. Additionally, many parasomnias seem to run in families, which may indicate that sleep eating is genetically linked.
When Should you See a Doctor?
In many cases, sleep eating is the outward sign of an underlying problem. Many sufferers are overweight and dieting. When their control is diminished by sleep, these individuals binge at night to satisfy their hunger. Some sleep eaters have histories of alcoholism, drug abuse, or a primary sleep disorder, such as sleepwalking, Restless Legs Syndrome, or sleep apnea. An article in Sleep (October 1991: 14(5): 419-431) suggested that sleep eating is directly linked to the onset of another medical problem.
Because sleep eating occurs in people that are usually dieting and emotionally distressed, attempts at weight loss may be unsuccessful and cause even more stress. Compounded with the dangers of sleepwalking, compulsive eating while asleep is a sleep disorder that results in weight gain, disrupted sleep, and daytime sleepiness. As these consequences of sleep eating impact daily living, the necessity of seeing a healthcare professional becomes more important.
Parasomnias are complex and often serious in nature. If you think you suffer from sleep eating, consult with your physician or a healthcare professional who can refer you to a sleep disorders treatment center. It is strongly recommended that a sleep specialist carry out the diagnosis and treatment. Medical or psychological evaluation should also be investigated.
The first step in treating any sleep disorder is to ascertain any underlying causes. As with most parasomnias, sleep eating is usually the result of an underlying problem, which may include another sleep disorder, prescription drug abuse, nicotine withdrawal, chronic autoimmune hepatitis, encephalitis (or hypothalmic injury), or acute stress (Sleep 1991 Oct; 14(5): 419-431).
It is important to keep in mind that throughout life, people experience varying patterns of sleep and nutrition during positive and negative situations. Problems with eating are defined as overeating or not eating enough. Problems with sleeping can be simplified with two symptoms, too much or not enough sleep. Medical attention is required for abnormal behaviors in either or both areas.
For some people who have been diagnosed with sleep eating, interventions without the use of medications have proven helpful. Courses on stress management, group or one-on-one counseling with a therapist, or self-confidence training may alleviate the stress and anxiety that leads to nighttime bingeing. Although considered an alternative treatment, hypnosis may be an option for some sleep eaters. A change in diet that includes avoiding certain foods and eating at specified times of the day, as well as reducing the intake of caffeine or alcohol, may be therapeutic. Professional advice may also suggest avoiding certain medications.
If the underlying problem is diagnosed as sleepwalking, medications in the benzodiazepinefamily have had some success. In sleepwalkers, this class of drugs reduces motor activity during sleep. Another class of drug found to be effective for sleep eaters has been the dopaminergic agents such as Sinemet (carbidopa or levodopa) and Mirapex (pramipexole dihydrochloride). Refer to the chart in the Restless Legs section of this website for more information about dopaminergic agents and benzodiazepines.
If the underlying problem is a primary sleep disorder, such as sleep apnea or narcolepsy, check out the sections on this web site devoted to the treatment of these disorders.
Night Eating: Another Disorder of Sleep and Eating:
A similar sleep-related eating disorder has also been clinically described. It is different from sleep eating in that the individual is awake during episodes of nocturnal bingeing. This disorder has many names: nocturnal eating (or drinking) syndrome, nighttime hunger, nocturnal eating, night eating or drinking (syndrome), or the “Dagwood” syndrome. Affected individuals are physically unable to sleep without food intake.
The Merck Manual lists night eating under the heading obesity. It states that the disorder “consists of morning anorexia, excessive ingestion of food in the evening, and insomnia.” Because night eating is associated with increased weight gain as well as insomnia, this may cause the individual stress, anxiety, or depression.
Night eating or drinking may occur once or many times during the night. It is diagnosed when 50% or more of an individual’s diet is consumed between sleeping hours. Unlike sleep eaters, this person will eat foods that are similar to his/her normal diet.
People who are night eaters typically avoid food until noon or later, eat small portions frequently when they do eat, and binge in the evening. They are usually overweight and in adults, overly stressed or anxious. They will also complain of not being able to maintain sleep or not being able to initiate sleep. For night eaters, the urge to eat is an abnormal need, rather than true hunger, according to an article in Sleep by Italian researchers (September 1997; 20(9): 734-738).
Night eaters/drinkers are usually children, although the disorder can occur in adults. For children, eating or drinking at night is a conditioned behavior. This is a common occurrence for babies, but most infants can sleep the entire night by the age of 6 months. Sleep disturbance can persist to an older age if the child is allowed a bottle or drinks throughout the night. An older child may consistently wake up during the night and ask for a drink or something to eat and refuse to return to bed until the snack is consumed. In this case, the caregiver should identify actual need versus repeated requests.
According to the International Classification of Sleep Disorders, night eating is characterized as a dyssomnia (as opposed to sleep eating, which is considered a parasomnia). A dyssomnia is a disorder of sleep or wakefulness in which insomnia or excessive daytime sleepiness daytime sleepiness is a complaint. Within the heading of dyssomnia, night eating is classified as an extrinsic sleep disorder, which means that it originates, develops or is caused by an external source. Eating or drinking at night is usually a conditioned, conscious behavior; although it is a disorder, in many cases night eating is not caused by a psychological or medical condition.
Night eating may arise because of an ulcer, by dieting during the day, by undue stress or by a routine expectation (conditioned behavior). Hypoglycemia, or low blood sugar, has also been proposed as possible cause of nighttime bingeing in some people. This can be determined by a glucose tolerance test.
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