Night-eating syndrome has not yet been formally defined as an eating disorder. Underlying causes are being identified, and treatment plans are still being developed. It seems likely that a combination of biological, genetic, and emotional factors contribute to the problem.

Signs and symptoms of Night Eating Syndrome

1. The person has little or no appetite for breakfast. Delays first meal for several hours after waking up. Is not hungry or is upset about how much was eaten the night before.
2. Eats more food after dinner than during that meal.
3. Eats more than half of daily food intake during and after dinner but before breakfast. May wake up and leave the bed to snack at night. May not be aware at the time of what they are doing.
4. This pattern has persisted for at least two months.
5. Person feels tense, anxious, upset, or guilty while eating.
6. NES is thought to be stress related and is often accompanied by depression. Especially at night the person may be moody, tense, anxious, nervous, agitated, etc.
7. Has trouble falling asleep or staying asleep. Wakes frequently and then often eats.
8. Foods ingested are often carbohydrates: sugary and starchy.
9. Behavior is not like binge eating which is done in relatively short episodes. Night-eating syndrome involves continual eating throughout evening hours.
10. This eating produces guilt and shame, not enjoyment.

One theory postulates that people with this condition are under stress, either recognized or hidden. Their bodies are flooded with cortisol, a stress hormone. Eating may be the body's attempt to neutralize cortisol or slow down its production. More research needs to be done before this explanation can be accepted or rejected. In any event, stress appears to be a cause or trigger of NES, and stress-reduction programs, including mental health therapy, seem to help.

Researchers are especially interested in the foods chosen by night eaters. The heavy preference for carbohydrates, which trigger the brain to produce so-called "feel-good" neurochemicals, suggests that night eating may be an unconscious attempt to self-medicate mood problems and relieve stress.

NES may run in families. At this time is appears to respond to treatment with the SSRI sertraline (a prescription medication). NES is remarkable for characteristic disturbances in the circadian rhythm of food intake while circadian sleep rhythms remain normal.

If you are seeking help for night-eating syndrome, you would be wise to schedule a complete physical exam with your physician and also an evaluation with a counselor experienced in the treatment of eating disorders and also sleep disorders. In addition, a dietitian can help develop meal plans that distribute intake more evenly throughout the day so that you are not so vulnerable to caloric loading in the evening.

Evaluation in a sleep laboratory could be worthwhile. Most large hospitals have such facilities. It is not yet clear whether night eating is an eating disorder or sleep disorder or both. The more information available to the person and treatment team, the greater the chances are of developing an effective treatment plan.

Nocturnal Sleep-Related Eating Disorder
In spite of its name, Nocturnal Sleep-Related Eating Disorder (NS-RED) is not considered an eating disorder (yet). It is thought to be a type of sleep disorder in which people eat while seeming to be sound asleep. They may eat in bed or roam through the house and prowl the kitchen.

These people are not conscious during episodes of NS-RED, which may be related to sleep-walking. They are not aware that they are eating. They have no memories of having done so when they wake, or they have only fragmentary memories. Episodes seem to occur in a state somewhere between wakefulness and sleep.

When people with NS-RED awake and discover the evidence of their nighttime forays, they are embarrassed, ashamed, and afraid they may be losing their minds. Some, when confronted with the evidence by family members, deny that they were the perpetrators. They truly do not believe they could have done such a thing and cannot admit to such dramatic loss of control.

Food consumed during NS-RED episodes tends to be high-fat, high-sugar comfort food that people deny themselves while awake. Sometimes these folks eat bizarre combinations of food (hotdogs dipped in peanut butter, raw bacon smeared with mayonnaise, etc.) or non-food items like soap that they have sliced like they would slice cheese.

Who gets NS-RED?
One to three percent of the general population (3 to 9 million people) seems to be subject to this disorder, and ten to fifteen percent of people with eating disorders are affected. The problem may be chronic or appear once or twice and then disappear. Many of these people are severely stressed, anxious individuals who are dismayed and angry at themselves for their nocturnal loss of control. Their behaviors may pave the way to depression and weight gain.

Many of these individuals diet during the day, which leaves them hungry and vulnerable to binge eating at night when their control is weakened by sleep.

People with NS-RED sometimes have histories of alcoholism, drug abuse, and sleep disorders other than NS-RED, problems such as sleep walking, restless legs, and sleep apnea. Their sleep is fragmented, and they are often tired when they wake.

Sleep disorders, including NS-RED, seem to run in families. They may have a genetic component.

Reports have been received by the FDA and the makers of Ambien, a prescription sleep aid, to the effect that some of the people who took this medication discovered that they had eaten or binge eaten while they slept under the influence of the drug. Most had no memory of doing so when they awoke in the morning. A scientific paper is pending. For more information see Newsweek, March 27, 2006, p.54.

How can people eat and not remember doing so? Are they lying?
No, they are not lying. It seems that parts of their brains are truly asleep, and, at the same time, other parts are awake. The parts that regulate waking consciousness are asleep, so the next day there are no memories of eating the night before.

Is there any treatment for NS-RED? If there is, what is it?
Yes, there is treatment. It begins with a clinical interview and a night or two at a sleep-disorders center where brain activity is monitored. Sometimes medication is helpful, but sleeping pills should be avoided. They can make matters worse by increasing confusion and clumsiness that can lead to injury. Regular use of sleeping pills can also lead to dependency and rebound wakefulness on withdrawal. Instead, ask your doctor about prescription SSRIs.

Also helpful are interventions that reduce stress and anxiety; for example, stress management classes, assertiveness training, counseling, and reducing intake of alcohol, street drugs, and caffeine.

How about self-help techniques? Are there any that work?
Some people find that sleep-eating episodes are fewer and farther between if they play soft, rhythmic music at night. Headsets and earbuds can eliminate annoyance for bed partners, but the volume should be low enough to prevent damage to one's hearing.

Some people enlist the help of family members who lock cupboards and the refrigerator at night and then hide the keys. Others tie one end of a thread or string to a wrist and the other to the bed frame so that they wake themselves if they get up and walk away from the bed. Some have even used baby alarms or burglar alarms that are triggered by motion.

These techniques should be implemented carefully and safely so that a person who is somewhere between sleep and wakefulness does not hurt her/himself during a sleep-walking/eating episode.

Recommendation
If you think you may have NS-RED, before you try self-help, talk to your physician and ask for a referral to a sleep-disorders treatment center. You especially need to talk to your doctor if you are taking, or have taken, the sleep medication Ambien. Help is available. Take advantage of it.

References
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