What Is Night Eating Syndrome

What Is Night Eating Syndrome Eating Disorders Symptoms Print Night Eating Syndrome Signs, Symptoms, and Treatment of the Condition By Lauren Muhlheim, PsyD, CEDS facebook twitter linkedin Lauren Muhlheim, PsyD, is a certified eating disorders expert and clinical psychologist who provides cognitive behavioral psychotherapy. Learn about our editorial policy Lauren Muhlheim, PsyD, CEDS Medically reviewed by Medically reviewed by Steven Gans, MD on June 25, 2018 Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital. Learn about our Medical Review Board Steven Gans, MD Updated on October 21, 2019 Jill Giardino / Getty Images More in Eating Disorders Symptoms Treatment Diagnosis Awareness and Prevention In This Article Table of Contents Expand Definition Diagnosis Related Disorders Causes Behavioral Treatment Other Treatments View All Back To Top Do you stick closely to your diet during the day, but blow your diet at night? Maybe you’re never hungry in the morning and have your first meal in the afternoon. If you find yourself eating large quantities of food at nightâ€"even waking up from sleep to eatâ€"you may have a specific eating disorder, called night eating syndrome (NES). Definition People who have NES or are living with someone who has the condition may notice certain clues in the home. You may find messes in the kitchen or missing food, suggesting that someone has been awake and eating in the middle of the night. These are indications that someone in the home may have night eating syndrome. People with NES often eat because they believe that it will improve sleep or help them fall back asleep. People with NES often report mornings with neither appetite nor significant food intake. They commonly experience guilt and shame related to their eating. Diagnosis Night eating syndrome is currently classified as an Other Specified Feeding or Eating Disorder (OSFED) by the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). The criteria for NES are repeated episodes of eating at nightâ€"including waking from sleep to eat, excessive consumption of food after the evening meal, and awareness and recall of night eatingâ€"and significant distress or impairment related to the night eating. Additional proposed diagnostic criteria for NES also suggest that at least 25% of food intake be consumed after the evening meal, on average, for at least three months; and that nocturnal ingestions occur at least twice per week for three months. People with NES may binge eat (that is, eat a large amount of food in a short period of time while feeling out of control) or they may just graze. Nighttime Binges and Sleep Eating Individuals with NES seem to have a disruption to their circadian rhythm, the biological process that regulates sleeping and eating patterns according to the natural cycle of light and darkness. In humans, appetite and food consumption tend to correspond closely with the primary hours of wakefulness: meals are generally consumed between early morning and early evening. Individuals with NES retain a normal sleep cycle but display a delayed food intake pattern. One study showed that people who have NES consumed 56% of their calories between 8 p.m. and 6 a.m. People who didnt have NES only consumed 15% of their calories during this time. NES was first described in 1955 by psychiatrist Albert Stunkard, who saw it as a behavioral variation of obesity. As a result, it has most often been studied in the context of research on obesity. Compared to other eating disorders, NES has been scantly studied. It is estimated that 1.5% of the general population has NES. It is more common in certain populations, with prevalence rates of 6% to 14% among those who have lost weight and 9% to 42% among candidates for bariatric surgery. Assessment of NES can be made via the Night Eating Questionnaire (NEQ) or the Night Eating Diagnostic Scale (NEDS), two self-report measures. There is also the Night Eating Syndrome History and Inventory (NESHI), a diagnostic interview. Related Disorders People can meet the criteria for NES and another eating disorder concurrently. Studies show that approximately 7% to 25% of people with NES also met criteria for binge-eating disorder. Research indicates that among those with bulimia nervosa, 40% of inpatients and 50% of outpatients reported night eating symptoms. In light of this, NES can be thought of as a specific variant of binge eating disorder or bulimia nervosa that presents a disrupted circadian pattern of eating and significant eating during the person’s sleeping hours. A similar, but different, disorder is sleep-related eating disorder (SRED). SRED is primarily a sleep disorder, while NES is primarily an eating disorder. The main difference is that people with SRED eat either while sleeping or while in a twilight state between sleep and wakefulness, and are not aware of what they are doing. They often wake up to find food in their bed and have no memory of having eaten. By contrast, people with NES are fully awake while they are eating and remember afterward.  In some studies, a high percentage of people with SRED  were using prescription  psychiatric medications, which may indicate that these medications  are relevant to the disorder.   Patients with NES often have depression and anxiety. They may also have a history of substance abuse. Drugs, Alcohol, and Abnormal Sleep Behaviors Causes The exact cause of NES is unknown. Some postulate that it involves a hormone imbalance that disrupts eating patterns. It also may develop in response to a pattern of staying up and eating late at night, as can be common among college students. Once one becomes set in this habit, it can be hard to break. NES may also be a response to dieting. When people reduce their food intake during the day and the body is in a state of physical deprivation, the drive to eat later in the day is a normal response to the restriction. Over time, the self-soothing pattern of eating at night can become ingrained. Behavioral Treatment Cognitive-Behavioral Therapy (CBT) is one of the most successful treatments for eating disorders.  While it has been successfully applied to NES, only one empirical study has been published. Psychological treatment for NES will typically include both psychoeducation about the condition and self-monitoring to understand the disorder and maintaining factors. It will involve a reduction of dieting behavior. Behavioral interventions common to other eating disorders include meal planning and structuring of regular eating. NES treatment adds a specific focus on shifting eating patterns to earlier in the day to align better with sleep and wake cycles. Breakfast is implemented in order to reset eating patterns. This is a necessary step to breaking the cycle, even though it can be challenging while the night eating is continuing and you have no appetite in the morning. It can be done gradually, with a slow increase of morning meal intake until an adequate breakfast can be consumed regularly. The conflict between sleep and eating patterns characteristic of NES encourages dysfunctional beliefs which can, in turn, reinforce behaviors. For example, a person with NES may feel unable to avoid food at night, be convinced they have to eat to fall asleep, and believe that evening anxiety can only be managed with food. These beliefs perpetuate the disorder, but they can be dispelled through cognitive restructuring and the use of behavioral experiments. When night eating episodes occur, behavioral chain analyses can be conducted to identify cognitive and behavioral interventions to reduce the behavior. After an episode of night eating, you would reconstruct when you first started thinking about wanting to eat and each step that was involved in getting to the food, choosing it, eating it, and then what happened. Thinking about where you could change the typical chain of events along the way and break the chain to produce a different outcome provides guidance for navigating future similar situations.   Breaking the pattern of night eating can be difficult and may require the use of psychological techniques such as making a list of reasons not to engage in the behavior (and reviewing it before bed) as well as installing physical barriers, such as blocking access to the kitchen at night. Sleep hygiene strategies used in the CBT treatment of insomnia, such as sticking to a consistent bedtime and morning awakening time, are also incorporated. How to Fix Your Sleep Hygiene Other Treatments Other treatments for NES include phototherapyâ€" light exposureâ€"similar to that used to treat seasonal affective disorder (SAD). Bright light therapy is believed to affect melatonin, a hormone which helps regulate circadian rhythms. In phototherapy for NES, patients are exposed to bright light in the morning. This treatment targets the circadian rhythm disruption by trying to reset the body clock using light. At this time, there is little formal research on the approach, although it has shown to be effective in two case studies. Psychiatric medication has been the most researched treatment for NES. Although there is little evidence in support for the use of psychiatric medication for the treatment of eating disorders overall, there is some support for doing so in the case of NES, where the circadian rhythm disruption suggests a larger biological component. Medications that have been studied and used include selective serotonin reuptake inhibitors (SSRIs) including paroxetine (Paxil), fluvoxamine  (Luvox), and sertraline (Zoloft). There are two books on Night Eating Syndrome, one for patients and one for professionals. These books may provide more insight into the condition if you or someone you know is struggling: Allison, K.C., A.J. Stunkard, and S. L. Tier. 2004.  ?Overcoming the night eating syndrome: A step-by-step guide to breaking the cycle  is a self-help guide for people with NES.Lundgren, J.D., K.C., Allison, A.J. Stunkard (Eds). 2012.  Night eating syndrome: Research, assessment, and treatment. New York, Guilford. This is a comprehensive overview of NES for professionals and includes a treatment manual.   A Word From Verywell If you are experiencing symptoms consistent with night eating syndrome, you may be feeling ashamed and reluctant to find treatment. Please don’t hesitate to seek help; eating disorder professionals can help you recover.   Treatment for Sleep Eating Disorders