Eating disorders are mental disorders characterized by out-of-ordinary eating habits that have adverse, often fatal effects on a person’s body and mind. Contrary to popular belief, these disorders are serious and require medical treatment often lasting up to five years, sometimes longer, depending on how severe they are and how soon you start. Disorders that fall under this category include anorexia nervosa, bulimia nervosa, binge eating disorder, rumination disorder, pica, avoidant or restrictive food intake disorder, and some other specified feeding or eating disorders.
The cause of eating disorders isn’t clear in most cases, but it has been determined that both environmental and biological factors contribute to their development. While eating disorders aren’t lifestyle choices, specific ways of living may put one at a heightened risk of developing such an illness. Strict and persistent dieting, vigorous physical activity and the cultural idealization of the slim figure make eating disorders prevalent in certain pressured population groups like models or dancers, with the incidence rate of over 12% in the latter group alone. People who have a history of sexual abuse have an increased risk of eating disorders, and certain disorders like pica are more prevalent in people who also have intellectual disabilities. Other mental conditions like depression and anxiety regularly comorbid many of these disorders and sleep disturbances are not rare, either, bringing their own sets of complications into the already unstable situation.
Mental health awareness is just gaining momentum. Even with the frequent misconceptions about them, eating disorders, too, are finally starting to get more recognition in the public eye – at least the more prevalent types. But one specific type of eating disorder, while quite intriguing, remains largely unknown and unexplored. A case in point is the sleep-related eating disorder (SRED), which will be the point of focus in this article. To bring more light to the subject, continue reading.
What are Sleep-Related Eating Disorders?
It is common knowledge that you aren’t supposed to eat right before bedtime, especially when it comes to high-fat junk foods. You may be guilty of doing that anyway, or even of grabbing a bite if you happen to wake up during the night – but that’s not SRED, exactly. What makes the difference between such moments in an otherwise healthy person and an SRED scenario is that you are awake and aware of what’s happening. Now, imagine getting up, walking to the fridge and devouring whatever you found in there – while being asleep!
This blend of binge eating disorder and sleepwalking is a type of parasomnia displaying through recurring episodes of eating during one’s sleep. It causes a person to eat a large portion of highly caloric food and wake up in the morning feeling foggy, confused, disoriented and in most cases without any recollection of what had happened during the night. People who experience SRED often eat inedible items, too – paper, washing detergents, anything that they come across in their episode, which usually lasts about ten minutes and happens at least once every night. Needless to say, this is extremely dangerous, even deadly, as the person can unconsciously eat a toxic chemical, or get injured during the food preparation by using a knife or the oven. Too many things can go wrong. Even in less extreme scenarios, sleep-eating can disrupt the normal cycle and cause weight gain or insomnia, which then contributes to the development of a new wave of difficulties.
SRED is classified as a sort of parasomnia. Often confused with this disorder is the Nocturnal Eating Syndrome (NES), which is classified as a type of eating disorder – the two are sometimes hard to differentiate and regularly merged into a single term. The difference between them consists in the fact that SRED includes partial or complete amnesia after a nightly eating episode, doesn’t cause insomnia or hunger prior to sleep onset and has a greater link with other sleep disorders than NES does.
It is estimated that over 5% of the population has SRED, with the incidence rate in people who have a type of eating disorder climbing up to 17%. At the greater risk are women, making over 65% of the general population statistic, while roughly 40% of people with this disorder are overweight.
The cause of sleep-related eating disorder is unclear, with most precise research so far leading to abnormalities in ghrelin and leptin hormones, which regulate one’s hunger. Other triggering factors include:
- Dieting, stress, and sudden cessation of substance or alcohol abuse
- Sleep disorders like narcolepsy, restless leg syndrome, sleepwalking, periodic limb movement, obstructive sleep apnea, irregular sleep-wake rhythm disorder, and sleep-related dissociative disorders
- Autoimmune hepatitis
- Some medications like antipsychotics, antidepressants or some hypnotic drugs used to treat insomnia like Ambien, Intermezzo, Zolpimist, etc.
- Mental disorders like anxiety or depression
- Suffering from another eating disorder like anorexia, bulimia, peca, and so forth
- Being closely related to a person who experiences SRED or sleepwalking
- Sleep deprivation
The symptoms of SRED include:
- Regularly eating or drinking during sleep, mostly in its first half, with this pattern repeating every night
- Impaired alertness while preparing and eating food, and eating it in a very sloppy, uncontrollable manner
- Little to no memory of the event the next morning
- Eating high-fat, calorie-rich foods or strange combinations of foods
- Eating inedible items like detergents, cigarettes, napkins, uncooked, frozen foods or foods still wrapped in foil
- Being clumsy while preparing food or eating in such an episode, potentially even getting injured while cutting or using some hot appliance like the oven, kettle, etc.
- Not being easily woken up or redirected from engaging in such actions
The diagnostic of this disorder has no single fool-proof method. After you’ve been admitted into a sleep clinic, a doctor might begin with a few questionnaires and a physical exam, but not before taking your thorough medical history. This will typically be done to confirm whether you have a second existing condition or any allergies, the types of medication you were using in the past, recently stopped taking or still take, your overall health status and your age.
For a more concise and accurate, although subjective status report, your doctor might instruct you to start filling out a sleep journal. This will include writing an entry every single day for about two weeks minimum, recording everything you deem significant during both day and night – and don’t be shy here. Anything remotely associated with your sleep, health and emotional state is welcome. The more you write, the easier it will be later to assess the information, distinguish patterns from circumstantial events and ultimately help diagnose you. In fact, having your partner, parent or other household member keep their own log at the same time would be even better, especially in a case like this, as they might notice some behaviors that you might be unaware of and add valuable input as a third party. This ensures that, although you may not be conscious while binging in your sleep, your partner will be able to explain how and when it happened and how long it lasted.
Besides that, you may be asked and tested for insomnia, excessive sleepiness, and polysomnography might be ordered to eliminate the possibility of obstructive sleep apnea.
Similarly to the diagnostic part of this equation, treating SRED isn’t a one-size-fits-all situation. If you have previously read other articles on this website, you might have noticed an approach that is similar for various types of sleep disorders when it comes to sleep hygiene. However, in this particular case, as well as in the case of many other eating disorders, some of the tips commonly listed in this area are best not to be followed. In fact, doing the exact opposite in certain scenarios might be just what you need. For example, a rule of thumb is, you should reduce calorie-rich foods in the evening to promote better sleep. Except, in this case, your problem is more likely to be undereating and dangerous restrictions that your body attempts to compensate for during the night, which means you should increase the amount and volume of the foods you eat, not decrease it. Even the simple “keeping your weight in check” might trigger the disordered eating mindset and would best be avoided.
Being one of the most health-threatening parasomnias, the treatment of SRED will require a meticulous approach from your doctor, and the therapy plan will depend on the particular cause of your problem. To address a few possible scenarios, the treatment may take one or more of these routes:
- Discontinuing Intermezzo or other sleep meds and reevaluating all other medication use. Discuss this with your doctor and remember to stay in contact even if the first solution didn’t work for you. It’s smarter to explore options under supervision than to risk putting your life on the line by conducting your own experiments.
- Therapy change. Reconsidering the therapy options for insomnia, attempting cognitive behavioral therapy (CBT) or some less invasive supplementing system. Ask your doctor to walk you through the different possibilities.
- Addressing anxiety, depression and any other present medical condition. You need to tackle all the health problems if you hope to be successful in treating any single one.
- No extreme dieting. Do your best to eat abundantly during the day, and even before bedtime, contrary to what we usually suggest here. This may satiate your body enough to stop it from taking its own measures in survival mode during your sleep. Making sure you eat enough calories from balanced foods and not skip meals is essential here.
- Avoid overly strenuous exercise. Especially if you are likely to undereat or barely reach the average bar, wasting that energy so recklessly isn’t a good idea.
- Stress management. Meditation, yoga, engaging in a hobby or even booking some time with a therapist to learn how to cope with difficult situations and setbacks is another critical factor for treating any problem. Stress is linked with a lot of extremes – weight gain, weight loss, hair loss, poor sleep, impaired metabolism, and immunity system, etc.
- Light therapy. Using light therapy to help keep the circadian rhythm in check, promoting a regular sleep schedule and quality but also reintroducing regular mealtimes.
Lastly, if a combination of the above isn’t enough, SRED can be treated with medications like dopamine agonists, opiates, topiramate, and trazodone. Remember that this isn’t indicated to replace proper physical and mental hygiene. You still need to do your best to keep a healthy mindset and build sustainable habits. It is entirely okay to need medication, but don’t rely on them first and foremost.
Co-founder of Counting Sheep and Sleepaholic