What Is Night Eating Syndrome? Symptoms, Causes, Diagnosis, Treatment, and Prevention

Whether it’s cold pizza, a few cookies, or a second helping of dinner, we all love a little bedtime snack. But for some people, nighttime eating stretches beyond that sneaky bowl of ice cream before turning in. For a small segment of Americans, night eating syndrome (NES) is a very real eating disorder.

People with the condition feel an uncontrollable urge to eat after dinner and during the night, and typically have a large portion of their daily food intake at these times, according to the Sleep Foundation. They do this even if they don’t feel hungry. They may wake up several times in the night and can’t go back to sleep until they’ve eaten.

“It’s an eating disorder that disrupts sleep, causing a form of insomnia. The person usually feels that if they do not feel full or eat something in particular, they will not be able to return to sleep,” says Michael Breus, PhD, a diplomate of the American Board of Sleep Medicine and a fellow of the American Academy of Sleep Medicine.

He says the disorder is relatively rare, affecting less than 2 percent of the population. “It is most common in people being overweight, obese, depressed, anxious, or abusing drugs or alcohol,” Dr. Breus says.

If left untreated, it can lead to significant weight gain and other health problems, such as type 2 diabetes, hypertension, and depression. "If you suspect you have a nighttime eating disorder, speak with your doctor," says David Schulman, MD, MPH, a professor at Emory University School of Medicine in Atlanta who specializes in sleep disorders.

The symptoms of NES, according to the Cleveland Clinic and the Sleep Foundation, include:

• Hyperphagia, or an intense hunger and need to overeat in the evening and overnight
• Waking up during the night to eat, sometimes several times in one night
• Being consciously aware of night eating episodes and able to remember them
• Regularly eating at least 25 percent of your day’s calories after dinner
• Not feeling hungry in the morning
• Trouble falling or staying asleep
• Depressed mood, particularly at night
• Feeling a loss of control over eating, with feelings of shame, sadness, or embarrassment
• Negative effects on daily functioning from disrupted sleep

People with NES tend to crave foods that are high in calories, carbohydrates, or sugar during their nighttime meals, and may gain weight.

Researchers aren’t sure what causes NES, and many different factors may be involved. According to the Cleveland Clinic, these include:

• Circadian Rhythm Disorders Our bodies have an internal clock that controls when we feel tired, awake, and even hungry, by releasing certain hormones at different times. That clock doesn’t work the way it should for people with night eating syndrome. For instance, the Sleep Foundation notes that people with NES appear to have lower-than-normal levels in the evening of leptin, a hormone that causes feelings of fullness.
• Genetics Some studies have shown that a family history of the condition may increase your risk. Researchers are trying to determine if specific genes are involved.
• Daytime Dieting If you’re restricting yourself from eating during the daytime, you may be more susceptible to night eating disorder as your body craves calories and may send you the message to binge at night.

Your risk of night eating syndrome doesn’t appear to change based on your sex, age, ethnicity, or socioeconomic status, according to the Sleep Foundation. However, it is more common in people with:

• Other eating disorders, such as binge eating disorder or bulimia
• Mental health problems, like depression, anxiety, low self-esteem, or substance abuse
• Sleep disorders including insomnia, sleep apnea, and restless legs syndrome
• Type 2 diabetes

Research suggests that people who prefer to stay up late and wake up later tend to be more susceptible to night eating syndrome, too.

Talk to your doctor about your symptoms. They’ll examine you for any health issues, and ask questions about your mood, stress levels, and mental health.

There are several tools doctors use to make a diagnosis of NES:

• Night Eating Questionnaire (NEQ) This questionnaire asks 14 questions about things like how much you eat at night and how often, whether you feel hungry at night or in the morning, and how often you wake up at night or have trouble falling asleep.
• Sleep and Food Log Your doctor may ask you to keep a sleep and food diary, keeping track of when you go to bed, when you wake up, and what you eat during the day and night.
• Polysomnography (Sleep Study) In some cases, your doctor may refer you to a sleep specialist for an overnight study in a sleep laboratory. You’ll have sensors placed on your body that will record and monitor your brain waves, heart rate and breathing, as well as eye, leg, and body movements while you sleep.

Prognosis of Night Eating Syndrome

If left untreated, NES can cause health problems, such as obesity, diabetes, high cholesterol, and high blood pressure, and other issues tied to carrying excess body weight. It can cause emotional challenges, too, ranging from daytime fatigue to shame and guilt.

But NES can be treated with tools such as therapy, medications, and lifestyle changes.

Experts are still determining the best treatment for NES. However, treatment typically includes a combination of therapy and medication, according to Breus.

Medication Options

Once a formal diagnosis has been made for NES, your doctor may prescribe medication to help treat your condition.

Antidepressants called selective serotonin reuptake inhibitors (SSRIs) are the main drugs that have been studied for treating NES, according to the Sleep Foundation. Problems with the way your body manages serotonin could upset your circadian rhythms. Antidepressants can also be helpful if your NES is related to a mood disorder.

Research is also being done on drugs that act in your brain like melatonin, a hormone that helps you sleep.

The anti-seizure medication topiramate (Topamax) is sometimes prescribed off-label to treat NES. "It works on the appetite center of the brain to dull it a little," explains Dr. Schulman. "It also helps with weight loss."

Cognitive Behavioral Therapy

Breus notes that cognitive behavioral therapy (CBT), a type of therapy that helps patients develop more effective thinking patterns and behaviors, can help with NES. During CBT, patients might record their thoughts about food, stress, and their relationship with eating before they sleep. Therapy can also help you “unlearn” the belief that you must eat to be able fall asleep, research suggests. Your therapist may connect you with a dietitian who will help you develop healthy eating habits.

Other Treatments

• Treating Underlying Causes If your doctor finds your NES episodes are tied to an underlying medical problem, like sleep apnea or restless legs syndrome, or a mental health condition like depression or anxiety, they’ll need to treat that condition first, Breus says. That may end incidents of night eating syndrome.
• Bright Light Therapy Research suggests that bright light therapy used in the morning can help people with mood, symptoms of insomnia, and night eating syndrome, potentially by affecting serotonin and melatonin levels. Bright light may help people’s bodies release cues for wakefulness, hunger, and sleepiness on time.
• Progressive Muscle Relaxation Research has also pointed to this therapy, which teaches participants to slowly tense and relax muscle groups, as a way to alleviate depression, stress and, in turn, NES symptoms.

In addition to getting proper treatment, there are things you can do on your own to try to prevent episodes of NES. The Cleveland Clinic suggests:

• Make sure you aren’t calorie-restricting during the day. Being hungry in the evening makes it harder to resist nighttime eating.
• Choose healthy foods. Aim for a balanced diet that includes healthy carbohydrates, protein, fiber, and fats. If you don’t have sugary snacks in the house, you won’t be tempted to eat them at night.
• Practice sleep hygiene. Aim for at least seven or eight hours of sleep each night. Keep your bedroom cool, dark, and quiet. Avoid alcohol or caffeine too close to bedtime.
• Pay attention to your mental health. Monitor your stress levels and your thoughts throughout the day. Give yourself time to relax and decompress. If needed, talk to a friend, family member, or licensed counsellor.
• Stay active during the day. Regular exercise and physical activity can help you sleep better at night.

Researchers have estimated that about 1.5 percent of the general population in the United States has night eating syndrome. The prevalence is higher among people who are obese, and it often overlaps with other eating disorders.

Another condition that involves nighttime eating is sleep-related eating disorder (SRED). According to the Cleveland Clinic, it’s a parasomnia, like sleepwalking, that usually happens in the first few hours after falling asleep.

The main difference between SRED and NES is that people with SRED are asleep when they get up and eat. They aren’t aware of what they’re doing and don’t remember it in the morning. They may also eat things that aren’t food.