A sleep disorder often underdiagnosed or mistreated
MDlinx Sep 18, 2024
Sleep-related eating disorder (SRED), or sleep eating, is an unusual condition that few people (including HCPs) really understand.
Sleep Eating Disorder. American Academy of Sleep Medicine. September 2020.
Despite its significant implications for physical and mental health, sleep eating is often underdiagnosed or left untreated.
What is sleep-related eating disorder?
People with SRED sleepwalk to engage in nighttime binges, of which they usually have no recollection the next day. Despite not being hungry or thirsty, they repeat this behavior almost nightly and, sometimes, multiple times per night.
Sleep-Related Eating Disorders. Cleveland Clinic. September 16, 2021.
Sleep eaters opt for calorie-dense foods they may not normally consume, piling hundreds or thousands of extra calories per night. They scarf down food quickly—in 10 minutes or less in some cases—and return to bed, leaving a trail of empty packages, crumbs, and perplexed housemates.
Sleep Eating Disorder. American Academy of Sleep Medicine. September 2020.
Sleep-Related Eating Disorders. Cleveland Clinic. September 16, 2021.
Sleep eating tends to strike between sleep cycles within the first few hours of going to bed. It can be almost impossible to wake up sleep eaters when they’re in this altered state.
Sleep-Related Eating Disorders. Cleveland Clinic. September 16, 2021.
Who is sleep eating?
There are two general types of SRED: drug-induced or primary.
Sleep-Related Eating Disorders. Cleveland Clinic. September 16, 2021.
Medications, such as those meant to treat sleep disorders, may cause sleep eating as a side effect for some patients. Sleep eating may be a side effect of zolpidem (Ambien) and some antipsychotics and antidepressants.
Primary sleep-eating disorder isn’t a direct result of medication. However, sedatives or other substances may worsen an existing primary sleep-eating disorder.
Additional risk factors for primary sleep eating disorder include the following:
Sleep Eating Disorder. American Academy of Sleep Medicine. September 2020.
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Daytime dieting or eating disorders
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Encephalitis
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Hepatitis
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Restless leg syndrome
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Stopping an alcohol, drug, or smoking habit
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Stress
Overall, up to 5% of adults have some form of parasomnia, which could include behaviors like sleepwalking, talking, sexual activity, or sleep eating.
Sleep-Related Eating Disorders. Cleveland Clinic. September 16, 2021.
Over 50% of sleep eaters exhibit another parasomnia first, usually sleepwalking.
Sleep Eating Disorder. American Academy of Sleep Medicine. September 2020.
Sleep eating is also associated with other eating disorders. More than half of people with anorexia nervosa have a comorbid parasomnia.
Crevits L, Silva C, Bat-Pitault F. Preliminary study: cognitive behavioural therapy for insomnia in adolescents with anorexia nervosa. Eat Weight Disord. 2024;29(1):3.
Sleep eating disorder typically affects young women under 20.
Sleep-Related Eating Disorders. Cleveland Clinic. September 16, 2021.
Up to 80% of sleep eaters are women.
Sleep Eating Disorder. American Academy of Sleep Medicine. September 2020.
The physical and emotional toll
Although sleep eating tends to start before age 30, it often continues for several decades. The lack of restful sleep combined with reckless overconsumption sets sleep eaters up for excessive weight gain and its associated comorbidities.
Sleep eaters often feel misunderstood and frustrated by their lack of control. Any healthy daytime habits are quickly undone by unconscious overeating at night. Family members and roommates may be confused by their behavior, not understanding the gravity of sleep eating as a disorder.
Additional safety risks
Sleep eating isn’t just bad for your BMI. It can also put you at risk for serious injuries in the kitchen.
Sleep Eating Disorder. American Academy of Sleep Medicine. September 2020.
As sleep eaters are asleep while preparing food, they aren’t always as careful as they should be. They may start fires, burn themselves on a hot stove, or consume food that’s not properly cooked. Haphazardly handling knives and utensils also puts them at risk for cuts.
Additionally, there have been reports of people consuming toxic substances, like cleaning supplies, during episodes of sleep eating.
Sleep Eating Disorder. American Academy of Sleep Medicine. September 2020.
Those with food allergies or other food-related health conditions (like diabetes) may also make poor choices while sleep eating that compromise their safety and well-being. Clinicians must take signs or reports of sleep eating seriously and direct patients to an effective pathway for treatment.
Treatment options
People who engage in sleep eating must be referred for a sleep study under the supervision of a sleep doctor. Sleep eating’s significant risks and negative impacts on quality of life should never be brushed aside.
The first steps of treatment include locking pantry doors and kitchen cabinets. Knives and other dangerous equipment should be made inaccessible at night. Any obstructions from the bedroom to the kitchen should be removed to avoid accidents while sleepwalking.
Sleep Eating Disorder. American Academy of Sleep Medicine. September 2020.
Sleep-Related Eating Disorders. Cleveland Clinic. September 16, 2021.
The clinician should review all medications and screen for other sleep problems, like sleep apnea.
Patients must be advised to develop a consistent sleep routine, as lack of sleep can make sleep eating worse. Relaxation techniques and avoiding alcohol and caffeine can also be helpful.
Selective serotonin reuptake inhibitors (SSRIs) are considered the primary treatment for SRED. In addition, treatment for any contributing conditions, like restless legs syndrome, should be provided.
Sleep-Related Eating Disorders. Cleveland Clinic. September 16, 2021.
What this means for you
Doctors can make a difference in the lives of people who suffer from sleep eating. While it’s a relatively uncommon condition, it too often goes under the radar or gets downplayed by patients’ families and their physicians. All sleep disorders pose risks and can be better managed with the support of a medical professional.
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