Night eating syndrome

Overview

Night Eating Syndrome (NES) is a type of eating disorder and circadian rhythm-related condition characterized by recurrent episodes of excessive eating during the evening and nighttime. Individuals with NES typically consume a significant portion of their daily caloric intake after dinner or during nocturnal awakenings, often accompanied by sleep disturbances and feelings of distress or lack of control.

First described in the 1950s, NES lies at the intersection of disordered eating, sleep disorders, and mood disturbances. It is distinct from other eating disorders like binge eating disorder or bulimia nervosa due to its timing and behavioral patterns. NES can interfere with sleep quality, contribute to weight gain or obesity, and significantly impact emotional well-being.

Causes

The exact cause of Night Eating Syndrome is not fully understood, but it is believed to be multifactorial, involving a combination of biological, psychological, and behavioral components. Dysregulation of circadian rhythms and hormone imbalances play a central role.

Possible Contributing Factors

• Disrupted circadian rhythms: Altered timing of appetite and satiety hormones (e.g., leptin, ghrelin, melatonin) can lead to night-time hunger

• Psychological stress: High levels of stress or emotional distress may trigger nighttime eating as a coping mechanism

• Sleep disorders: Conditions like insomnia or fragmented sleep patterns are strongly associated with NES

• Depression and anxiety: NES is commonly seen in individuals with mood disorders

• Dieting and food restriction: Skipping meals or restrictive diets during the day can lead to compensatory eating at night

• Genetic predisposition: Family history of eating disorders or obesity may increase risk

Symptoms

The hallmark feature of Night Eating Syndrome is a delayed pattern of food intake. The condition is typically persistent and often worsens during periods of stress or sleep disruption.

Key Signs and Symptoms

• Consuming at least 25% of daily food intake after the evening meal

• Frequent nighttime awakenings associated with eating (night eating episodes)

• Insomnia or difficulty maintaining sleep

• Morning anorexia (lack of appetite in the morning)

• Awareness during nighttime eating episodes (unlike sleep-related eating disorder)

• Strong urge to eat to fall back asleep

• Feelings of guilt, shame, or distress related to eating behaviors

• Association with weight gain or obesity in many cases

Diagnosis

Night Eating Syndrome is recognized in the DSM-5 as an “Other Specified Feeding or Eating Disorder (OSFED)” and is diagnosed based on clinical criteria, patient history, and behavioral assessment.

Diagnostic Criteria (proposed)

• Recurrent episodes of night eating, defined as excessive food consumption after the evening meal or upon nighttime awakening

• Awareness and recall of eating episodes

• At least three of the following:

  • Morning anorexia

  • Strong urge to eat between dinner and sleep onset

  • Sleep maintenance insomnia

  • Belief that eating is necessary to sleep

  • Mood worsens in the evening or night

• Distress or functional impairment due to the eating pattern

• Symptoms have persisted for at least 3 months

Assessment Tools

• Night Eating Questionnaire (NEQ): A validated screening tool

• Food and sleep diaries: To monitor patterns and behavior

• Clinical interviews: To rule out other eating and sleep disorders

Treatment

Treatment for Night Eating Syndrome typically involves a multidisciplinary approach, combining behavioral therapy, nutritional counseling, and sometimes pharmacological intervention. The goal is to normalize eating patterns, improve sleep, and address underlying psychological or emotional issues.

Behavioral and Psychological Therapies

• Cognitive Behavioral Therapy (CBT): The most evidence-based approach for NES; addresses maladaptive thoughts and behaviors around eating and sleep

• Interpersonal therapy: Helps address mood regulation and interpersonal stressors that may contribute to NES

• Sleep hygiene education: To improve sleep quality and reduce awakenings

Nutritional Interventions

• Structured meal planning with regular daytime eating

• Avoiding restrictive diets to prevent rebound night eating

• Education on healthy evening snacks to reduce cravings

Medications

• Selective serotonin reuptake inhibitors (SSRIs): Such as sertraline, may reduce night eating episodes and improve mood

• Melatonin: May help regulate circadian rhythms and improve sleep patterns

• Topiramate or other appetite suppressants: Occasionally considered in specific cases under close medical supervision

Additional Support

• Support groups or group therapy sessions

• Involvement of family members or caregivers for accountability

• Technology-based interventions such as smartphone apps or text reminders

Prognosis

The prognosis for individuals with Night Eating Syndrome varies depending on the severity of the condition, the presence of comorbid disorders, and the effectiveness of the treatment approach. With appropriate management, many individuals can achieve significant reductions in night eating behaviors, improved sleep quality, and better overall functioning.

Long-term untreated NES can lead to complications such as:

• Obesity and metabolic syndrome

• Type 2 diabetes

• Chronic insomnia

• Depression or anxiety

Early diagnosis, lifestyle modification, and psychological support are key to improving outcomes and preventing long-term health consequences.