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18 October 2017Last updated
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Features | Health

The people who sleep-eat

Night eating syndrome is linked to depression and stress

Sarah Gibbons
9 Jun 2017 | 11:01 am
  • Source:Supplied

Grabbing a cookie from the jar on his way to bed, Dane didn’t stop to think about the crumbs he’d find in his sheets when he woke up. He just craved the sweet feel-good factor of the late night sugary snack.

It was becoming increasingly common for him to shake his duvet in the morning and tip handfuls of food debris onto the floor.

He found himself crunching on crisps underfoot when he stepped out of bed and food wrappers littered his bedroom floor.

But the 27-year-old social media marketer had little recollection of how they found their way there -nor were they leftovers from a late night party.

In fact, Dane Cobain, like an estimated 1.5 per cent of the population, suffers from an eating disorder known as Night Eating Syndrome (NES).

‘I wake up in the middle of the night, go to the toilet and eat stuff before getting back into bed,’ he explains. ‘I usually know that I’m doing it but I’m mostly asleep, so it’s almost like a waking dream but quite often, I don’t even remember doing it and I don’t realise until the next morning when I discover the wrappers.

‘I usually go for crisps, biscuits and that sort of thing, or leftover food if it’s there. Anything that’s convenient. It’s always pre-prepared, which is probably a good thing or I might burn the house down!’

Dietician Cathy Leman says NES is characterized by a lack of appetite in the morning, overeating at night, and waking to eat throughout the night.

She said: ‘Seen as a delay in the circadian rhythm of food intake while retaining a normal sleep-wake cycle, it is defined by two core criteria: the ingestion of at least 25% of daily calories after supper and/or awakening to eat at least three times per week.

‘First identified some 50 years ago, yet only recently familiar to healthcare professionals and the public, NES can disrupt lives and damage health.

‘Basically, food intake is shifted toward the end of the day. The actual behaviour may not particularly “rule the life” of a sufferer, as someone with anorexia typically experiences – but the embarrassment and shame are real and can certainly impact someone who struggles. Individuals with NES feel like they have no control over their eating.’

Often connected with stress, NES does not necessarily lead to binge eating but the preference for most sufferers to reach for sweet food items or instantly gratifying carbohydrates can lead to weight gain.

Cathy, from Illinois, USA, said: ‘NES sufferers tend to have a genetic predisposition, that when coupled with stress can trigger NES behaviour. They often have history of substance abuse, may suffer from depression, and also have sleep disorders like insomnia.’

Dane, from High Wycombe, UK, said he first noticed symptoms after suffering with an anxiety disorder and IBS.

‘It’s only been a fairly recent thing, and so I’m still figuring out what to do. I haven’t spoken to my doctor about it yet and so that’s the next step. I haven’t put on any weight or anything and so it hasn’t been a problem, but then it probably does cancel out the jogging that I do.’

In the first instance, he plans to buy less snack items to keep in the house in a bid to curb his late night cravings.

Cathy said that like other eating disorders, NES can be treated effectively.

‘Education and identifying triggers is a good start,’ she said. ‘Most people don’t realize that NES is very real, so offering that information can make a client feel less isolated in their behaviour and increase their awareness.

‘There are several “causes”, and identifying them on an individual basis determines best course of treatment.

‘Working with their therapist to address underlying depression or other psychological concerns, encouraging them to begin a fitness program to manage stress/anxiety/depression (and become more active overall – not so much for weight loss, although it can contribute), remove food from bedrooms, help create portion/calorie control in the kitchen (need to strategise on how to do this on an individual basis), get them off the “dieting roller coaster” and on a more balanced eating pattern/schedule, include foods that contribute to lasting satiety/satisfaction/fullness, managing stress and emotions, doing a review of eating patterns and intake for a 24 hour period (although not always 100% accurate) can provide an overview for identifying excessive caffeine, alcohol, etc. that may interfere with a restful sleep pattern, and identify habits and behaviours that support good sleep hygiene.

‘NES is also linked with high levels of emotional eating, so addressing that component (and the underlying issues driving it) is also critical. Increasing levels of serotonin (through food AND medication) may also help.

‘Depression, anxiety, hostility, and stress are strongly implicated in NES. These negative emotions, merged with the guilt and embarrassment associated with such unconventional eating patterns, form a perfect psychological storm that exacerbates the problem.’

Men appear slightly more at risk of developing NES than women although figures are generally similar for both genders with other factors more likely to trigger the disorder.

While the percentage of the overall population diagnosed, or believed to suffer with NES stands at around 1.5 per cent, that figure rises to between six and 16 per cent of clients in weight-reduction programs, and 8% to 42% of patients awaiting surgery to tackle obesity.

Cathy recalls: ‘One of my male clients has an unhealthy lipid profile, including triglycerides in the 800s and a body mass index of 35.

‘At least five nights per week, he falls asleep easily, only to wake one hour later and head to the kitchen for something to eat, unable to get back to sleep until he does so. As the stress in his life has escalated in recent months, so have his NES behaviours.

‘Alicia* is a young woman in recovery due to an eating disorder. Initially she experienced behaviours that paralleled those of my other NES clients, but she progressed from eating only in the kitchen to keeping food in her room and then ultimately to stashing food next to her on her twin bed. When she woke up, she would eat in an almost dreamlike state until she fell back to sleep.’

She said the condition is often overlooked by healthcare professionals and, like other eating disorders, can be hard to spot in sufferers by those nearest and dearest to them.

However, she added: ‘In families, NES comes to light eventually because it’s difficult to keep secret when dirtied dishes, wrappers, food crumbs and remains are left behind as tell-tale signs.’

‘Just as night eating is recognizable, it is also treatable. Alicia’s therapist first worked to get the food out of her room and then to decrease the number of calories she consumed when she did experience a night eating episode. Alicia no longer struggles with NES. “Now, whenever I wake up in the middle of the night, I never even think about eating,” she says.’

‘Not only is night-eating syndrome an eating disorder, but one of mood and sleep as well,” said Albert Stunkard, MD, of the University of Pennsylvania’s Weight and Eating Disorders Program.

‘People who fall prey to this syndrome are not simply indulging in a bad habit. They have a real clinical illness, reflected by changes in hormone levels.

‘People with this syndrome start out daily with morning anorexia--or not eating anything all morning--and consume fewer than average calories throughout the day. As the day wears on, their mood worsens and they become more and more depressed.’

His research suggested that sufferers wake up to five times a night to raid the fridge and kitchen cupboards for sugary or high-carb snacks – with many complaining they are unable to go back to sleep without eating.

‘This snacking may be a way for these persons to medicate themselves,’ he said ‘because they eat a lot of carbohydrates, increasing serotonin in the brain which in turn, leads to sleep.’

Ms. Archana P.V, Clinical Dietcian at the Burjeel Hospital in Abu Dhabi, said there is lack of awareness among parents and teachers around potential eating disorders and she urged friends and family members to look out for potential warning signs before a sufferer’s life is blighted.

She said: ‘Typically they will face lack of appetite for breakfast or in the day time. They tend to eat more after dinner. They may suffer from disturbed sleep and in between the sleep they tend to snack a lot. Also they seem to be more anxious and depressed in the late evening.

‘People with NES are likely to be overweight to obese. This affects their social live negatively as they will lack self-esteem, friends, outings, and even going to school becomes a challenge.

‘Keep a close eye on any of the following symptoms; disturbed sleep, late night overeating, gaining weight due to overeating in the late evening, depressed or loss of appetite in the morning hours. If you do notice any of these symptoms, I urge you not to overlook and do take him/her to the physician for early diagnosis and treatment.

‘I think that there is some lack of awareness from the parents and teachers in school that over eating can be developed as a result of an uncontrollable issue. Once parents or teachers start noticing some weight changes, maybe they need to start discussing and trying to understand if he/she is facing personal problems. A visit to a professional wouldn’t hurt either.’

Among other things once in treatment, she said, patients are allocated a dietician who works to produce a meal plan to distribute the calorific intake more evenly throughout the day.

Key to a diagnosis of NES is the patient being even partially awake during the preparation and consumption of snacks.

For those who find the kitchen – or bed – littered with evidence of late night snacking with absolutely no recollection of eating after going to sleep, the diagnosis is likely to be one of Sleep Related Eating Disorder (SRED) or sleep eating – a similar phenomenon to sleep walking when the activity takes place without the person’s conscious knowledge.

But that’s another story…

*Name has been changed.

What is NES?

• The person has little or no appetite for breakfast. Delays first meal for several hours after waking up. Is not hungry or is upset about how much was eaten the night before.

• Eats more food after dinner than during that meal.

• Eats more than half of daily food intake during and after dinner but before breakfast. May leave the bed to snack at night.

• This pattern has persisted for at least two months.

• Person feels tense, anxious, upset, or guilty while eating.

• NES is thought to be stress related and is often accompanied by depression. Especially at night the person may be moody, tense, anxious, nervous, agitated, etc.

• Has trouble falling asleep or staying asleep. Wakes frequently and then often eats.

• Foods ingested are often carbohydrates: sugary and starch.

• Behaviour is not like binge eating which is done in relatively short episodes. Night-eating syndrome involves continual eating throughout evening hours.

• This eating produces guilt and shame, not enjoyment.

Sarah Gibbons

Sarah Gibbons