Help for Night Eating Syndrome

Do you find yourself eating late into the night? Do you wake up and eat large meals before going back to sleep? Have you wondered whether this is an eating disorder? Read on to learn more about the problem and how we can help.

What is Night Eating Syndrome?

Night Eating Syndrome (NES) is a type of eating disorder. It’s like an eating disorder plus a circadian rhythm disorder. Circadian rhythm is the biological process that regulates sleeping and eating patterns according to the natural cycle of light and darkness. In NES there is a disruption in the normal circadian (24-hour) pattern of food intake.

Appetite—like sleep—is related to circadian rhythms. In most people, meals are consumed primarily between early morning and early evening. This period coincides with times of wakefulness and activity. However, in Night Eating Syndrome, this eating pattern is shifted later: eating begins in the afternoon and continues into the night. Energy intake is reduced in the first half of the day and greatly increased in the second half. Sleep is subsequently disrupted in the service of food intake.

It is estimated that approximately 1.5% of the adult population suffers from Night Eating Syndrome.

Symptoms

Some of the symptoms of night eating syndrome that people experience include:

• Lack of appetite in the morning
• Binge eating and/or grazing at night, most often after the evening meal
• Disrupted sleep
• Trouble falling back asleep
• Feeling out of control around food later in the day/evening
• Inability to stop this pattern of eating
• Awareness of and memory of the night eating
• Depression
• Guilt and shame

Night Eating Syndrome is Different from a Sleep Disorder

Night Eating Syndrome may be distinguished from Sleep-Related Eating Disorder (SRED), which is not an Eating Disorder at all but a Sleep Disorder. People with SRED eat while sleepwalking or while not fully awake. People with SRED are not aware of what they are doing and may wake up to find dishes or food waste and have no memory of eating at all. By contrast, people with Night Eating Syndrome are fully awake and aware of what they are consuming.

How Do I Know if I Have Night Eating Syndrome?

The core feature of Night Eating Syndrome is abnormally increased food intake in the evening and nighttime. Specifically, people with the disorder consume at least 25% of their daily calories after the evening meal. To qualify for a diagnosis, individuals must have a consistent pattern of nighttime eating episodes at least twice per week for three months. Occasional late-night snacks do not constitute Night Eating Syndrome. Individuals with NES may wake from sleep to eat or they may stay up late consuming food.

People with NES may binge eat—that is, eat a large amount of food in a short period of time while feeling out of control. However, other people with NES consume small amounts of food each time they eat but report eating multiple times over the course of the night. These foods typically include leftovers and snack foods that are quick and easy to prepare in the middle of the night, such as cereal or cookies.

Night Eating Syndrome is associated with other features that include a lack of morning hunger, depression, interrupted sleep, urges to eat at night and the belief that eating will help one sleep. There is some overlap with Binge Eating Disorder, but People with Night Eating Syndrome may or may not binge eat.

People with Night Eating Syndrome report significant distress. They commonly worry about their weight and the loss of sleep. Night Eating Syndrome is found among people of a variety of body sizes and may be prominent when weight is suppressed. Night Eating Syndrome may cause acid reflux and may contribute to dental cavities (particularly if individuals go back to sleep without brushing their teeth).

Recognizing NES in a Family Member

Signs that a family member may be suffering from Night Eating Syndrome include missing food, crumbs and wrappers in the bed, messes in the kitchen in the morning, and regular sleep disturbance.

What Causes Night Eating Syndrome?

The exact cause of Night Eating Syndrome is not known. As with other eating disorders, there is likely an interplay between genetic and environmental factors. Stress, negative mood, and anxiety are a few known triggers, as is weight suppression. People with NES seem to have a disruption in their circadian rhythm. A habit of staying up and eating late at night—common among college students for example—could play a factor.

Daytime dieting likely plays a role in the development and maintenance of night eating syndrome. When a person restricts their food intake during the day, the body is in a state of deprivation. This may drive increased eating later in the day when defenses are down and the urge to eat becomes overpowering. The body needs food and will override attempts at restriction.

Assessment for Night Eating Syndrome

Measures that assess for night eating include the following:

• The Night Eating Questionnaire (NEQ)
• The Night Eating Diagnostic Scale (NEDS)

Treatment for Night Eating Syndrome

Addressing Dieting

If you or someone you know experiences night eating syndrome, it’s likely that dietary restriction—and not eating enough—helps maintain the disorder. Our toxic culture perpetuates the belief that thinness is the key to happiness and success. You might feel desperate to maintain or lose weight. However, if you are waking at night to eat, or staying up late and eating, it might be time to get off the diet train and stop restricting. Our caring therapists can support you with our non-diet HAES-aligned CBT-based approach.

Cognitive Behavioral Therapy for Night Eating Syndrome

Cognitive behavioral therapy (CBT) is an effective treatment for Night Eating Syndrome. We usually ask people to keep food and sleep logs to gather more information. We work to modify patterns of eating and sleep. Regularly eating breakfast and increasing food consumption earlier in the day is key. This helps to reset the circadian rhythm.

Over time, eating patterns and hunger will shift earlier and more closely line up with periods of peak activity. This will reduce the need for “catchup” eating later in the day. Of course, this is often challenging for patients with Night Eating Syndrome. It will require consistently eating a morning meal, even when not hungry.

Once a person with NES is eating greater amounts earlier in the day, we can work on addressing commonly held beliefs that maintain the disorder. We use cognitive restructuring to address the belief that one will not be able to go to bed—or return to sleep—without eating. We will often work on trying strategies other than eating to encourage a return to sleep and run behavioral experiments to see what might work.

After an episode of night eating, we will help you to show yourself compassion We will conduct a behavioral chain analysis to identify steps in the chain that led to the eating and the consequences. Breaking this apart can help identify ways to navigate similar situations differently in the future.

Strategies to Stop Night Eating

We can also work on stress management and the curation of other coping or soothing skills that can be used in lieu of food. Sleep hygiene strategies, including the maintenance of a consistent bedtime and wake-up time, are other strategies we use.

Breaking a pattern of night eating can be challenging because eating—generally a positive activity—has reinforced the behaviors of waking up and looking for food late at night. Another useful strategy can include making a list of reasons not to engage in night eating and reading it before going to sleep.

Sometimes, in order to break the pattern, it is necessary to block access to food at night temporarily. These can include not keeping food in the bedroom and shutting doors between the bedroom and the kitchen. But it cannot be emphasized enough that strategies such as these will not work—and should not be used—if a person is still undereating during the earlier parts of the day.

Other Treatments for NES

Because of the circadian rhythm—a biological component that impacts night eating syndrome—sometimes antidepressants and other medications for sleep can help with NES.

Bright light therapy disorder applied during the morning, which is thought to reset circadian rhythms and is used for Seasonal Affective Disorder, is being investigated as a potential treatment. It might help to reset the body clock. You might want to try waking earlier, getting exposure to morning sunlight, and eating breakfast as an early intervention.

Resources for Night Eating Syndrome

Two books are available on the topic of night eating syndrome—one targeted towards individuals grappling with the condition, and the other designed for healthcare professionals. These resources provide a deeper understanding of the condition.

• Overcoming the Night Eating Syndrome: A Step-by-Step Guide to Breaking the Cycle by Allison, Stunkard, and Tier is a self-help book designed to assist individuals experiencing NES.”
• Night Eating Syndrome: Research, Assessment, and Treatment by Lundgren, Allison, and Stunkard (eds.). This resource provides professionals with a comprehensive overview of NES, accompanied by a detailed treatment manual.

It should be noted that neither of these books are HAES(R)-aligned so we recommend getting help from a HAES professional.

Get Help for Night Eating Syndrome in California

If you or someone you know suffers from Night Eating Syndrome in California, our therapists can help. Contact us now.

Sources

Berner LA, Allison K. Behavioral management of night eating disorders. Psychol Res Behav Manag. 2013;6:1-8
https://doi.org/10.2147/PRBM.S31929

Kucukgoncu S, Midura M, Tek C. Optimal management of night eating syndrome: challenges and solutions. Neuropsychiatr Dis Treat. 2015;11:751-760
https://doi.org/10.2147/NDT.S70312

Salman EJ, Kabir R. Night Eating Syndrome. [Updated 2022 Sep 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK585047/