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Sleep and Eating Disorders

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Abstract

Insomnia is related to an increased risk of eating disorders, while eating disorders are related to more disrupted sleep. Insomnia is also linked to poorer treatment outcomes for eating disorders. However, over the last decade, studies examining sleep and eating disorders have relied on surveys, with no objective measures of sleep for anorexia nervosa or bulimia nervosa, and only actigraphy data for binge eating disorder. Sleep disturbance is better defined for night eating syndrome, where sleep efficiency is reduced and melatonin release is delayed. Studies that include objectively measured sleep and metabolic parameters combined with psychiatric comorbidity data would help identify under what circumstances eating disorders and sleep disturbance produce an additive effect for symptom severity and for whom poor sleep would increase risk for an eating disorder. Cognitive behavior therapy for insomnia may be a helpful addition to treatment of those with both eating disorder and insomnia.
SLEEP DISORDERS (P GEHRMAN, SECTION EDITOR)
Sleep and Eating Disorders
Kelly C. Allison
1,2
&Andrea Spaeth
1,3
&Christina M. Hopkins
1,2
Published online: 23 August 2016
#Springer Science+Business Media New York 2016
Abstract Insomnia is related to an increased risk of eating
disorders, while eating disorders are related to more disrupted
sleep. Insomnia is also linked to poorer treatment outcomes
for eating disorders. However, over the last decade, studies
examining sleep and eating disorders have relied on surveys,
with no objective measures of sleep for anorexia nervosa or
bulimia nervosa, and only actigraphy data for binge eating
disorder. Sleep disturbance is better defined for night eating
syndrome, where sleep efficiency is reduced and melatonin
release is delayed. Studies that include objectively measured
sleep and metabolic parameters combined with psychiatric
comorbidity data would help identify under what circum-
stances eating disorders and sleep disturbance produce an
additive effect for symptom severity and for whom poor sleep
would increase risk for an eating disorder. Cognitive behavior
therapy for insomnia may be a helpful addition to treatment of
those with both eating disorder and insomnia.
Keywords Eating disorders .Anorexia nervosa .Bulimia
nervosa .Night eating syndrome .Binge eating disorder .
Insomnia
Introduction
Human survival depends on both eating and sleeping behav-
iors. Dysregulation of these behaviors leads to distress and
negative health and psychological outcomes. Research on
the relationship between sleep and eating has historically
focused on studies of the effect of starvation and re-feeding
on sleep, the connection among markers of sleep disturbance,
eating disorders, and mood disorders and, more recently, the
characterization of two forms of disordered eating and
sleeping: the night eating syndrome (NES) and sleep-related
eating disorder (SRED). The aim of this paper is to review the
clinical features of anorexia nervosa (AN), bulimia nervosa
(BN), binge eating disorder (BED), and NES and to discuss
the literature examining the relationship between sleep distur-
bances and these forms of disordered eating. Although the
goal was to examine the recent literature, we extended the
focus to encompass the last decade given the limited number
of studies on this topic.
Anorexia Nervosa
AN is characterized as an inability to maintain a healthy body
weight, manifested by (1) a body weight that is less than what
would be expected based on height and age, (2) an intense fear
of gaining weight or becoming fat, (3) disturbance in the way
in which one experiences body weight and shape, (4) undue
influence of body weight and shape on self-worth, and (5)
denial of the seriousness of ones low body weight or
This article is part of the Topical Collection on Sleep Disorders
*Kelly C. Allison
kca@mail.med.upenn.edu
Andrea Spaeth
aspaeth@sas.upenn.edu
Christina M. Hopkins
chopkin@mail.med.upenn.edu
1
Department of Psychiatry, Perelman School of Medicine at the
University of Pennsylvania, Philadelphia, PA 19104, USA
2
Center for Weight and Eating Disorders, Department of Psychiatry,
Perelman School of Medicine, 3535 Market St., 3rd Floor,
Philadelphia, PA 19104, USA
3
Center for Sleep and Circadian Neurobiology, Perelman School of
Medicine, 504 Richards Medical Research Laboratories, 3700
Hamilton Walk, Philadelphia, PA 19104, USA
Curr Psychiatry Rep (2016) 18: 92
DOI 10.1007/s11920-016-0728-8
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
... Eating disorders often foster sleep disturbances [1]. Conversely, sleep disorders may interfere with eating behaviors. ...
... Diagnostic criteria for SRED were updated in 2014 by the American Academy of Sleep Medicine [4]. SRED is characterized by dysfunctional eating behaviors that occur after an arousal during the main sleep period, associated with at least one of the following signs: consumption of peculiar forms or combinations of food or inedible or toxic substances, sleep-related injurious or potentially injurious behaviors performed while in pursuit of food or while cooking food, and/or adverse health consequences from recurrent nocturnal eating (such as weight gain) [1]. There is a partial or complete loss of conscious awareness during the eating episode, with subsequent impaired recall. ...
... Besides, nonbenzodiazepines act on selective benzodiazepine receptor sites in the GABA A -receptor complex [31]. This specificity, while reducing the global neurologic ADR risk, could also increase the duration of slow-wave sleep [31], therefore fostering SRED [1]. In addition, zolpidem has been found to increase the risk of other NREM parasomnias (potentially leading to various CSBs), suggesting a shared pathophysiology [3]. ...
Article
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Sleep-related eating disorder (SRED) is a parasomnia with recurrent, involuntary, amnestic eating episodes during sleep. There is growing evidence of the association between SRED and medications. Therefore, we aimed to rank drugs showing the strongest association. VigiBase® (WHO pharmacovigilance database) was queried for all reports of “Sleep-related eating disorder”. Disproportionality analysis relied on the Reporting Odds Ratio, with its 95% Confidence Interval (CI), and the Information Component. Our VigiBase® query yielded 676 cases of drug-associated SRED. Reports mostly involved zolpidem (243, 35.9%), sodium oxybate (185, 27.4%), and quetiapine (97, 14.3%). Significant disproportionality was found for 35 medications, including zolpidem (387.6; 95%CI 331.2–453.7), sodium oxybate (204.2; 95%CI 172.4–241.8), suvorexant (67.3; 95%CI 38.0–119.2), quetiapine (53.3; 95%CI 43.0–66.1), and several psychostimulants and serotonin-norepinephrine reuptake inhibitors (SNRIs). Patients treated with nonbenzodiazepines or SNRIs were significantly older (mean age: 49.0 vs. 37.5; p < 0.001) and their SRED were more likely to be serious (62.6% vs. 51.4%; p = 0.014) than patients treated with sodium oxybate or psychostimulants. Psychotropic drugs are involved in almost all reports. In patients with SRED, an iatrogenic trigger should be searched for.
... For this reason, it is accepted that sleep plays a role in the balance and restoration of normal brain functions [9]. Sleep disturbance can lead to eating disorders and NES by reducing sleep efficiency [10]. Eating disorders and NES also affect quality of life. ...
... It was correlated with the response to the question "What do you prefer when you want to consume something at night?" (and the statement "I don't consume anything at night"). NES is one of the most frequently observed eating behavior disorders in recent years [10]. It can be thought the fact that university students continuing their education online from home due to pandemic affects their health behaviors such as day/night confusion, sleep, physical activity and nutrition, and can be a reason behind the prevalence of NES being high in our study. ...
... Based on the results obtained from the studies in the literature, it can be deduced that quality of life of individuals may decrease due to sleep quality deterioration. In literature, poor sleep quality was thought to be associated with worse life quality as it can cause serious physiological and psychological problems, and poor academic performance in the context of educational success [5,10,21]. ...
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Sleeping disorders can impair sleeping efficiency and lead to eating disorders and night eating syndrome. Eating disorders and night eating syndrome can be considered as factors that reduce the quality of life. The aim of the study was to investigate the effects of eating and sleeping disorders, and night eating syndrome, on quality of life. Material and methods. The sample of the descriptive, cross-sectional research was comprised of 846 students, who were studying at Uskudar University in the 2020/2021 academic year, accepted to participate in the study and provided complete information. Data was collected with a diagnostic form, a SCOFF Eating Disorders Scale form, a Night Eating Questionnaire (NEQ) form, a Pittsburgh Sleep Quality Index (PSQI) form, and a World Health Organization Quality of Life Short Form (WHOQOL-BREF-TR) together, all were created in Google Forms and applied online. Research data was evaluated with IBM SPSS v® software. Results. A total of 846 university students, consisting of 712 (84.2%) females and 134 (15.8%) males participated in the study. The mean age of the participants was 21.4±3.1 years, and the mean body mass index was 22.5±8.0 kg/m2. Eating disorders risk was found as 38.4%, night eating syndrome risk as 67.7% and all participants had poor sleep quality. WHOQOL-BREF-TR scale's total and all sub-dimension mean scores were found to be lower in students with a risk of eating disorders and night eating syndrome, compared to students without it (p<0.001). A statistically significant negative correlation was found between the PSQI total score and WHOQOL-BREF-TR scale's total and all sub-dimension scores of the participants (p<0.001). Conclusion. Students with a risk of night eating syndrome have interrupted sleep due to desire to eat at night, which is another factor that reduces sleep quality. For healthy generations, sleep and nutrition habits should be carefully examined and appropriate treatment methods should be applied by determining the faulty attitudes of individuals in nutrition, eating and sleeping disorders.
... One meta-analysis including 76 studies revealed that the prevalence of sleep disturbance among Chinese university students was 25.7% (4). Sleep disturbance among students is found to be negatively associated with both mental and physical health, such as academic failure, depression, and poor quality of life (5-7), but also adverse health behaviors, such as Internet addiction, sedentary, and binge-eating behavior (8)(9)(10). Individuals with sleep disturbance are characterized by being insufficiently physically active, having poor social relationships and economic status, and reporting greater academic stress (11)(12)(13)(14). ...
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... found that the levels of abnormal eating attitudes were more correlated with anxiety than depression; however, the opposite was found in (12). In addition, our study found that a higher level of insomnia was associated with higher levels of abnormal eating attitudes, consistent with previous findings (39). The potential mechanisms underlying bidirectional associations between them were described in (40). ...
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... With respect to opportunities, it is significant to note that frequent awakenings and reduced sleep efficiency are characteristic of one particular eating disorder, anorexia nervosa (Allison et al., 2016;Christensen & Short, 2021;Nobili et al., 1999). From an adaptive perspective, it makes sense that an organism in a state of caloric and nutritional deprivation would be better served by staying awake and monitoring their environment for potential food sources. ...
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... Eating disorder behaviors are associated with indicators of circadian disruption, including blunted rest-activity circadian rhythms and poorer sleep efficiency (e.g., Allison et al., 2016;Roveda et al., 2018). ...
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Objective: Although binge eating disorder (BED) is the most prevalent eating disorder, the impact of untreated BED is underappreciated. This review describes the relationship of BED to physical and mental health, quality of life, and functionality. Data sources: PubMed searches were conducted on March 21, 2014; searches were limited to English-language research articles, meta-analyses, and reviews published between January 1, 2003 and March 21, 2014. Search terms included (binge eating OR binge-eating OR binge eating disorder) AND (cardiovascular OR metabolic OR metabolic syndrome OR gastrointestinal OR health OR rehabilitation OR recovery OR sleep OR pregnancy OR quality of life OR functional impairment OR activities of daily living OR QoL OR SF-12 OR ED-5D OR SF-36 OR psychosocial OR depressive OR anxiety OR self-esteem OR suicidality OR suicide OR productivity OR family). Study selection/data extraction: Of 326 identified publications, 43 were relevant to the topic and reported on the association of BED with psychiatric and medical comorbidities, quality of life, and functional outcomes. Results: Individuals diagnosed with BED have increased rates of mental health comorbidities (eg, depression and anxiety) and more pronounced medical impairments (eg, cardiovascular disorders) compared with individuals without BED. BED is also associated with functional impairment and reduced quality of life. Conclusions: Binge eating disorder is associated with impairments in physical and mental health, which can decrease quality of life and functionality and lead to increased health care utilization and decreased productivity. However, some caution is warranted in interpreting these findings because it remains unclear whether BED is an antecedent condition, a complication associated with a comorbid psychiatric condition, or an unrelated feature that occurs concurrently with these comorbidities and impairments. Much of the research on BED is based on observational or epidemiologic studies. Controlled studies are needed to clearly define the long-term impairments associated with BED.
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Night eating syndrome (NES) is a circadian rhythm disorder in which food intake is shifted toward the end of the day, interfering with sleep. According to the biobehavioral model of NES, the disorder is the result of a genetic predisposition that, coupled with stress, leads to enhanced reuptake of serotonin, thereby dysregulating circadian rhythms and decreasing satiety. Using the biobehavioral model as a guide, we developed a brief behavioral intervention using education, relaxation strategies, and exercise to address the core symptoms of NES. In this pilot randomized controlled clinical trial, 44 participants with NES were randomly assigned to an educational group (E; n = 14), E plus progressive muscle relaxation therapy (PMR; n = 15); or PMR plus exercise (PMR Plus, n = 15). Participants received a baseline intervention with 1- and 3-week follow-up sessions. Effectiveness analyses showed that participants in all three groups evidenced significant reductions on measures of NES symptoms (p < .001), depression (p < .05), anxiety (p < .01), and perceived stress (p < .05). However, the only significant between group change was for the percent of food eaten after the evening meal, with the PMR group showing the greatest reduction (-30.54%), followed by the PMR Plus group (- 20.42%) and the E group (-9.5%); only the difference between the PMR and E groups was statistically significant (p = .012). Reductions in NES scores were significantly associated with reductions on measures of depression (r = .47; p < .01) and perceived stress (r = .37; p < .05), but not anxiety (r = .26, p = ns). Results support the role of education and relaxation in the behavioral treatment of NES. Copyright © 2015. Published by Elsevier Ltd.
Article
Objective: nocturnal eating behavior is shared by patients affected by a parasomnia the Sleep related Eating Disorder (SRED) and several eating disorders: mainly , Night Eating Syndrome (NES) and Binge Eating Disorder (BED), but characteristics of these patients have been poorly studied, so this maintains the difficulties in defining the borders between these pathologies. Aim of this study was to evaluate polysomnographic and personality characteristics of nocturnal eaters to further differentiate the syndromes. Methods: for 6 months, consecutive patients complaining of nocturnal eating were asked to participate in the study. Twenty-four patients who were found to eat during the PSG study and gender-matched control subjects were included. All subjects underwent a full night video-PSG study and a psychometric assessment including the Eating Disorder Inventory (EDI-2), the self-rating Bulimic Investigatory Test-Edinburgh (BITE), the temperament and character inventory and the Barratt Impulsivity Scale (BIS). Results: we found a mild reduction in sleep efficiency and duration due to a moderate sleep fragmentation, while the percentages of the single sleep stages were not significantly affected. NES scored higher on many subscales of the EDI-2, on the BITE, symptoms subscale and on BIS attentional impulsivity subscale. Conclusions: Psychological characteristics of NES are typical of patients affected by eating disorders, further sustaining the hypothesis that their nocturnal behavior is due to an eating disorder, moreover specific traits allowing to further differentiate NES from BED have been found.