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Sleep-Related Eating Disorder and Night Eating Syndrome: Sleep Disorders, Eating Disorders, or Both?

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SLEEP, Vol. 29, No. 7, 2006
876
HUNGER AND SLEEP ARE FUNDAMENTAL BIOLOGIC
DRIVES UNDER THE CONTROL OF BOTH HOMEOSTATIC
AND CIRCADIAN INFLUENCES. NOCTURNAL EATING
disorders occur when the coordination of these 2 drives is dys
-
regulated, resulting in the disordered eating of a daytime eating
disorder combined with the disordered sleep of a sleep disorder.
Investigations into nocturnal eating have proceeded along 2 par
-
allel tracks. Eating disorders specialists use the term night eating
syndrome (NES), coined by Stunkard et al in 1955,
1
for patients
with nighttime eating. Criteria for NES include the consumption
of 50% or more of daily calories after the evening meal, eating
after waking from sleep, and morning anorexia.
2
Concurrently,
clinical sleep researchers have described sleep-related eating dis
-
order (SRED), with a focus on its relationship to parasomnias and
other primary sleep disorders.
3,4
Whether NES and SRED are the same or distinct disorders is
unclear. Both involve nearly nightly binging at multiple nocturnal
awakenings, defined as excess calorie intake or loss of control
over consumption. Both have a prevalence of about 1% to 5% of
adults
5,6
; are predominantly found in women, with a young adult
onset; and have a chronic course.
7
Both have a primary morbidity
of weight gain, sleep disruption, and shame over loss of control
over food intake.
8,9
Purging, as seen in bulimia nervosa, is rarely
present. Both have familial bases.
4,10
Comorbid depression
6,11
and
daytime eating disorders
4,11
are often observed in both NES and
SRED. Both may respond to similar pharmacologic treatments.
2,12
Unfortunately, an assessment of the relationship between NES
and SRED is hampered by the lack of standardized assessments
for nocturnal eating and variations in the diagnostic criteria for
the disorders, as well as a lack of coordinated research between
the 2 specialist fields.
The most prominent cited distinction between NES and SRED
is the level of consciousness during nighttime eating episodes.
Whereas those with NES eat after attaining full awareness, those
with SRED often report that they are “half asleep, half awake”
or even fully asleep during nocturnal episodes and may have im
-
paired recollection for the event the following morning.
2,4
Some
of the variance between these 2 sets of patients may relate to the
referral patterns and biases of the researchers: sleep disorders
specialists see those with parasomnias and are more concerned
with the fine points of level of consciousness during nocturnal
behaviors, whereas those with an eating disorders background are
more focused on the timing, type, and number of calories con
-
sumed.
To characterize night eating from the 2 specialists’ perspec
-
tives in brief: patients with SRED are sleepwalkers who happen
to eat, whereas patients with NES are those with binge eating dis
-
order who happen to eat at night. Both of these explanations are
probably too simple. Recent data suggest that the previously ob
-
served endocrine abnormalities in NES demonstrating a delay in
the phase relationship of eating to sleep
13
are probably the result,
rather than the cause, of night eating.
14,15
From the opposite per-
spective, many of the patients with SRED may not have primary
sleep disorders.
12
To further confound matters, many of those
with alterations in level of consciousness during nocturnal eating
(and thus diagnosed with SRED) may also have night eating with
full alertness, either at other episodes in the same night or at other
periods during the course of the nocturnal eating disorder.
16
In
this way, rather than being two distinct disorders, pure SRED and
NES may reflect opposite ends of a continuum of impairment of
consciousness during nocturnal eating.
Although these diagnostic issues remain unresolved on clinical
and scientific bases, the recent revision of the International Clas
-
sification of Sleep Disorders (
ICSD) has effectively eliminated
the distinction between the 2 disorders
13
(Table 1). The diagnostic
criteria for SRED in the revised
ICSD do not specify a level of
consciousness during episodes of nocturnal eating and, thus, in
-
corporates NES into SRED. Whether this “lumping” will advance
our understanding of the biology of nocturnal eating disorders is
yet to be seen. However, the new nosology provides a uniform
diagnostic code for all such disorders, facilitating better identifi
-
cation across specialty clinics.
The paper by Vetrugno and associates
17
from a sleep disorders
clinic in Italy describes 35 patients who in many respects confirm
the previous SRED phenotype: young overweight women with
a chronic course of multiple awakenings from sleep per night
with nocturnal eating. However, only 1 patient had a history of
sleepwalking. Polysomnography demonstrated reduced sleep
efficiency, and two-thirds had a periodic limb movement index
greater than 5. In the laboratory, more than 70% ate at nocturnal
awakenings, all with full consciousness during electroencephalo
-
gram-defined wakefulness, consistent with previous reports
.
4
No
patients had amnesia for the episodes the following morning. In
these latter respects, the patients more closely approximated those
Sleep-Related Eating Disorder and Night Eating Syndrome: Sleep Disorders,
Eating Disorders, or Both?
John W. Winkelman, MD, PhD
Sleep Health Center, Brigham & Women’s Hospital, Newton Center, MA
Editorial—Winkelman
EDITORIAL
Disclosure Statement
Dr. Winkelman is a member of the Speakers’ Bureau for Cephalon, King,
Sanofi-Aventis, Sepracor, GlaxoSmithKline, and Takeda; is a member of the
Advisory Board for Pfizer, GlaxoSmithKline, Sepracor, Schwarz-Pharma,
Sanofi-Aventis, Takeda, and Boehringer-Ingelheim; and has received re
-
search support from Pfizer, GlaxoSmithKline, UCB Pharma, Boehringer-In
-
gelheim, and Schwarz-Pharma.
Address correspondence to: John W. Winkelman, MD PhD, Sleep Health
Center, Brigham & Women’s Hospital, 1400 Center Street, Suite 109, New
-
ton Center, Massachusetts 02459; Tel: (617) 527-2227; Fax: (617) 527-2098;
E-mail: jwinkelman@sleephealth.com
Comment on Vetrugno R; Manconi M; Ferini-Strambi L et al. Nocturnal eating: sleep-related eating disor-
der or night eating syndrome? A videopolysomnographic study. SLEEP 2006;29(7):949-954.
SLEEP, Vol. 29, No. 7, 2006
877
Editorial—Winkelman
usually characterized as having NES rather than SRED, even in
sleep laboratory settings.
18
Unfortunately, the authors do not spec-
ify whether their patients reported altered levels of consciousness
during their episodes of nocturnal eating outside the sleep labora
-
tory. The presence of full alertness during such episodes on poly
-
somnography is not a legitimate test of their standard behavior
(as is clear with parasomnias). Thus, it is unclear whether this is
another common example in medicine of “didn’t ask, so don’t
know.”
The Vetrugno report includes the first documentation of recur
-
rent sleep-related masseter and orbicularis oris electromyographic
activity in SRED, confirmed by video polysomnography to be
masticatory and swallowing behavior. This periodic activity was
present in most (29/35) of the patients at high rates (mean of 116
movements per patient per night), occurred during stages 1 and
2 sleep (and not during wake), and was associated with electro
-
encephalogram arousal and tachycardia. Such electromyographic
activity has previously been named rhythmic masticatory-muscle
activity and is seen in bruxism.
19
The co-occurrence of periodic
limb movements of sleep and this masticatory behavior suggested
to the authors that SRED and restless legs syndrome/periodic limb
movements of sleep may have a common dopaminergic mecha
-
nism.
The inclusion of a definition of SRED in the revised
ICSD
that consolidates all nocturnal eating disorders presents multiple
opportunities for advancement in this area. With consistently de
-
fined patient populations, questions of prevalence, clinical hetero
-
geneity, course, familial prevalence, and therapy can be addressed
more definitively. SRED may eventually be split into subtypes
in the future based upon clinical features (e.g., amnesia), poly
-
somnographic characteristics, or associated sleep or daytime eat
-
ing disorders. Coordination between specialists in sleep disorders
with those researching energy regulation and cognition has already
provided new insights,
20,21
which can now hopefully be applied to
patients with night eating. Finally, recognition of SRED by the
revised ICSD may ultimately provide legitimacy to this highly
impairing disorder in an era suspicious of “new” diagnoses.
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Night-
time eating: a descriptive study. Int J Eat Disord 2006;39:224-32.
12. Winkelman JW. Efficacy and tolerability of topiramate in the treat
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ment of sleep-related eating disorder: an open-label, retrospective
case series. J Clin Psychiatry 2006;In Press.
13. Birketvedt GS, Florholmen J, Sundsfjord J, et al. Behavioral and
neuroendocrine characteristics of the night-eating syndrome. JAMA
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(abstract). Sleep Research 1997:31.
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Table 1—Definition and Diagnostic Criteria for Sleep-Related Eating
Disorder
a
A. Recurrent episodes of involuntary eating and drinking occur during
the main sleep period.
B. One or more of the following must be present with the recurrent
episodes of involuntary eating and drinking:
1. Consumption of peculiar forms or combinations of food or ined
-
ible or toxic substances.
2. Insomnia related to sleep disruption from repeated episodes of
eating, with a complaint non restorative sleep, daytime fatigue,
or somnolence.
3. Sleep-related injury.
4. Dangerous behaviors performed while in pursuit of food or
while cooking food
5. Morning anorexia.
6. Adverse health consequences from recurrent binge eating of
high caloric food.
C. The disturbance is not better explained by another sleep disorder,
medical or neurologic disorder, mental disorder, medication use or
substance use disorder (hypoglycemic states, peptic ulcer disease,
reflux esophagitis, Kleine-Levin syndrome, Kluver-Bucy syndrome,
and nighttime extension of daytime Anorexia Nervosa (binge/purge
subtype), bulimia nervosa, and binge eating disorder).
a
From The International Classification of Sleep Disorders: Diagnostic
and Coding Manual, 2
nd
ed. Westchester, IL: American Academy of
Sleep Medicine; 2005:174-5.
... The principal distinction between SRED and NES is the presence of awareness during the eating episodes with subsequent recall of the episodes [156]. Indeed, SRED patients are thought to eat in a "half sleep, half awake" state with no morning recollection of their eating episodes, while NES patients typically eat in a state a full or almost full awareness [165]. However, many SRED patients can display various degrees of awareness, even during the same night [165], challenging the idea of a clear-cut distinction between SRED and NES. ...
... Indeed, SRED patients are thought to eat in a "half sleep, half awake" state with no morning recollection of their eating episodes, while NES patients typically eat in a state a full or almost full awareness [165]. However, many SRED patients can display various degrees of awareness, even during the same night [165], challenging the idea of a clear-cut distinction between SRED and NES. Furthermore, several studies reported overlapping clinical features between SRED and NES, including nightly binging at multiple nocturnal awakenings, a female prevalence, a chronic course, a primary morbidity of overweight and sleep impairment, the response to similar treatments, a familial recurrence and the frequent co-existence of mood oscillations [165]. ...
... However, many SRED patients can display various degrees of awareness, even during the same night [165], challenging the idea of a clear-cut distinction between SRED and NES. Furthermore, several studies reported overlapping clinical features between SRED and NES, including nightly binging at multiple nocturnal awakenings, a female prevalence, a chronic course, a primary morbidity of overweight and sleep impairment, the response to similar treatments, a familial recurrence and the frequent co-existence of mood oscillations [165]. In addition, a VPSG case series on patients that satisfied clinical criteria of NES, described a nocturnal ingestion sub-type with a VPSG profile similar to SRED, with episodes occurring within 1 min from a NREM sleep awakening [156]. ...
Diagnosis and Management of NREM Sleep Parasomnias in Children and Adults
Article
Full-text available
  • Mar 2023
Non-rapid eye movement (NREM) sleep parasomnias are recurrent abnormal behaviors emerging as incomplete arousals out of NREM sleep. Mounting evidence on NREM sleep parasomnias calls for an update of clinical and therapeutical strategies. In the current review, we summarize the state of the art and provide the necessary background to stimulate a critical revision of diagnostic criteria of disorders of arousal (DoA), the most common NREM sleep parasomnia. In particular, we highlight the poor sensitivity of the diagnostic items related to amnesia and absence of conscious experiences during DoA episodes, encourage the role of video-polysomnography and home-video recordings in the diagnostic and treatment work-up, and suggest three levels of diagnostic certainty based on clinical and objective findings. Furthermore, we highlight current gaps of knowledge that prevent the definition of standard guidelines and future research avenues.
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... Another key debate in the literature is around its classification as an ED (Shoar et al., 2019), which is especially controversial because of the overlap of NES symptoms with Sleep-Related Eating Disorder (SRED). Patients with NES and SRED both present with nightly binging, an increase in weight, and a disruption in sleep (Winkelman, 2006). Moreover, both are highly prevalent amongst women and are often comorbid with depression. ...
... Moreover, both are highly prevalent amongst women and are often comorbid with depression. It has been argued that these similarities in symptoms may indicate that the two disorders are the same but have previously been studied through two different lenses in the literature (Winkelman, 2006). The only key difference noted in the literature is the level of consciousness of the individual during the night eating episode. ...
... The only key difference noted in the literature is the level of consciousness of the individual during the night eating episode. While NES patients are fully conscious and aware of their night binging episode(s), SRED patients have partial or no consciousness of the night eating episode (Winkelman, 2006). Supporting this claim, researchers such as Latzer and Tzischinsky (2012b) believe that NES should be considered an ED because of the presence of psychopathological features related to disordered eating (such as binge eating and emotional eating). ...
Night Eating Syndrome in Patients With Obesity and Binge Eating Disorder: A Systematic Review
Article
Full-text available
  • Jan 2022
Night eating syndrome (NES) is currently classified as an Other Specified Feeding or Eating Disorder (OSFED) under the Diagnostic Statistical Manual−5 (DSM-5). This systematic review aims to consolidate the studies that describe the sociodemographic, clinical and psychological features of NES in a population of patients with eating disorders (ED), obesity, or those undergoing bariatric surgery, and were published after the publication of the DSM-5. A further aim was to compare, where possible, NES with BED on the aforementioned variables. Lastly, we aimed to appraise the quality of the studies being included in the review. We conducted a systematic search on three databases (MEDLINE, PubMed and Embase) which resulted in the selection of 22 studies for the review. We included the articles that studied patients with NES and their sociodemographic, clinical and psychological features in a clinical (i.e., ED, obese or bariatric surgery) population, through a quantitative study design. Articles were excluded if the NES patients included in the study had a comorbid psychological disorder, and/or the sample was collected from a university/non-clinical population, and/or the study design was qualitative, and/or NES features were compared with any other disorder, except BED. Our study found that no conclusions about the link between any sociodemographic feature (such as, age, gender, income, etc.) and an NES diagnosis could be made. Further, NES patients presented with elevated ED pathology (including emotional eating and loss of control eating) and higher occurrence of depressive symptoms than controls. Contrary to the literature suggesting that NES and Binge Eating Disorder (BED; an ED subtype which is also comorbid with obesity) patients often report overlapping features, questioning the validity of NES as an ED diagnosis, we found that BED can be differentiated from NES by the higher occurrence of emotional eating, body related concerns and abnormal eating episodes. The review also suggested an overlap between NES and Sleep-Related Eating Disorder. We recommend that it is essential to study NES as an independent disorder to further develop its diagnostic criteria and treatment options, thereby, increasing the quality of life of the patients suffering from this syndrome.
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... However, it is unclear whether NES is an extension of a daytime eating disorder, such as binge eating disorder with nocturnal eating, or if it constitutes an independent eating disorder. Alternatively, NES may represent a separate manifestation of the same condition as sleep-related eating disorder (SRED), which is characterized by awakening at night to eat without conscious awareness of the activity [13][14][15]. Advancing various aspects of the nosology of NES may facilitate the understanding of NES and identify treatment options. ...
... Keywords Night eating syndrome, Eating disorders, Diagnosis, Clinical biobank, Genetics, Phenome-wide association study "Probable" cases of NES were designated for patients with explicit diagnosis of NES by a healthcare provider in the medical chart. Three patients with diagnosed SRED were further designated as NES cases [14]. "Possible" cases of NES were designated for patients with symptoms of NES (e.g., hyperphagia or binging after the evening meal, or awakening at night to eat with or without consciousness of awakening) but not formally assessed by the standardized criteria. ...
Clinical and genetic associations for night eating syndrome in a patient biobank
Article
Full-text available
  • Dec 2024
Objective Night eating syndrome (NES) is an eating disorder characterized by evening hyperphagia. Despite having a prevalence comparable to some other eating disorders, NES remains sparsely investigated and poorly characterized. The present study examined the phenotypic and genetic associations for NES in the clinical Mass General Brigham Biobank. Method Cases of NES were identified through relevant billing codes for eating disorders (F50.89/F50.9) and subsequent chart review; patients likely without NES were set as controls. Other diagnoses were determined from billing codes and collapsed into one of 1,857 distinct phenotypes based on clinical similarity. NES associations with diagnoses were systematically conducted in phenome-wide association scans using logistic regression models with adjustments for age, sex, race, and ethnicity. Polygenic scores for six related traits, namely for anorexia nervosa, depression, insomnia, sleep apnea, obesity, and type 2 diabetes were tested for associations with NES among participants of European ancestry using adjusted logistic regression models. Results Phenome-wide scans comparing patients with NES against controls (cases n = 88; controls n = 64,539) identified associations with 159 clinical diagnoses spanning 13 broad disease groups including endocrine/metabolic and digestive diseases. Notable associations were evident for bariatric surgery, vitamin D deficiency, sleep disorders (sleep apnea, insomnia, and restless legs syndrome), and attention deficit hyperactivity disorder. The polygenic scores for insomnia and obesity were associated with higher odds of NES (insomnia: odds ratio [OR], 1.24; 95% CI, 1.07, 1.43; obesity: 1.98; 95% CI, 1.71, 2.28). Discussion Complementary phenome-wide and genetic exploratory analyses provided information on unique and shared features of NES, offering insights that may facilitate its precise definition, diagnosis, and the development of targeted therapeutic interventions.
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... In a clinical comparison that explored the medical records of 30 patients with primary SRED and 10 patients with drug-induced SRED (pharmacological agents with sedative properties, mainly zolpidem or benzodiazepines), a higher mean age of onset (40 vs. 26-year-old), higher rate of total amnesia (75% vs. 32%), lower rate of comorbid NES (0% vs. 63%), and lower rate of sleepwalking history (10% vs. 46.7%) were present in patients with drug-induced SRED (128). The combination of multiple types of sedative agents was observed in all patients with SRED induced by drugs (114). ...
... Higher doses of benzodiazepines may be responsible for the onset of SRED. The polysomnography recordings showed in drug-induced SRED a longer sleep-onset latency and a lower duration of deep sleep, possibly related to insomnia or pharmacologic effects of sedatives in these patients (128). Unlike SRED, the existence of drug-induced NES was not demonstrated (59). ...
Current evidence and future perspectives in the exploration of sleep-related eating disorder–a systematic literature review
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  • May 2024
Sleep-related eating disorder (SRED) is a non-REM parasomnia with potentially significant negative effects on general health (dangerous activities during night eating episodes, obesity, or metabolic syndrome, for example). Although the history of SRED encompasses more than six decades, public awareness and even the awareness of the mental health specialists of this disorder is very limited, a phenomenon that hinders the development of research in this field. Therefore, a systematic review based on PRISMA 2020 guidelines explored the available evidence for SRED found in four electronic databases (PubMed, Cochrane Collaboration, Google Scholar, and Clarivate/Web of Science). A number of 94 primary and secondary reports were retrieved, investigating aspects regarding the risk factors, epidemiology, clinical data and differential diagnosis, epidemiology, structured evaluation, and treatment of SRED. Based on the results of these reports, Z-drugs, but also certain benzodiazepines, antidepressants, antipsychotics, and psychostimulants may trigger the onset of SRED. Psychiatric and neurologic disorders have also been associated with SRED, either as risk factors or comorbid conditions. Cerebral glucose metabolism dysfunctions, neurotransmitter dysfunctions, and genetic factors have been invoked as pathogenetic contributors. Structured assessment of SRED is possible, but there is a dearth of instruments dedicated to this purpose. Data on the prevalence and treatment of SRED exist, but good-quality epidemiological studies and clinical trials are still missing. In conclusion, future research is expected to address the shortcomings of SRED exploration by creating the conditions for better quality and larger group clinical research. The need for such investigation is granted by the importance of this pathology and its negative functional consequences.
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Sleep Profiles in Eating Disorders: A Scientometric Study on 50 Years of Clinical Research
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Sleep and diet are essential for maintaining physical and mental health. These two factors are closely intertwined and affect each other in both timing and quality. Eating disorders, including anorexia nervosa and bulimia nervosa, are often accompanied by different sleep problems. In modern society, an increasing number of studies are being conducted on the relationship between eating disorders and sleep. To gain a more comprehensive understanding of this field and highlight influential papers as well as the main research domains in this area, a scientometric approach was used to review 727 publications from 1971 to 2023. All documents were retrieved from Scopus through the following string “TITLE-ABS ((“sleep” OR “insomnia”) AND (“anorexia nervosa” OR “bulimia nervosa” OR “binge eating” OR “eating disorder*”) AND NOT “obes*”) AND (LIMIT-TO (LANGUAGE, “English”))”. A document co-citation analysis was applied to map the relationship between relevant articles and their cited references as well as the gaps in the literature. Nine publications on sleep and eating disorders were frequently cited, with an article by Vetrugno and colleagues on nocturnal eating being the most impactful in the network. The results also indicated a total of seven major thematic research clusters. The qualitative inspection of clusters strongly highlights the reciprocal influence of disordered eating and sleeping patterns. Researchers have modelled this reciprocal influence by taking into account the role played by pharmacological (e.g., zolpidem, topiramate), hormonal (e.g., ghrelin), and psychological (e.g., anxiety, depression) factors, pharmacological triggers, and treatments for eating disorders and sleep problems. The use of scientometric perspectives provides valuable insights into the field related to sleep and eating disorders, which can guide future research directions and foster a more comprehensive understanding of this important area.
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Case 36. A Cerebral Change in Eating Behavior
Chapter
  • Mar 2023
A 27-year-old man with a history of parasomnias during youth, and a car accident with facial trauma, presented with nocturnal eating behaviors, which worsened following the accident. Prior to his accident, he would have no memory of his nocturnal eating. After his accident, the episodes of nocturnal eating became more frequent, and would occur during full consciousness upon sudden arousal during the sleep period. The patient has features of both nocturnal eating syndrome (NES) and sleep-related eating disorder (SRED). He experienced a great deal of stress following his accident, contributory to the development and worsening of his nocturnal eating behaviors. He would benefit from cognitive behavioral therapy, education about healthy eating, stress relief and relaxation strategies, establishing social support, improving physical activity, in addition to management of any underlying mental health issues including depression and anxiety.KeywordsNocturnal eating syndromeSleep-related eatingNESSRED
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Case 28. Sleeping Up an Appetite
Chapter
  • Mar 2023
Sleep-related eating disorder (SRED) and night eating syndrome (NES) are conditions involving abnormal food consumption during the typical sleep period. SRED is a NREM parasomnia characterized by partial, dissociated arousals from NREM with impaired consciousness and recall of the eating episodes. By contrast, NES occurs in full consciousness. These entities may co-exist within a same patient but require different treatment strategies. Here, we present a patient with a previous history of NES who developed SRED upon introduction of the sedating antipsychotic, quetiapine. The clinical presentation, diagnostic approach and management strategies of these disorders are outlined.KeywordsSREDNight-eatingParasomniasSleepwalkingEating disorders
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Sleep-Related Eating Disorders: Polysomnographic Correlates of a Heterogeneous Syndrome Distinct from Daytime Eating Disorders
Article
Full-text available
  • Nov 1991
Over a 5-yr period, 19 adults presented to our sleep disorders center with histories of involuntary, nocturnal, sleep-related eating that usually occurred with other problematic nocturnal behaviors. Mean age (+/- SD) at presentation was 37.4 (+/- 9.1) yr (range 18-54); 73.7% of the patients (n = 14) were female. Mean age of sleep-related eating onset was 24.7 (+/- 12.9) yr (range 5-44). Eating occurred from sleep nightly in 57.9% (n = 11) of patients. Chief complaints included excessive weight gain, concerns about choking while eating or about starting fires from cooking and sleep disruption. Extensive polysomnographic studies, clinical evaluations and treatment outcome data identified three etiologic categories for the sleep-related eating: (a) sleepwalking (SW), 84.2% (n = 16); (b) periodic movements of sleep (PMS), 10.5% (n = 2) and (c) triazolam abuse (0.75 mg hs), 5.3% (n = 1). DSM-III Axis 1 psychiatric disorders (affective, anxiety) were present in 47.4% (n = 9) of the patients, and only two patients had a daytime eating disorder (anorexia nervosa), each in remission for 3-7 yr. Nearly half of all patients fulfilled established criteria for being overweight, based on the body mass index. Onset of sleep-related eating was linked directly to the onset of SW, PMS, triazolam abuse, nicotine abstinence, chronic autoimmune hepatitis, narcolepsy, encephalitis or acute stress. In the SW group, 72.7% (8/11) of patients had nocturnal eating and other SW behavior suppressed by clonazepam (n = 7) and/or bromocriptine (n = 2) treatment. Both patients with PMS likewise responded to treatment with combinations of carbidopa/L-dopa, codeine and clonazepam. Thus, sleep-related eating disorders can generally be controlled with treatment of the underlying sleep disorder.
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Additional Categories of Sleep-Related Eating Disorders and the Current Status of Treatment
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Full-text available
  • Aug 1993
Sleep-related eating disorders distinct from daytime eating disorders have recently been shown to be associated with sleepwalking (SW), periodic limb movement (PLM) disorder and triazolam abuse in a series of 19 adults. We now report eight other primary or combined etiologies identified by clinical evaluations and polysomnographic monitoring of 19 additional adults (mean age 40 years; 58% female): i) obstructive sleep apnea (OSA), with eating during apnea-induced confusional arousals (n = 3); ii) OSA-PLM disorder (n = 1); iii) familial SW and sleep-related eating (n = 2); iv) SW-PLM disorder (n = 1); v) SW-irregular sleep/wake pattern disorder (n = 1); vi) familial restless legs syndrome and sleep-related eating (n = 2); vii) anorexia nervosa with nocturnal bulimia (n = 2) and viii) amitriptyline treatment of migraines (n = 1). In our cumulative series of 38 patients (excluding six with simple obesity from daytime overeating), 44% were overweight (i.e. > 20% excess weight) from sleep-related eating. Nightly sleep-related binge eating (without hunger or purging) had occurred in 84% of patients. Onset of sleep-related eating was also closely linked with i) acute stress involving reality-based concerns about the safety of family members or about relationship problems (n = 6), ii) abstinence from alcohol and opiate/cocaine abuse (n = 2) and iii) cessation of cigarette smoking (n = 2). Current treatment data indicate a primary role of dopaminergic agents (carbidopa/L-dopa; bromocriptine), often combined with codeine and clonazepam, in controlling most cases involving SW and/or PLM disorder. Fluoxetine was effective in two of three patients. Nasal continuous positive airway pressure therapy controlled sleep-related eating in two OSA patients.
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Behavioral and Neuroendocrine Characteristics of the Night-Eating Syndrome
Article
Full-text available
  • Sep 1999
Investigators first described the night-eating syndrome (NES), which consists of morning anorexia, evening hyperphagia, and insomnia, in 1955, but, to our knowledge, this syndrome has never been subjected to careful clinical study. To characterize NES on the basis of behavioral characteristics and neuroendocrine data. A behavioral observational study was conducted between January 1996 and June 1997 in a weight and eating disorders program at the University of Pennsylvania. A neuroendocrine study was conducted from May through August 1997 at the Clinical Research Center of the University Hospital, Tromso, Norway. The behavioral study included 10 obese subjects who met criteria for NES and 10 matched control subjects. The neuroendocrine study included 12 night eaters and 21 control subjects. Behavioral study subjects were observed for 1 week on an outpatient basis, and neuroendocrine study subjects were observed during a 24-hour period in the hospital. The behavioral study measured timing of energy intake, mood level, and sleep disturbances. The neuroendocrine study measured circadian levels of plasma melatonin, leptin, and cortisol. In the behavioral study, compared with control subjects, night eaters had more eating episodes in the 24 hours (mean [SD], 9.3 [0.6] vs 4.2 [0.2]; P<.001) and consumed significantly more of their daily energy intake at night than did control subjects (56% vs 15%; P<.001). They averaged 3.6 (0.9) awakenings per night compared with 0.3 (0.3) by controls (P<.001). In night eaters, 52% of these awakenings were associated with food intake, with a mean intake per ingestion of 1134 (1197) kJ. None of the controls ate during their awakenings. In the neuroendocrine study, compared with control subjects, night eaters had attenuation of the nocturnal rise in plasma melatonin and leptin levels (P<.001 for both) and higher circadian levels of plasma cortisol (P = .001). A coherent pattern of behavioral and neuroendocrine characteristics was found in subjects with NES.
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Association Between Sleep Bruxism, Swallowing-Related Laryngeal Movement, and Sleep Positions
Article
Full-text available
  • Jun 2003
To describe the relationships of sleep bruxism to swallowing and sleep positions. Controlled descriptive study. Polysomnography and audio-video recordings were done in a hospital sleep laboratory. Nine patients with sleep bruxism and 7 normal subjects were matched for age and sex. Interventions: n/a. During sleep, patients with sleep bruxism showed a higher frequency of rhythmic masticatory muscle activity episodes (6.8 +/- 1.0 [SEM]/h) than did normals (0.5 +/- 0.1/h, p < 0.01). Swallowing-related laryngeal movements occurred more frequently in sleep of patients with sleep bruxism (6.8 +/- 0.8/h) than in normals (3.7 +/- 0.3/h, p < 0.01). In both groups, during sleep, close to 60% of rhythmic masticatory muscle activity episodes were associated with swallowing. In sleep bruxism patients, 68% of swallowing events occurred during rhythmic masticatory muscle activity episodes, while only 10% of swallowing events were associated with rhythmic masticatory muscle activity in normal subjects. Sleep bruxism patients and normals spent 95.5% and 87.3% of sleeping time in the supine and lateral decubitus positions, respectively. In both groups, up to 96% of rhythmic masticatory muscle activity and swallowing were observed in the supine and lateral decubitus position. In sleep bruxism patients, although sleeping time did not differ between the 2 sleeping body positions, 74% of rhythmic masticatory muscle activity and swallowing events were scored in the supine position compared to 23% in the lateral decubitus position. During sleep, rhythmic masticatory muscle activity is often associated with swallowing. In sleep bruxism patients, most of these oromotor events are observed in the supine position. The physiologic link between rhythmic masticatory muscle activity and swallowing and the clinical relevance of sleep position in sleep bruxism management need to be investigated.
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Night time eating: A review of the literature
Article
  • Jan 2003
  • EUR EAT DISORD REV
This study reviews the published research on night time eating, including the night eating syndrome (NES) and the nocturnal eating/drinking syndrome (NEDS). Studies were identified by a computerized literature search (PubMed, PsycInfo) and by references from the papers obtained. In addition, published abstracts from recent conferences in the areas of eating disorders and obesity were included. Individual studies were reviewed and their results summarized. Wakeful night time eating appears to be a frequent symptom which is more common among the obese. The data suggest an early age of onset with a chronic course in many patients. There appears to be considerable overlap between NES and NEDS. Treatment studies are sparse. The clinical features of these syndromes, their comorbidities, and their prevalence rates remain a matter of debate. It is unclear if the night eating syndrome presents a distinct entity that is of clinical relevance. The current nosologies may not capture the natural clustering of eating and sleep-related pathology as it occurs in general population samples. Copyright © 2003 John Wiley & Sons, Ltd and Eating Disorders Association.
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The prevalence of sleep-related disorder in psychiatric and non-psychiatric populations
Article
  • Nov 1999
Sleep-related eating disorder is a little-described syndrome combining features of sleep disorders and eating disorders. The behaviour consists of partial arousals from sleep followed by rapid ingestion of food, commonly with at least partial amnesia for the episode the following day. The aim of this study was to provide an estimate of the prevalence of sleep-related eating disorder. The Inventory of Nocturnal Eating, a self-report questionnaire addressing nocturnal eating and sleep disturbance, was administered to out-patients (N = 126) and in-patients (N = 24) with eating disorders, obese subjects (N = 126) in a trial of an anorexic agent, depressed subjects (N = 207) in an antidepressant trial, and an unselected group (N = 217) of college students. Sleep-related eating disorder was operationally defined as nocturnal eating with a self-reported reduced level of awareness, occurring at least once per week. Almost 5.0% (33/700) of the sample described symptoms consistent with sleep-related eating disorder. The in-patient eating disorders group had nearly twice the prevalence (16.7%) of the out-patient eating disorder sample (8.7%), which had nearly twice the prevalence of the next highest group, the student sample (4.6%). Subjects with sleep-related eating disorder endorsed more symptoms consistent with sleep disorders and had higher levels of depression and dissociation than those without nocturnal eating. Sleep-related eating disorder is more common than is generally recognized, especially in those with a daytime eating disorder. Sleep disorder symptoms are often associated with sleep-related eating disorder, as are depression and dissociation. Evaluation of individuals with eating disorders should include assessment for sleep-related eating.
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Nocturnal Eating Syndrome in Adults
Article
  • Jul 1994
Ten adult subjects were referred to our sleep disorders center complaining of difficulty in maintaining sleep due to frequent and recurrent awakenings to eat or drink. All patients manifested more than one episode per night, characterized by compulsive food seeking and a return to sleep only after adequate food intake. Food-seeking drive was described as an urgent abnormal need to swallow food and was associated with an absence of real hunger. Six subjects showed an elective nighttime intake of carbohydrates, and in all cases only edible substances were injected. The patients were always fully awake during the episodes and could clearly recall them in the morning. Polysomnographic investigation showed low levels of sleep efficiency, a high number of awakenings and a strict relation between nocturnal eating episodes and nonrapid eye movement (NREM) sleep. The average length of each episode was 3.5 minutes. The "eating latency", that is the interval between awakening and chewing start, was shorter than 30 seconds in 50% of the episodes. No medical, hormonal or neurological disorders were found during clinical and laboratory investigations. Body mass index was abnormally high in six patients. Anorexia nervosa and bulimia were carefully excluded. Various psychiatric disturbances were found in nine subjects, who were nevertheless well-functioning adults. Concurrent dyssomniac disorders, such as narcolepsy or periodic leg movements occasionally associated with restless legs syndrome, were diagnosed in five patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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The night eating syndrome in the general population and among postoperative obesity surgery patients
Article
  • Aug 1997
To determine the prevalence of night-eating syndrome in the general population and among a new sample of obesity surgery patients. Night-eating syndrome was defined by presence of morning anorexia, excessive evening eating, evening tension and/or feeling upset, and insomnia. A randomly selected sample of 2,097 adults (survey sample) answered structured interview questions on night-eating syndrome. A self-report form was completed by 111 patients who had received gastric restriction surgery for obesity at a patient reunion (patient sample). Prevalence of night-eating syndrome in the survey sample was 1.5% (31 of 2,097). Prevalence in the patient sample was 27% (30 of 111). Weights for subjects in each sample, with and without the syndrome, were comparable. Prevalence of night-eating syndrome was higher in the patient sample than in the survey sample. Within each sample, presence of the syndrome was not related to weight. Prevalence in the survey sample was within the range reported for binge-eating disorder. Night-eating syndrome may warrant consideration as a distinct eating disorder.
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Clinical and Polysomnographic Features of Sleep-Related Eating Disorder
Article
  • Feb 1998
Sleep-related eating disorder is a recently described clinical syndrome that combines characteristics of both eating and sleep disorders. Nocturnal partial arousals are followed by rapid ingestion of food and subsequent poor memory for the episode. Only two case series examining this disorder have been published, and both are from the same sleep disorders center in a general hospital. The author describes 23 consecutive cases of sleep-related eating disorder that presented to the Sleep Disorders Center at McLean Hospital. All patients were administered at a standardized clinical sleep disorders evaluation followed by a semistructured interview to elicit information regarding characteristics of sleep-related eating disorder. Polysomnographic evaluation was performed on all patients with clinical histories of sleep-related eating disorder. Eighty-three percent (N = 19) of the 23 patients were female. For most of the patients, the disorder had begun in adolescence (mean +/- SD = 21.6 +/- 10.9 years) and had been chronic, with a mean duration of 15.8 +/- 11.2 years. Nearly all patients reported eating on a nightly basis (1-6 times per night), and all episodes followed a period of sleep. All patients described their eating as "out of control," and two thirds stated that they "binged" during the night. Over 90% (21/23) reported their state at the time of nocturnal eating as "half-awake, half-asleep" or "asleep", and over 90% reported "consistent" or "occasional" amnesia for the event. Nearly half (11/23) of the sample were given a polysomnographic diagnosis of somnambulism. Thirty-five percent (8/23) had a lifetime eating disorder diagnosis. Sleep-related eating disorder appears to be a relatively homogeneous syndrome combining features of somnambulism and daytime eating disorders. However, no current nosology accurately characterizes these patients. Physicians should be aware of the existence of the disorder and the value of referring patients with sleep-related eating disorder to a sleep disorders center.
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