disordered eating, Eating Disorders, Health & Wellness, Mental Health, overeating, wellness

Are you a night eater? This is for you.

night eating

Written by Pamela K. Orgeron, M.A., Ed.S., BCCC, ACLC

Did you know there’s an eating disorder (ED) referred to as night eating syndrome? I was unaware of this syndrome until a former therapist about 25 years ago taught me about the disorder after I described to her of my having symptoms of the condition.

What is night eating syndrome? “Night eating syndrome (NES) is a condition that combines overeating at night with sleep problems. With NES, you eat a lot after dinner, have trouble sleeping, and eat when you wake up at night” (WebMD Staff, 2017. ¶ 1).

Night eating syndrome was first chronicled in 1955 (Stunkard, Grace, and Wolff, 1955). Stunkard, Grace, and Wolff reported

Observation of twenty-five obese patients at a special study clinic of the New York Hospital has disclosed that the eating patterns of a large number form a distinctive syndrome characterized by nocturnal hyperphagia, insomnia, and morning anorexia. Such a pattern was not found in any of thirty-eight subjects without history of weight disorder. This “night-eating syndrome” was particularly prominent during periods of weight gain and life stress (p. 78).

Since 1955, the study of NES was disregarded “until the late 1990s, when the focus of eating-related research shifted in response to the growing prevalence of obesity in the United States” (Birketvedt, Florholmen, Sundsfjord, et. al., 1990, as cited by Allison & Tarves, 2011, p. 785). The increased study of NES “within the past decade has prompted several modifications to its core diagnostic criteria, aided in a better understanding of its causes, and promoted interest in developing effective treatments” (Allison & Tarves, p. 785).

 Currently the American Psychiatric Association (2013) classifies night-eating syndrome in the Other Specified Feeding or Eating Disorder category of the Diagnostic and statistical manual of mental disorders, Fifth Edition (DSM-5). The DSM-5 describes NES as

Recurrent episodes of night eating, as manifested by eating after awakening from sleep or by excessive food consumption after the evening meal. There is awareness and recall of the eating. The night eating is not better explained by external influences such as changes in the individual’s sleep-wake cycle or by local social norms. The night eating causes significant distress and/or impairment in functioning. The disordered pattern of eating is not better explained by binge-eating disorder or another mental disorder, including substance use, and is not attributable to another medical disorder or to an effect of medication. (p. 354).

Symptoms

For persons with NES, they eat a minimum of one-fourth of their daily calories after the evening meal. Additionally, this fact bothers them.

If that’s you, and you wake up to eat at least twice a week, you may have NES if you also have at least three of these:
     * Lack of appetite in the morning
     * A strong urge to eat between dinner and sleep
     * Insomnia four or five nights a week
     * A belief that eating is necessary to get to sleep or get back to sleep
     * A depressed mood that gets worse during evening hours (WebMD Staff, 2017, Symptoms section, ¶ 2).

WebMD Staff also distinguished between NES and binge eating disorder (BED). With BED, a person is more apt to consume more during a single sitting. Those persons who have NES are more apt to consume lesser amounts several times through the night.

Causes

WebMD Staff (2017) reports the cause of NES is unclear. However, one theory stipulates that NES might be linked to problems with one’s sleep-wake cycle and hormone imbalances. Variations in a person’s sleep routine and schedule have been ruled out as possible causes.

Genetic factors also may be another cause of NES, according to WebMD Staff (2017).  “There’s a gene called PER1 that’s thought to have a hand in controlling your body clock. Scientists believe a defect in the gene could cause NES. More research is needed” (Genetic Reasons section, ¶ 1).

Risk Factors

Risk factors reported by WebMD Staff (2017) for having NES include:

  • Obesity (More than one percent of the general population are affected by NES. In the obese, there’s a ten percent chance of having NES.)
  • The presence of another ED.
  • History of depression, anxiety, and substance abuse.

Though NES and obesity are linked, WebMD Staff pointed out that it’s uncertain whether “obesity is the cause or the effect of NES. One thing is known: The disorder makes it tough to lose weight. Not all studies have shown that you eat more if you have NES, and not everyone with night eating syndrome is obese” (Health Effects section, ¶ 1).

Treatment

 Allison and Tarves (2011) discussed suggested treatment options for NES. Among these options, in name only, are:
  • Pharmacotherapy
  • Behavior Therapy
  • Cognitive Behavior Therapy
  • Progressive Muscle Relaxation
  • Phototherapy (using light to treat an illness)

Closing Remarks

In my closing remarks, I’d like to discuss my battle with NES further and what I believe caused the condition in me. First, my guess is that the condition developed in me out of ignorance, making poor choices regarding my eating habits, and perhaps out of my own chemical imbalance triggered by past abuse.

Skipping breakfast became a habit early on as I have always been a “night person” and preferred to sleep later in the mornings rather than get up earlier to take time to prepare and eat breakfast. When I first moved to Nashville and just getting on my feet financially, I did not have money to eat lunch out. Thus, I would skip lunch to read or sometimes take a walk. I would go all day without eating. Then after work I would munch on my comfort foods the rest of the evening.

Once my therapist educated me on the importance of eating breakfast, and how our bodies need food in the mornings for fuel to get our metabolism going, I made a conscious decision to break the bad habit of skipping breakfast. I also set a time (7 PM) in the evenings where I choose to discipline myself not to eat before bedtime. I made that decision after someone told me that one of the easiest ways to lose weight was by not eating before you go to bed. Through self-disciple, mindfulness of my eating behaviors, and, of course, prayer, I no longer struggle with NES. 

If you suspect that you have NES, I encourage you to see a psychiatrist or psychologist for a professional consultation. The unhealthy eating and other behaviors associated with NES are no laughing matter. Seek professional help now!

References

Allison, K. C., & Tarves, E. (2011). Treatment of Night Eating Syndrome. The Psychiatric Clinics of North America34(4), 785–796. http://doi.org/10.1016/j.psc.2011.08.002

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Birketvedt GS, Florholmen J, Sundsfjord J, et al. (1999). Behavioral and neuroendocrine characteristics of the night-eating syndrome. JAMA. 282(70, 657–663.

Stunkard, A. J., Grace, W. J. & Wolff, H. G. (1955). The night-eating syndrome*: A pattern of food intake among certain obese patients. The American Journal of Medicine,  19(1), 78-86. Article available for purchase at http://www.amjmed.com/article/0002-9343(55)90276-X/pdf

WebMD Staff (2018). What is night eating syndrome? Retrieved February 22, 2018 from https://www.webmd.com/mental-health/eating-disorders/binge-eating-disorder/what-is-night-eating-syndrome#1

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