Night eating syndrome is linked to depression and stress, finds out Sarah Gibbons
Do you find crumbs and wrappers on and around your bed when you wake up in the morning? You could be suffering from Night Eating Syndrome.
GGrabbing 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 feel-good factor of the late-night sugary snack.
It was becoming increasingly common for him to shake his duvet in the morning and find handfuls of food debris. He found himself crunching on crisps 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 got there.
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 preprepared, which is probably a good thing or I might burn the house down!’
US-based dietician Cathy Leman says NES is characterised by a lack of appetite in the morning, overeating at night, and waking to eat throughout the night.
She says ‘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 per cent of daily calories after supper and/or waking 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 towards the end of the day,’ says Cathy. 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 impact someone who struggles. Those 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.
Adds Cathy, ‘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 have sleep disorders like insomnia.’
Cathy says that like other eating disorders, NES can be treated effectively.
‘Education and identifying triggers is a good start,’ she says. ‘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.
‘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.’
MMen 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 programmes, and 8-42 per cent 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, so have his NES behaviours.
Another of Cathy’s patients, 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 stashing food on her bed. In the middle of the night she would eat in an almost dreamlike state until she fell back to sleep.’
Cathy says 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, althought it comes to light eventually because it’s difficult to keep secret when dirty dishes, wrappers and food crumbs are left behind as tell-tale signs.
Just as night eating is recognisable, 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.
The late Dr Albert Stunkard, a leading figure in research of obesity and eating disorders, wrote on NES that ‘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’.
His research suggested that sufferers wake up up to five times a night to raid the kitchen for sugary or high-carb snacks – with many saying 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.’
Archana Baju, clinical dietcian at Burjeel Hospital in Abu Dhabi, says 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.
She says: ‘Typically sufferers will face a 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 life negatively as they will lack self-esteem, friends, while 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, depression or loss of appetite in the morning hours. If you do notice any of these symptoms, I urge you not to overlook them – go 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.’
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.
While the percentage of the population DIAGNOSED, or believed to suffer with NES, is around 1.5 per cent, that figure rises to between six and 16 per cent of those in WEIGHT-REDUCTION programmes