Night eat­ing syn­drome is linked to de­pres­sion and stress, finds out Sarah Gib­bons

Friday - - Contents -

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

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