Eating disorders are common, treatable conditions that affect people in many different ways. Living with an eating disorder can make everyday activities and normal routines challenging. Some eating disorders can disrupt even necessary activities like sleep. This article will explore sleep-related eating disorders, their causes and symptoms, and how to find help.  

What Is an Eating Disorder? 

An eating disorder is a serious health condition involving persistent and intense changes in eating behaviors, body image, and relationships with food. Eating disorders include conditions like anorexia nervosa, bulimia nervosa, binge-eating disorder, OSFED, and ARFID. Those experiencing eating disorders often struggle with obsessions with food and eating, perseveration on body weight and shape, and distorted body image. Additionally, these challenging symptoms can co-occur with mental health problems such as anxiety, depression, and obsessive-compulsive disorder, which can make a difficult condition even more challenging to manage day-to-day. 

Eating disorders are experienced differently by everyone, however there are some common signs and symptoms of eating disorders that are important to understand: 

• significant weight gain or weight loss
• Constant dieting and excessive exercise
• Altered relationship with food and eating 
• Obsession with calories, nutrients, and particular food groups
• Secretive eating habits
• Binging and purging behaviors, such as induced vomiting and laxative misuse
• Changes in mood, behavior, and worsening mental health

These common eating disorder signs can have significant health impacts in both the long- and short-term. Resulting complications may include gastrointestinal issues, osteoporosis, organ failure, and even loss of life.The mental toll of eating disorders is also a cause for concern. Many people who experience eating disorders have strong feelings of guilt and shape, struggle with substance abuse or addiction, and suffer from anxiety or depression. Though these effects can be lasting and detrimental, an eating disorder is always treatable. Prompt diagnosis and attention from a medical professional can help minimize the effects of an eating disorder and get a patient on the road to recovery. 

What causes eating disorders? Eating disorders can arise due to a wide variety of influences. Personal medical history, family medical history, social and cultural influences, and other environmental factors all play a role in the development of an eating disorder. It is notable that the highest predictor of developing an eating disorder is if a relative has experienced an eating disorder, either currently or in the past. 

Eating disorders can occur regardless of gender, age, race, or other demographics. Understanding signs and symptoms of eating disorders can help you or a loved one get the help you need. Remember that all eating disorders are treatable and recovery is always possible.

What are Sleep-Related Eating Disorders? 

Most people know about more common eating disorders like anorexia nervosa or bulimia nervosa, but lesser known eating disorders, like sleep-related eating disorders, are real conditions, too. So what are sleep-related eating disorders? These conditions, also known as SRED, are when an individual exhibits recurrent episodes of nighttime eating with impaired consciousness or amnesia. The individual typically does not remember the nocturnal eating episode. This type of behavior is known as parasomnia, or abnormalities in sleeping behaviors, and can have serious impacts on health and wellbeing. Sleep-related eating disorders often occur as a result of adverse reactions to medications or accompany other sleep-related conditions, such as restless legs syndrome (RLS) or insomnia. Those who suffer from sleep-related eating disorders are at risk of health concerns related to unconscious eating as well as disrupted sleep patterns. 

Causes of Sleep-Related Eating Disorders

There are two typical causes of sleep-related eating disorders. First, there is drug-induced SRED. This occurs when a person is experiencing a side effect from medication. Some medications that treat conditions like insomnia, depression, or psychosis can cause patients to exhibit parasomniac behaviors. These medications cause a person to awaken enough to move about and eat food unconsciously, but leave little to no trace of the event in their memory. Melatonin supplements can infrequently cause drug-induced SRED as well. 

Secondly, SRED can be caused by other sleep-related conditions. Sleep disorders like insomnia, restless legs syndrome, narcolepsy, or obstructive sleep apnea (snoring) can cause an individual to engage in unconscious nocturnal eating episodes. Like drug-induced SRED, a person will not be able to remember their eating episode. Much like eating disorders, sleeping disorders are also genetically linked, meaning that a primary predictor of having a sleeping disorder or sleep-related eating disorder is if a family member also has these conditions. 

Along with medication and sleep problems, there are additional causes and risk factors of sleep-related eating disorders. Studies have shown that heritability and a previous diagnosis of a mental health condition can be triggers for sleep-related eating disorders. Stressful or traumatic life events can also precipitate the behaviors of sleep-related eating disorders. Lastly, there is an increased prevalence of SRED among female patients.

Regardless of the cause of SRED, these unconscious awakenings and nocturnal events can be unsettling, embarrassing, and potentially dangerous, both in the moment of the event and in terms of long-term health consequences.

Symptoms of Sleep-Related Eating Disorders

The symptoms of sleep-related eating disorders have similarities to those of other eating disorders, but can appear different due to the fact that the individual is eating unconsciously. Obsessions and fixations on food, eating, and body may not necessarily arise with this condition because the disordered behaviors occur unconsciously and are often not remembered by the individual. Symptoms of sleep-related eating disorders include:

• Reduced appetite in the morning
• Fatigue and marked drowsiness during the day
• Weight gain
• Drastic changes in food intake 
• Gastrointestinal symptoms such as bloating, diarrhea, constipation, or nausea
• Changes in mood and attention span

A less considered outcome of sleep-related eating disorders are accidental injuries. When a person unconsciously moves about, eats, or even prepares food, there is a major risk of injury. Patients have been known to fall, cut or burn oneself, or cause damage to their home with unconscious use of kitchen appliances. 

Those who experience sleep-related eating disorders may also experience a co-occurrence of pica disorder. Pica disorder is an eating disorder wherein a person ingests non-nutritive, non-food substances. Sometimes those who experience sleep-related eating disorders will ingest household cleaners or toxic substances which can lead to severe and acute health problems. Food poisoning can also be an issue if an individual consumes raw food in their unconscious state. 

It is important to understand that those who experience sleep-related eating disorders have little to no recollection of their disordered eating behaviors. This can make detection and diagnosis increasingly challenging, so understanding the nuances of the symptoms is critical to getting the care you or a loved one may need. 

SRED versus NES

There are other eating disorders, such as night eating syndrome (also called nocturnal eating syndrome), that are related to disrupted sleep patterns and it is important to understand the distinct differences between these disorders. While sleep-related eating disorders (SRED) occur when a person is unconscious and sleepwalking, night eating syndrome (NES) occurs when a person frequently awakens during the night to eat. Night eating syndrome is characterized by an uncontrollable urge to eat and an inability to go back to sleep without eating. While sleeping conditions are common to both varieties of disordered eating, night eating syndrome is more closely linked with insomnia, or the inability to sleep. However, medications that are used to treat insomnia can lead to the unconscious SRED episodes of eating that characterize sleep-related eating disorders. Clearly the relationship between these conditions are complex and challenging to disentangle and treat. Overall, both sleep-related eating disorders and night eating syndrome are real and serious conditions that require professional eating disorder care. 

Managing and Treating SRED

Like all eating disorders, sleep-related eating disorders are treatable conditions and recovery is always possible. Diagnosis of a sleep-related eating disorder may involve a sleep study, neurology assessment, and an assessment of sleep quality. Depending on the result of diagnostic testing, the treatment of sleep-related eating disorders may vary depending on the patient. If an individual’s condition is linked to medication, a doctor may recommend reducing or stopping the medication causing the reaction. However, it is very important to never reduce, stop, or start a medication without a doctor’s approval.

Always check in with your healthcare professional before making changes to your medication. If SRED is not caused by an adverse medication reaction, a doctor may recommend antidepressants like selective serotonin reuptake inhibitors (SSRIs) to regulate various functions that may be resulting in sleep-related eating disorders. Your physician may also recommend changes to your lifestyle. Treatment options may include stress reduction, sleep hygiene, reduced screen time, therapy, caffeine avoidance, and sobriety. While unconscious nocturnal eating episodes continue, placing locks on kitchen cabinets and the refrigerator or clearing a walking path for safer somnambulism (sleepwalking) may be actions to take for harm reduction. 

Seek Help

If you or a loved one is experiencing symptoms of a sleep-related eating disorder or other signs of disordered eating, you are not alone. Recovery is always possible and help is available with the National Alliance for Eating Disorders.