Night Eating Syndrome: Signs, Symptoms & Treatments

What Is Night Eating Syndrome?

Night eating syndrome (NES) is an eating disorder which is different from anorexia and bulimia, as NES often disrupts sleep. NES can overlap with these conditions, however NES occurs only at night and is linked to sleep health. Those with NES often experience insomnia and other mood disorders. Often, those with NES are unable to go to sleep until they eat, and feel out of control with their urges to eat. This can look like binge eating at night.¹

How Common Is Night Eating Syndrome?

The prevalence of night eating syndrome is similar to other eating disorders such as bulimia nervosa and anorexia nervosa. According to the available data, its prevalence in the general population of the United States is estimated to be around 1.5%. Nonetheless, this condition seems to be more common among certain populations, including people who are obese or seeking treatment for obesity.²

Normal Night Eating Vs. Night Eating Syndrome

Normal night eating and night eating syndrome (NES) represent two different ends of the spectrum in terms of nighttime eating behavior. For example, normal night eating occurs sporadically, is fairly common, and typically isn’t a cause for concern. Many people may consume a small snack or drink before bedtime without it significantly impacting their overall health, weight, and quality of life. Furthermore, regular nighttime eating is often prompted by hunger, social activities, or relaxation routines and doesn’t interfere with sleep patterns or cause distress.^2,3

In contrast, NES is a condition marked by a pattern of recurrent episodes of nighttime eating. People with this condition often consume a significant portion of their daily food intake during the evening and nighttime hours, eating very little or skipping meals throughout the day. Night eating syndrome is typically associated with emotional distress, guilt, and shame surrounding nocturnal eating episodes. It can also disrupt sleep patterns, leading to difficulty falling asleep or staying asleep. Lastly, NES is a diagnosable disorder that requires professional help.

Signs & Symptoms of Night Eating Syndrome

A person who experiences NES will engage in certain behaviors related to food and certain signs will be recognizable by those around them. These symptoms can vary depending on the individual, however, most who struggle with night eating syndrome eat when they are not hungry and fixate on food at night as a way to regain control in their lives. Many often have body image issues and struggle with emotional regulation. They may go out of their way to cover their tracks so they are not caught in the act of eating late at night.

Night eating syndrome symptoms can include:²

• Waking up to eat: Those struggling with NES have repeated episodes of eating at night and typically wake up just to eat.
• Eating more than 25% of calories at night: People with NES typically consume more than a quarter of their daily food intake after their evening meal or during nighttime awakenings.
• Decreased appetite during the day: People with NES don’t usually have an appetite in the morning, which may lead to skipping breakfast or other daytime meals.
• Trouble falling asleep or staying asleep: Those with NES can have difficulty falling asleep or staying asleep and believe they must eat in order to fall back asleep.
• Depression, especially at night: NES is associated with depression that worsens during the night when feelings of loneliness or sadness may be more pronounced.

What Causes Night Eating Syndrome?

While the exact causes of this disorder are unknown, it is believed to stem from a variety of different factors. Genetics may make someone more susceptible to developing this eating disorder, however there are environmental triggers that can also lead someone to begin engaging in unhealthy eating behaviors. Additionally, having other mental health issues such as PTSD, depression and anxiety, or other eating disorders can also put someone at a higher risk of developing NES.

Some who experience NES may have developed it as a result of lifestyle challenges, such as those who are in college, professional graduate school, or have jobs with long hours. This population can oftentimes skip daytime meals due to a lack of time in their day and eat more at night to compensate for the lack of eating during the day. This in itself isn’t a problematic behavior, however it has the potential to develop into NES and disordered eating, and trigger further stress, guilt, and shame.

Night eating syndrome may also be caused by:

• Genetics: Genetics can play a role, such as with the gene PER1, which impacts our body’s natural internal clock.
• Circadian rhythm problems: The sleep-wake cycle can be disrupted, which can trigger NES. This is our body’s natural timekeeping tool that helps us to know when to be awake and eat.
• Hormone imbalances: Hormone imbalances can impact when and how much someone eats, and often certain hormones can trigger you to eat more, eat only at specific times, or not eat during appropriate times.⁴
• Mental health disorders: Conditions such as depression or anxiety, and increased stress levels can contribute to NES. Emotional distress may lead people to seek comfort or distraction through food.²
• Restricted eating during the day: This can lead to increased hunger and cravings, particularly in the evening and at night. It can create a cycle of undereating during the day followed by overeating at night.²

Health Effects of Binge Eating at Night

The symptoms of night eating syndrome can affect a person’s daily activities and life, as well as their future health. They may struggle to fit in at social gatherings or with their family at mealtimes, and have health issues as a result of NES, which can lower their quality of life. These issues can escalate into weight gain, which can trigger other problems with heart health, cholesterol, and thyroid issues. People may try to self medicate with other substances or turn to other diet methods which further harm their health. It can make it hard to break out of the cycle of living with NES.

People with night eating syndrome may experience long-term health conditions, including:⁵

• Diabetes
• Obesity
• Early artery disease
• High blood pressure
• Sleep disorders
• Depression
• Anxiety
• Bulimia
• Anorexia

Diagnosis of Night Eating Syndrome

To obtain a diagnosis of this eating disorder, a psychiatrist will likely be the primary provider you see. You may also see a therapist who can help to identify specific symptoms and behaviors. You might be asked to get a physical exam as well as updated labs to get a baseline. Once all the information is gathered, your medical team will be able to come to a diagnosis.

Diagnosing night eating syndrome may require:⁶

• Polysomnography: A sleep test that measures your vitals and brain waves.
• Night Eating Questionnaire (NEQ): A self report of your night eating habits.
• Night Eating Diagnostic Scale (NEDS): An assessment tool with yes or no options to understand night eating behaviors.
• Night Eating Syndrome History and Inventory (NESHI): An interactive questionnaire facilitated by a therapist that dives deeper into the night eating questionnaire.

Night Eating Syndrome Vs. Binge Eating Disorder

While both night eating syndrome (NES) and binge eating disorder (BED) are eating disorders marked by irregular eating habits and emotional distress, they also exhibit unique features. BED entails recurring episodes of consuming large amounts of food within a specific timeframe, typically a few hours, accompanied by a sense of loss of control, which can occur at any time of day. In contrast, NES is characterized by nighttime eating predominantly, often accompanied by disruptions in sleep patterns. Additionally, NES lacks the compensatory behaviors commonly seen in BED, where individuals may engage in activities like exercise or purging to “undo” the binge episode.^2,3

Night Eating Syndrome Vs. Sleep-Related Eating Disorder

Night eating syndrome (NES) and sleep-related eating disorder (SRED) may be similar in that they both involve eating during sleep hours. However, NES represents an eating disorder and SRED is a sleep condition. The main difference lies in the behavior exhibited during episodes. For instance, people with SRED consume food either during sleep or in a semi-conscious state between sleep and wakefulness, lacking awareness of their actions. They often awaken to discover food in their vicinity without any memory of eating. In contrast, those with NES are fully awake while eating and have awareness and can recall the night eating episode the next day.^2,3

Night Eating Syndrome Treatment

There are different methods of treatment available for night eating syndrome. Like most treatment plans for eating disorders, a combination of therapy and medication is key. While there are no accepted medications used to treat eating disorders, there are some medications that may help alleviate certain symptoms. Treatment also includes a lot of psychoeducation about the eating disorder, physical health, and how the disorder impacts overall wellbeing.

Psychotherapy Options

Psychotherapy is an option for treating NES as it explores the reasons behind why someone may engage in night eating, when it begins, significant trauma or other adverse experiences, and any underlying medical conditions. Therapy for eating disorders is a great way to uncover some of the reasons why we act the way we do, feel the way we do, when the problem began, how we cope, and how to adjust ourselves to be healthier.

When developing a treatment plan for NES, it is important to be open and vulnerable about your experiences with your therapist. Together, you and your therapist will come up with a plan with goals that are attainable and realistic so you are not set up to fail. It is meant to help keep you accountable and have someone to process with.

There are many types of therapy modalities that can be beneficial for night eating syndrome, including:

• CBT
• Cognitive restructuring
• DBT
• Trauma-informed therapy
• Motivational Interviewing
• Phototherapy to aid in sleep hygiene

Medications

While there is no one medication to treat night eating syndrome or other eating disorders, antidepressants can help with mood stabilization and regulate your mood enough to mitigate night eating. In addition, using melatonin can be helpful to encourage restful sleep without engaging in night eating.⁷

How to Find Treatment for Night Eating Syndrome

Finding a therapist from an online therapist directory that specializes in eating disorders can be beneficial, as well as finding local support groups and reaching out to family members. Taking time to call therapists and ask them about their experience with NES and eating disorders is a great step in making sure you pick someone you are comfortable with. You can also use an online eating disorder recovery program, like Equip Health or Within Health.

It can be hard to find treatment for NES, but know you are not alone. Learning and acknowledging you need help is the first step toward recovery. Assembling a support team to help you with NES can take time, but with the appropriate support and treatment plan you can gain relief from an eating disorder.

How to Stop Binge Eating at Night

Although getting professional help for NES can make a huge difference in your overall well being, there are ways to support yourself and manage your condition. By developing healthier habits that promote balanced eating and improved sleep quality you can overcome your symptoms and enhance your quality of life.

Here are some helpful tips for overcome night eating syndrome:

• Don’t restrict during the day: Restricting food intake during the day increases hunger and cravings at night, which may worsen night eating episodes. Eating balanced meals and snacks throughout the day helps maintain stable blood sugar levels and prevents excessive hunger later on.
• Eat a variety of healthy foods: Consuming a diverse range of nutrient-rich foods ensures that your body receives essential vitamins, minerals, and nutrients. This can aid regulate hunger and satiety signals, reducing the urge to binge eat at night.
• Practice mindful, consistent eating: Mindful eating involves paying attention to the sensory experience of eating, like taste, texture, and hunger cues. Consistent eating patterns, such as sticking to regular mealtimes, can help manage appetite and prevent NES’s erratic eating patterns.
• Practice good sleep hygiene: Establishing a consistent sleep schedule and creating a relaxing bedtime routine can improve sleep quality and reduce nighttime awakenings, which are common triggers for nocturnal eating bouts. Good sleep hygiene practices can include avoiding caffeine and screens before bed and creating a cozy sleep space.
• Manage your stress levels: Stress can trigger emotional eating and disturb normal eating patterns, contributing to NES. Finding healthy strategies for stress, like relaxation techniques, meditation, and leaving time for fun activities can prevent the likelihood of nighttime binge episodes.
• Get regular exercise during the day: Regular physical activity not only promotes good health but also improves mood and controls appetite. Engaging in regular exercise during the day can decrease stress, improve sleep quality, and regulate appetite, making you less likely to engage in nighttime eating behaviors.
• Use light to help regulate your circadian rhythm: Exposure to natural light during the day and minimizing exposure to artificial light at night can help regulate your circadian rhythm. A well-regulated sleep-wake cycle may contribute to more consistent eating patterns and improved overall health.