May 30, 2018

Night Eating Syndrome: The Eating Disorder We Need to Talk About

help for night eating syndromeRaise your hand if you struggle with grazing, nibbling, snacking, or binge eating in the evening between dinner and bedtime.
 
If you do, you’re not alone.
 
There are a number of reasons why we do this. Often, it’s because we have more access to food at night and we are relaxing at home alone — or with our family members.
 
Some of us eat a bit more than we would like to at night as a way to be social or a way to relax. Others may have different reasons.

When night eating is a problem

Several studies suggest that those who struggle with night eating habits tend to become anxious or agitated in the evening. They become physically hungrier in the evening because their "hunger" hormones increase at night. Night eating helps them feel calmer, perhaps even "numbs” them, and it helps them feel sleepy enough to try to fall asleep.
 
We talked to several patients that sought treatment for night eating syndrome at Eating Recovery Center. We wanted to get their take on how their night eating habits developed. 
 
Alum Vivian* shared her story with us, 
 
“I was working long hours in a demanding position, and I was always putting work first. I’d skip breakfast entirely in my rush to get to the office, and I wouldn’t stop for lunch until early afternoon. By the time I got home in the evenings, I was exhausted and ravenous.  Dinner would almost always be a binge, because it felt like the first opportunity I’d had all day not just to eat, but to relax. Those two things became so connected to me. Food was my number-one way to relax.”

What is night eating syndrome?

If you struggle with eating too much in the evening hours, you may think you have no willpower. You may think you lack self-control. Instead of blaming yourself, consider that you may, in fact, have an eating disorder. 
 
Night eating syndrome (NES) is a distinct eating disorder. It caused by an underlying "dysregulation" of body clocks that impact appetite, sleep/wake times, and overall energy levels. Thus, it is considered, in part, a combination of a mood, eating, and sleep disorder. 

Does your mood affect your appetite?

Alum Shari talks about how her depression seemed to make her night eating worse: 
 
“My depression made it hard for me to get out of bed in the morning. I often got out of bed at noon, and then my eating just got pushed back for the rest of the day. I’d be eating dinner around 9:00 p.m. and I’d stay up for several hours grazing before going to bed. It felt like a vicious cycle I couldn’t break out of.”
 
Night eating syndrome is not a very well-known eating disorder. It is underdiagnosed and undertreated, but it is fairly prevalent. About 2 percent of the population has NES. This makes NES 2 times more common than anorexia nervosa and makes NES almost as prevalent as the most common eating disorder binge eating disorder (BED). 

Symptoms of night eating syndrome

Night (nocturnal) eating behaviors are common. Many people binge eat, on occasion, at night. In order to meet the full diagnosis for night eating syndrome, one must have at least 3 of the following 5 criteria.
 

  1. "Morning anorexia" — skipping breakfast or not eating until 12:00 or later on four or more mornings per week
  2. "Evening hyperphagia" —  eating more than 25 percent of one’s total daily calories (possibly in the form of continuous "grazing") between dinner and bedtime
  3. Having difficulty falling or staying asleep
  4. Experiencing mood or anxiety symptoms that get worse at night — leaving one feeling more agitated, irritable, or depressed in the evening
  5. Presence of a belief that one must eat to go to sleep initially or to return to sleep

 
Alum David shared his own struggle regarding eating in the middle of the night with us, 
 
“I lost my mom and it was incredibly difficult to deal with. I was grieving and struggling with both anxiety and depression as a result. It was difficult for me to get a good night’s sleep. I got into a pattern where I would consistently wake up between 2:00 and 4:00 a.m. with my mind racing, and I felt like I needed something to eat in order to get back to sleep. I even started keeping snacks on my night stand for immediate relief.”

The struggle to eat less at night

Many patients overlook the possibility that the might have night eating syndrome because they:

  1. Feel "in control" during the day and thus, attribute night eating to losing "motivation" or "willpower" 
  2. They expect that having NES means that they must wake up in the middle of the night and eat to go back to sleep; in actuality, only a small percentage of NES sufferers do this

 
People who struggle with night eating behaviors often have feelings of shame and guilt; they attribute their eating patterns to "habit" and become "used to" having poor sleep and mood issues.
 
Gabriela tells us, 
 
“I always woke up with the intention of ‘being good’. I was super vigilant about my food choices and calorie intake for the first half of the day, not knowing that I was really underestimating how much my body needed. By mid- to late-afternoon, the bakery across the street or the vending machine in the hallway would be calling my name, and I would feel like I was ‘caving’ and abandoning all my good intentions.  By the time I got back into bed at night, I’d be feeling over-full and guilty, swearing I’d be good again the next day.” 

How to overcome night eating

Can we do anything about night eating behaviors? The answer is YES. Interventions like the following can be helpful:
 

  • Try spacing your meals out throughout the day — even if you have a lack of an appetite during daytime or morning hours. Here at the Binge Eating Treatment and Recovery Program, we work with patients to slowly increase their food intake earlier and earlier throughout the day.
  • Establish a different nighttime routine. Switch to a routine that can help you relax and wind down. This often includes things like turning off screens earlier, establishing habits that signal sleep (i.e. reading in low light and drinking decaf tea or journaling before bed) and getting into bed only when you are sleepy; our patients leave their beds if they are awake for specific time intervals so as not to "train" their bodies to lay awake or be awake in bed; we want you to associate your bed with sleep. Sleep is so important in recovery.
  • Incorporate interventions like limiting light in the evening and increasing exposure to bright light in the morning.

 
If you are struggling with night eating, we encourage you to get help sooner rather than later. Most people wait too long to get help or assume that help is not available. 
 
The good news here is that night eating syndrome is highly treatable, and most patients will respond well to relatively simple interventions!
 
Related content:
 

 
To learn more, view an educational video about Night Eating at the Binge Eating Connection Facebook page featuring Dr. Julie Friedman, Vice President of the Binge Eating Treatment & Recovery (BETR) Program at Eating Recovery Center. 
 
We thank Jean Curranregistered dietitian and professional relations coordinator for ERC’s Binge Eating Treatment & Recovery Program and Robyn CruzeNational Recovery Advocate and online community manager for Eating Recovery Center for their contributions to this piece.
 
*All patient names have been changed.

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