Night Eating Syndrome: The Eating Disorder We Need to Talk About
Raise 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. Oftentimes, it’s because we have more access to food at night, or we are relaxing at home.
Some of us eat more than we would like to at night, perhaps as a way to be social or unwind after a long day. 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, becoming physically hungrier because their "hunger" hormones increase at night. Night eating helps them feel calmer, perhaps even "numbs” them, and helps them feel tired enough to try to fall asleep.
We spoke with several patients who sought treatment for night eating syndrome at Eating Recovery Center 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 or lack self-control. Instead of blaming yourself, consider that you may have an eating disorder.
Night eating syndrome (NES) is a distinctly unique eating disorder caused by an underlying "dysregulation" of body clocks that impact appetite, sleep/wake times, and overall energy levels. Thus, it is considered a combination of a mood, eating, and sleep disorder.
Eating at Night vs. Night Eating Syndrome
It’s not uncommon for people to snack or eat at night, for various reasons. For those with night eating syndrome, you will overeat at night and have sleep challenges, often consuming a quarter of your daily calorie intake after dinner. There are specific factors to help determine and distinguish eating at night versus night eating syndrome, and form an accurate diagnosis.
Binge Eating Disorder vs. Night Eating Syndrome
For those with binge eating, it is more likely that they will “binge” or eat a lot in a single sitting – rather than eating smaller amounts during the night. A hallmark trait of binge eating disorder includes eating an unusually large amount of food in a specific timeframe.
Sleep-Related Eating Disorder vs. Night Eating Syndrome
For those with sleep-related eating disorder, you may not remember that you ate the night before. With night eating syndrome, you will likely remember that you ate.
Does your mood affect your appetite?
Alum Shari discusses how her depression made 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 well-known eating disorder. While often underdiagnosed and undertreated, it is fairly prevalent. Around 2 percent of the population has NES, making it 2 times more common than anorexia nervosa and almost as prevalent as binge eating disorder (BED). Moreover, one of the symptoms of NES includes a depressed mood that worsens during evening hours.
What are the causes of night eating syndrome?
We do not yet know what causes NES, although some evidence indicates that it may be related to hormonal or sleep-wake cycle issues. You are more likely to have NES if you have a co-occurring eating disorder, or struggle with obesity. Those with NES often struggle with mental health conditions and comorbidities such as depression, anxiety, and substance use disorder or addiction.
Symptoms of Night Eating Syndrome
Nocturnal eating behaviors are common; many people binge eat, on occasion, at night. In order to meet the full diagnosis for night eating syndrome, there must be at least 3 of the following 5 criteria:
- "Morning anorexia" — skipping breakfast or not eating until 12:00 or later on four or more mornings per week
- "Evening hyperphagia" — eating more than 25 percent of one’s total daily calories (possibly in the form of continuous "grazing") between dinner and bedtime
- Having difficulty falling or staying asleep
- Experiencing mood or anxiety symptoms that get worse at night — leaving one feeling more agitated, irritable, or depressed in the evening
- Believing that one must eat to go to sleep or 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.”
Medical Impacts and Health Effects of NES
While data indicates that there is some correlation between NES and obesity, it remains unclear if and how obesity causes or affects NES. Studies have demonstrated that those with NES will struggle to lose weight; in general, sleep issues are a contributor to weight gain. Some people with NES are susceptible to health issues including high blood pressure, diabetes and high cholesterol.
The struggle to eat less at night
Many patients overlook the possibility that the might have night eating syndrome because they:
- Feel "in control" during the day and thus, attribute night eating to losing "motivation" or "willpower"
- 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 Treat Night Eating Syndrome
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.
While there are no specific evidence-based treatments for NES, some clinicians have experienced success with cognitive behavioral therapy and various antidepressants.
Like many eating disorders or mental health conditions, most people wait too long to get help or assume that help is not available. If you are struggling with night eating syndrome, we encourage you to get help sooner rather than later.
But night eating syndrome is treatable, and most patients will respond well to relatively simple interventions.
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 Curran, registered dietitian and professional relations coordinator for ERC’s Binge Eating Treatment & Recovery Program and Robyn Cruze, National Recovery Advocate and online community manager for Eating Recovery Center for their contributions to this piece.
*All patient names have been changed.