You reach into the cabinet for a small after-dinner snack. Soon, you realize you’re grazing, nibbling or snacking after dinner every night of the week. You may think you have no willpower or self-control. But in reality, you could have an eating disorder called night eating syndrome (NES).
While you may not have heard about NES, it’s actually more common than most people think. Sometimes people need help to stop. So, if you or a loved one has difficulty controlling eating at night, read on to explore the causes, symptoms and treatment options for NES. We’ll also share stories from real people who have recovered from NES along with tools to help you stop binge eating at night.
What is night eating syndrome?
NES is an eating disorder characterized by:
- Repeated episodes of snacking, grazing or compulsive eating after dinnertime
- Constant urges to eat between dinner and bedtime
- Waking up from sleep to eat
NES falls under the category of other specified feeding and eating disorders (OSFED).[1] While NES is a real disorder, it’s not well known. Accordingly, it’s often underdiagnosed and undertreated
How common is night eating syndrome?
An estimated 1.5% of the population has NES.[2] Those seeking help for mental health concerns may have higher rates of NES. A 2006 study found that 12.3% of patients in two psychiatric outpatient clinics had NES.[3]
Night eating syndrome vs. binge eating disorder: What’s the difference?
NES and binge eating disorder (BED) are similar but have some key differences.
- People with NES tend to graze, eating small meals throughout the evening as opposed to bingeing.
- If someone with NES wakes up in the middle of the night, they will feel as if they can’t go back to sleep without eating something.
- BED is characterized by eating a large amount of food in a short time period.
- Binge eating most often happens during the day, although it can be active at night.
- People with BED will typically eat only while awake; they don’t tend to wake up during the night to binge.
NES and BED are similar in that both are characterized by feeling a lack of control and distress around eating behaviors. Because NES and BED are distinct, it is possible for someone to be diagnosed with both conditions at the same time.
What does night eating syndrome feel like?
Several studies suggest[2] that people who struggle with night eating habits tend to become anxious or agitated in the evening. They become physically hungrier because their “hunger” hormones increase at night. As a result, night eating helps them feel calmer and allows them to become tired enough to fall asleep. People who experience NES will usually remember eating overnight, unlike those with sleepwalking who do not recall what happened.
Eating Recovery Center (ERC) alum Joshua* describes his personal experience with NES, and what it felt like when he was trying to fall asleep:
“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 a.m. and 4 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 nightstand for immediate relief.”
What causes night eating syndrome?
The exact cause of eating disorders like NES remains unknown. It’s currently thought that a combination of psychological, neurological, genetic and environmental factors may trigger the disorder.
Some evidence indicates that NES may be related to hormonal or sleep-wake cycle issues, otherwise known as circadian rhythm desynchrony.[4] People with NES also may be susceptible to additional health issues, such as hypertension, high cholesterol and diabetes.[5]
Who is at risk for night eating syndrome?
You’re more likely to have NES if you have another type of eating disorder or mental health condition, such as:
- Depression
- Anxiety
- Substance use disorder
Living with these co-occurring conditions can create feelings of shame and guilt. It’s common for people with NES to attribute their eating patterns to a “habit”; they may feel as if their sleep and mood issues are normal.
Lauren*, an ERC alum, explains how symptoms of depression made her more susceptible to NES:
“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 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.”
Research into NES in other countries reveals additional groups who might be at higher risk. A European study found that more than 13% of esports players experienced signs of NES[6], while a Palestinian study revealed that nearly 30% of college students screened positive for NES.[7]
How do you know if you have night eating syndrome?
Many people overlook the possibility that they might have NES because they feel “in control” during the day. Therefore, they attribute their night eating to a loss of motivation or willpower. That’s how ERC alum Nia* felt. She explains:
“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 overly full and guilty, swearing I’d be good again the next day.”
Other people believe they don’t have NES because they don’t wake up in the middle of the night to eat. But while this is one of the telltale signs of NES, only a small percentage of people with NES actually do this.
What are the warning signs of night eating syndrome?
You must meet three of these five criteria to receive an NES diagnosis:
- Morning anorexia: Skipping breakfast or not eating until noon or later four or more mornings per week
- Evening hyperphagia: Eating more than 25% of your total daily calories (possibly in the form of continuous grazing) between dinner and bedtime
- Sleep disturbance: Having trouble falling or staying asleep
- Symptoms that worsen at night: Feeling more agitated, irritable or depressed in the evening
- Waking up and eating: Believing you must have something to eat in order to fall back to sleep
It’s common for people to eat at night, but not everyone who does so has NES. Sometimes NES symptoms start appearing as stress increases in a person’s life. ERC alum Sofia* explains:
“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.”
How to stop eating so much at night
If you’re in the habit of eating at night, you can take action to curb your behavior by integrating these steps into your daily routine:
- Don’t skip breakfast. Eat breakfast daily to reset your body clock and improve your circadian rhythm. Also, consider increasing exposure to bright light in the morning and reducing exposure to light at night.
- Space your meals throughout the day. Find ways to slowly increase your food intake earlier and during daytime hours, even if you lack an appetite in the morning.
- Establish a new nighttime routine. Emphasize relaxing before bed in healthier ways, such as turning off screens earlier, reading in low light, drinking herbal tea or journaling. Get into bed only when you’re feeling sleepy, so you start to associate bed only with sleep. Also, focus on pleasurable nighttime activities. Replace mindless channel surfing or web browsing. Instead, watch a TV show that you love or spend time with people you enjoy.
- Plan late-day meals wisely. Eat foods that are most likely to trigger nighttime eating or binge eating in the afternoon. At night, have a satisfying dinner and later a snack that contains protein, fat and fiber. This will help to keep you full and regulate your blood sugar overnight.
- Indulge your cravings. Yes, you read that correctly. While NES tends to contribute to cravings for sweet and starchy food, you don’t have to eliminate these foods from your diet. Instead, you may want to eat them earlier in the day when you’re less likely to binge on them. Consider incorporating a normalized portion of something you like to eat as a daytime snack so you can increase daytime eating and reduce nighttime cravings.
- See a mental health professional. People with NES and binge eating at night tend to be more irritable and anxious in the evening. An experienced mental health professional can help address these symptoms.
If you try any of these tips and still struggle with nighttime eating, please know that treatment is available for NES and binge eating at night.
How is night eating syndrome treated?
At ERC, we take a whole-person approach to treating NES and binge eating at night. We coordinate care to address the psychological, physiological and nutritional aspects that could be contributing to the eating disorder.
Often, our first recommendation to someone with NES is to receive an evaluation for sleep disorders at a certified sleep center. Our professionals can help coordinate this appointment with you.
Nutritional and emotional support for NES
From a nutritional perspective, ERC Pathlight’s dietitians focus on easing NES symptoms by lessening food deprivation during the day. Here are some examples of what we might recommend:
- Eat something every few hours. Eating every three to four hours can help to regulate your blood sugar and metabolism.
- Plan an evening snack. We often include a planned evening snack after dinner to prevent you from waking up hungry in the middle of the night.
- Challenge any food “rules” or restrictions. In our treatment centers, we use evidence-based practices to challenge any food rules and restrictions you might have, such as avoiding certain foods during the day and eating them at night. We may, for example, include a dessert with lunch or dinner, or chips as part of a snack.
- Discuss movement with your healthcare team. When appropriate, we recommend gentle and joyful movement on a regular basis. This can help to reduce night eating.
- Try group therapy. We recommend weekly group therapy where you can learn new coping skills and get peer support for disordered eating.
I reached out to Anne Marie O’Melia, MS, MD, FAAP, CEDS-S, chief clinical and quality officer at ERC Pathlight, who shared the following:
“You can attend programming at ERC and continue to work with your outpatient team. In fact, we recommend this approach for additional support. Our providers are dedicated to coordinating your care and keeping your outpatient providers informed at every step of your recovery.”
How to support a loved one with night eating syndrome
If you suspect someone you love struggles with NES, you can be there for them in these three ways:
- Start the conversation. Talk with your loved one about how they’d like to be supported. This may look like helping them to eat regularly, develop a meal plan, challenge negative thoughts around food or body image, or process their emotions.
- Help them research treatment options. Assist them in their search for eating disorder treatment programs that will work best for them. Find a list of our programs at ERC here.
- Get involved in their treatment. Attend individual therapy and/or nutrition sessions with your loved one. ERC also has many free online eating disorder support groups and resources that you may find helpful.
When seeking NES treatment, time is of the essence
Like with many eating disorders and mental health conditions, many people tend to wait too long to get help for NES, or they may assume help isn’t available.
If you or a loved one is struggling with NES, we encourage you to get help sooner rather than later. NES is treatable, and most people respond well to relatively simple interventions.
To learn more about treatment at ERC Pathlight, call us at 866-622-5914 or schedule a free assessment today. We’ll match you with the exact support you need.
*All patient names have been changed.
In this video, ERC Senior Clinical Advisor Susan McClanahan, PhD, CEDS discusses compulsive overeating.
