NIGHT EATING SYNDROME: WHAT IS IT AND WHAT CAN BE DONE ABOUT IT?
Our expert is Kelly C. Allison, Ph.D. Assistant Professor of Psychology in Psychiatry at the Perelman School of Medicine at the University of Pennsylvania and Director of Education at the Center for Weight and Eating Disorders.
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NIGHT EATING SYNDROME IS A DEBILITATING CONDITION
In night eating syndrome, the individual regularly consumes at least 25% of her calories after dinner. This can mean she feels that if she doesn’t eat that piece of chocolate cake in the refrigerator to relax before bed, she won’t be able to fall asleep. Or it can mean waking up during the night, feeling that if she doesn’t eat, she won’t be able to go back to sleep. Individuals with this syndrome may suffer from any or all of the following: obesity, insomnia, depression, and anxiety. It’s typical for a woman with night eating syndrome to start each morning feeling shame, thinking, “Oh no, I did it again!”
NIGHT EATING SYNDROME IS MORE PREVALENT THAN ANOREXIA OR BULIMIA
Depending on the study, somewhere between 1.5 and 5% of the population suffers from night eating syndrome. It’s more prevalent than anorexia or bulimia, and it’s on par with binge eating disorder. There’s a continuum from those at the low end who experience night eating a couple of times a week, all the way to those who wake up every single night as many as four or five times and cannot go back to sleep without eating.
HOW IT GETS STARTED
We know from twin studies that there’s a hereditary aspect to this, although the heritability is less than it is for anorexia. The age of onset is likely to be in the late 20s or early 30s, and it’s often accompanied by a stressful event such as a divorce or the loss of a job. The individual finds that food is comforting, but once the stressor is behind her, the habit of night eating continues.
YOUR PATIENT MAY NOT TELL YOU
It’s important to ask because she may feel uncomfortable volunteering this information. We know from sleep disorder laboratories that many women who come in for treatment don’t share this information unless asked, even though it may be a major factor in their insomnia. Ask your patient, particularly an overweight patient, “How much do you eat before going to bed?” and also, “Do you ever wake up at night to eat?”
EFFECTIVE AND INEFFECTIVE PHARMACOLOGICAL TREATMENT
We think that serotonin is involved, and in our trials with sertraline, including a randomized controlled trial, we found that the drug reduces night eating significantly. The trial was for 34 individuals, and we’d like to do larger trials in the future. Another drug, topiramate, has also been effective in small case studies, but there can be neurological side effects.
While sertraline and topiramate can be effective, we do not recommend sleeping pills such as zolpidem. It might seem that when someone comes in complaining that she’s not sleeping because she’s getting up to eat, that a sleeping pill would be the answer for her. The problem is, zolpidem or other sleep aids can exacerbate the night eating problem, particularly if there are underlying sleep disorders, such as restless legs syndrome.
We have had considerable success with a cognitive approach in which we tell the patient, “Your body is expecting food at night, and we have to move back the time of when your body expects that food.” We also explain that the night eating has become comfortable and expected, so we try to erect barriers so it’s uncomfortable and not expected. These can include barriers such as keeping the food locked or out of reach, taping notes reminding the individual why she doesn’t want to continue with her night eating, logging her food intake, and monitoring her mood and hunger when these urges to eat are present. It can mean coping with anxiety using deep breathing, or listening to her iPod. What works will be different for each patient but any improvement is worth the effort.
Dr. Allison’s book for the lay audience, Overcoming Night Eating Syndrome: A Step-by-Step Guide to Breaking the Cycle is available at Amazon.com. Dr. Allison is also a co-author of Night Eating Syndrome: Research, Assessment, and Treatment.
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