Very commonly thrown around is the concept of “midnight munchies.” Sometimes you might get hungry later in the evening or even during the late hours of the night, and you decide to rummage through various snack cabinets in your kitchen without making too much noise as to not be revealed. Finally, your hands land on the jar of peanuts, a box of Cheez-Its, and a half-empty of Milano cookies. You have a little of each, and your craving of the night is satisfied.
What if your “craving of the night” was not just a craving? What if you faced recurrent episodes of night eating after waking up from sleep or consuming high-calorie foods and snacks after an evening meal? You are also aware of these patterns and remember every moment of those times you had eaten, which causes you distress and even impairment in function. Only briefly mentioned in the “Other Specified Feeding or Eating Disorder” category of the American Psychiatric Association’s 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), night eating syndrome (NES) is characterized by these experiences. Note that in order for NES to be diagnosed by a clinician, the disordered pattern of eating cannot be attributed to binge-eating disorder or another mental disorder (e.g., substance use), and is also “not attributable to another medical or to an effect of medication” (American Psychiatric Association, 2013).
According to the National Institute of Mental Health, NES affects an estimated 1.5% of the population and is just as common in men as in women (Stunkard et al. 2008). The root of NES is perpetuated by a delayed circadian pattern of food intake, which can stem from a number of other influencing factors (Nolan et al. 2017). Some of these factors include:
- Overcompensation by eating more at night as a result of skipping meals, as often seen with high-achieving, working individuals and/or college students (Gholap et al. 2015).
- Response to dieting; restriction of calorie intake during the day will prompt the body to signal the brain to gain energy from food, leading to overcompensation for the insufficiency of calories at an earlier time in the day (Gholap et al. 2015 & Stunkard et al. 2017).
- Hormonal patterns that causes hunger to be inverted so that food is consumed during a designated meal time or times.
Another important distinction to make is that although individuals with NES often binge-eat, NES and BED are not interchangeable, and not all individuals with NES experience both NES and BED at the same time. Many individuals who have NES may feel that they have no control over their eating patterns and often encounter feelings of shame and guilt over their consumption (“Night Eating Syndrome,” n.d.), especially because both night-eating and binge-eating are not culturally accepted by group norms, such as the occasional late-night munchies after a gathering or fasting in light of a religious holiday or event (Runfola et al. , n.d.). Some notable signs of NES include being overweight (typically but not necessarily), frequent failed attempts at dieting, depression or anxiety, substance abuse, and even negative self-image and body dissatisfaction (Kucukgoncu & Bestepe, 2014).
An article published on The Huffington Post by David Cunnington, a sleep physician and director of the Melbourne Sleep Disorders Centre, further explored night-eating by engaging research proving that insomnia and other sleep disorders are related to the behaviors associated with night-eating and other possible eating disorders. Cunnington elaborates on the two main types of sleep eating, one of which is NES and the other being sleep-related eating disorder (SRED). The current diagnostic criteria for SRED is the presence of recurrent episodes of involuntary eating and drinking that occur during the main sleep period (Auger, 2006). He also makes the distinction that while individuals with NES “are awake and aware of what they are doing,” individuals with SRED are unaware and “eat while they sleep, much like sleepwalking or other forms of parasomnia.” As the article reaches the end, Cunnington writes:
Although the foods eaten can be similar, often with a strong preference for carbohydrate and both involve eating at night, it’s felt that these two[sic] disorders have quite different causes and therefore treatment approaches. However, the picture is not that clear, as I’ll often see people with features of both NES and SRED, so it’s clear we don’t have all the answers about sleep eating.
Although not much is known about the underlying mechanisms of NES, the treatment of NES is a hopeful process that requires a combination of therapies that include any of the following: nutrition assessment and therapy, exercise physiology, and an integration of cognitive-behavioral therapy (CBT), dialectical behavioral therapy (DBT), interpersonal therapy (IT), and stress management (“Night Eating Syndrome,” n.d. & Runfola et al. 2015). The point of listing these therapies is to showcase the many available options that individuals with NES have to embark on their journey towards recovery. Online support groups like MDJunction and Support Groups can help individuals gain back their control, and support from friends and family will help them make the changes necessary to overcome their struggles.
Most importantly, night eating syndrome is not just your midnight munchies; night eating syndrome is a serious burden on those who live with it, and we must be the ones to incite that change in those who feel alone.
References:
Auger, R. R. (2006). Sleep-Related Eating Disorders. Psychiatry (Edgmont), 3(11), 64–70.
American Psychiatric Association. (2013). Feeding and Eating Disorders. Other Specified Feeding or Eating Disorders. http://dx.doi.org/10.1176/appi.books.9780890425596.dsm10
Cunnington, D. (2015, September 21). Sleepwalking, sleeptalking, and other parasomnias. Sleep Hub. Retrieved from http://sleephub.com.au/sleepwalking-sleeptalking-and-other-parasomnias/
Cunnington, D. (2016, April 16). Night eating: It’s more common than you think. The Huffington Post. Retrieved from http://www.huffingtonpost.com/david-cunnington/night-eating-its-more-common-than-you-think_b_9647654.html
Gholap, V., Ayyer, S., & Dhavle, H. S. (2015). Study of risk of night eating syndrome (NES) among college students. Somaiya Medical Journal, 2(1), 1-6.
Kucukgoncu, S., & Bestepe, E. (2014). Night eating syndrome in major depression and anxiety disorders. Noropsikiyatri Arsivi, 51(4), 368-375. doi:10.5152/npa.2014.72
Nolan, L. J., & Geliebter, A. (2017). Validation of the Night Eating Diagnostic Questionnaire (NEDQ) and its relationship with depression, sleep quality, “food addiction,” and body mass index. Appetite, 11186-95. doi:10.1016/j.appet.2016.12.027
Runfola, C., Allison, K., Hardy, K., Lock, J., & Peebles, R. (n.d). Prevalence and Clinical Significance of Night Eating Syndrome in University Students. Journal Of Adolescent Health, 55(1), 41-48.
Stunkard, A.J., Allison, K.C., Lundgren, J. (2008). Issues for DSM-V: Night eating syndrome. American Journal of Psychiatry, 65(4), 424.
Walden Eating Disorders Treatment. (n.d.) Night eating syndrome. Retrieved from http://www.waldeneatingdisorders.com/popular-searches/night-eating-syndrome-nes/
