Nocturnal Sleep-Related Eating Disorder

When I woke up this morning, there were candy bar wrappers all over the kitchen, and I had a stomach ache. I had chocolate on my face and hands. My husband says I was up eating last night, but I have no memories of doing so. Could he be playing a joke on me?

Maybe not. You might have nocturnal sleep-related types of eating disorder, a relatively unknown condition that is just beginning to be investigated.

What is a nocturnal sleep-related eating disorder (NS-RED)?

In spite of its name, NS-RED is not, strictly speaking, an eating disorder. It is thought to be a type of sleep disorder in which people eat while seeming to be sound asleep. They may eat in bed or roam through the house and prowl the kitchen.

These people are not conscious during episodes of NS-RED, which may be related to sleep-walking. They are not aware they are eating. They have no memories of having done so when then wake, or they have only fragmentary memories. Episodes probably occur in a state somewhere between wakefulness and sleep.

When people with NS-RED awake and discover the evidence of their nighttime forays, they are embarrassed, ashamed, and afraid they may be losing their minds. Some, when confronted with the evidence by family members, deny that they were the perpetrators. They truly do not believe they could have done such a thing and cannot admit to such a dramatic loss of control.

Food consumed during NS-RED episodes tends to be high-fat, high-sugar comfort food that people restrain themselves from eating while awake. Sometimes these folks eat bizarre combinations of food (hotdogs dipped in peanut butter, raw bacon smeared with mayonnaise, etc.) or non-food items like soap they have sliced like they would slice cheese.

Who gets NS-RED?

One to three percent of the general population (3 to 9 million people) seems to be subject to this disorder, and ten to fifteen percent of people with eating disorders are affected. The problem may be chronic or appear once or twice and then disappear. Many of these people are severely stressed, anxious individuals who are dismayed and angry at themselves for their nocturnal loss of control. Their behaviors may pave the way to depression and weight gain.

Many of these individuals diet during the day, which may leave them hungry and vulnerable to binge eating at night when their control is weakened by sleep.

People with NS-RED sometimes have histories of alcoholism, drug abuse, and sleep disorders other than NS-RED, problems such as sleepwalking, restless legs, and sleep apnea. Their sleep is fragmented, and they are often tired when they wake.

Sleep disorders, including NS-RED, seem to run in families. They may have a genetic component.

How can people eat and not remember doing so?

Are they lying? No, they are not lying. It seems that parts of their brains are truly asleep, and, at the same time, other parts are awake. The parts that regulate waking consciousness are asleep, so the next day there are no memories of eating the night before.

Is there any treatment for NS-RED?

If there is, what is it? Yes, there is treatment. It begins with a clinical interview and a night or two at a sleep-disorders center where brain activity is monitored. Sometimes medication is helpful, but sleeping pills should be avoided. They can make matters worse by increasing confusion and clumsiness that can lead to injury. Regular use of sleeping pills can also lead to dependency and rebound wakefulness on withdrawal. Instead, ask your doctor about prescription SSRIs.

Also helpful are interventions that reduce stress and anxiety; for example, stress management classes, assertiveness training, counseling, and reducing intake of alcohol, street drugs, and caffeine.

If you think you may have NS-RED, talk to your physician and ask for a referral to a sleep-disorders treatment center. Help is available. Take advantage of it.