Sleep-Related Eating Disorders

Sleep-related eating disorders (SRED) are characterized by episodes of involuntary eating and drinking during the night, typically occurring in a state of partial arousal from sleep. These episodes may involve consuming large quantities of food or unusual food combinations, often leading to distress and functional impairment.

Prevalence and Impact

Research suggests that SRED affects approximately 1-3% of the general population, with higher prevalence rates among individuals with other sleep disorders, such as sleepwalking and restless legs syndrome. The impact of SRED extends beyond the nocturnal episodes of eating, contributing to disturbances in daytime functioning, impaired quality of life, and heightened risk of physical and psychological complications.

Types of Sleep-Related Eating Disorders

Sleep-Related Eating Disorder (SRED):

Characteristics and Symptoms

• SRED is characterized by recurrent episodes of involuntary eating and drinking during sleep, accompanied by partial or complete amnesia upon awakening. Individuals may consume large quantities of food, often high in calories and carbohydrates, without conscious awareness or control.

Diagnostic Criteria

• Diagnosis of SRED is based on specific criteria outlined in the International Classification of Sleep Disorders (ICSD). These criteria include recurrent episodes of involuntary eating during sleep, documented evidence of partial or complete amnesia, and distress or impairment in social, occupational, or other important areas of functioning.

Nocturnal Sleep-Related Eating Disorder (NS-RED)

Differentiating Features

• NS-RED is distinguished from SRED by the presence of complete awareness and recollection of eating episodes during sleep. Individuals with NS-RED may experience intense cravings for specific foods, engage in purposeful food preparation, and exhibit behaviors suggestive of disordered eating patterns.

Diagnostic Criteria

• The diagnosis of NS-RED is based on specific clinical criteria, including recurrent episodes of partial or complete awareness of eating during sleep, consumption of unusual or non-nutritive substances, and distress or impairment in daily functioning attributable to these episodes.

Causes and Risk Factors of Sleep-related eating disorders

Neurobiological Factors

Emerging evidence suggests that abnormalities in the regulation of neurotransmitters, such as dopamine and serotonin, may contribute to the development of SRED. Dysregulation of the hypothalamus, a key brain region involved in appetite and sleep-wake regulation, has also been implicated in the pathophysiology of SRED.

Psychological Factors

Psychological factors, including stress, anxiety, and mood disorders, may predispose individuals to sleep-related eating behaviors. These factors may interact with neurobiological mechanisms to exacerbate symptoms and perpetuate the cycle of disordered eating during sleep.

Medications and Substance Use

Certain medications, such as sedative-hypnotics, antidepressants, and antipsychotics, have been associated with an increased risk of sleep-related eating behaviors. Additionally, substance use, including alcohol and recreational drugs, may disrupt normal sleep patterns and contribute to the onset or exacerbation of SRED.

Diagnosis and Assessment of Sleep-related eating disorders

1.Clinical Evaluation

The diagnosis of SRED typically involves a comprehensive clinical evaluation, including a detailed medical history, assessment of sleep habits and behaviors, and evaluation of psychological and psychiatric symptoms.

2. Polysomnography

Polysomnography, a diagnostic test that monitors various physiological parameters during sleep, may be utilized to assess sleep architecture and detect abnormalities associated with SRED.

3. Actigraphy

Actigraphy, a non-invasive method of monitoring sleep-wake patterns using wrist-worn devices, may provide valuable insights into nocturnal eating behaviors and sleep disturbances in individuals with SRED.

Treatment Approaches

1, Behavioral Interventions

Behavioral interventions, such as stimulus control techniques, sleep hygiene education, and cognitive-behavioral therapy for insomnia (CBT-I), are often recommended as first-line treatments for SRED. These approaches aim to modify maladaptive sleep and eating behaviors, improve sleep quality, and reduce the frequency and severity of nocturnal eating episodes.

2. Pharmacotherapy

Healthcare providers are likely to consider pharmacotherapy for individuals with severe or refractory symptoms of SRED. Medications such as selective serotonin reuptake inhibitors (SSRIs), mood stabilizers, and appetite suppressants may help regulate neurotransmitter activity and reduce nocturnal eating behaviors.

3. Cognitive-Behavioral Therapy (CBT)

Cognitive-behavioral therapy (CBT), a structured psychotherapeutic approach, has shown promise in the treatment of SRED. CBT focuses on identifying and modifying dysfunctional thoughts and behaviors related to sleep and eating, promoting healthier coping strategies, and enhancing overall well-being.

Complications and Associated Conditions

• Weight Gain and Obesity

The recurrent consumption of high-calorie foods during sleep can contribute to weight gain and obesity in individuals with SRED. Excessive calorie intake during the night, coupled with disrupted sleep patterns, may disrupt the body’s energy balance and promote adiposity over time.

• Sleep Disturbances

SRED often coexists with other sleep disorders, such as insomnia, sleep apnea, and restless legs syndrome, further exacerbating sleep disturbances and impairing overall sleep quality. Disrupted sleep architecture and frequent awakenings during the night may perpetuate nocturnal eating behaviors and contribute to daytime fatigue and somnolence.

• Psychiatric Comorbidities

Individuals with SRED are at increased risk of psychiatric comorbidities, including depression, anxiety, and eating disorders. The interplay between disordered eating behaviors, sleep disturbances, and psychological symptoms underscores the importance of addressing both the sleep-related and psychiatric aspects of SRED in treatment planning and management.

Importance of Seeking Treatment

Sleep-related eating disorders pose significant challenges to affected individuals, impacting their physical health, psychological well-being, and overall quality of life. Early recognition and intervention are essential for mitigating the adverse effects of SRED and improving long-term outcomes.

Future Directions in Research

Further research is needed to elucidate the underlying mechanisms of SRED, identify novel treatment approaches, and explore potential biomarkers for diagnosis and monitoring. Collaborative efforts among researchers, clinicians, and advocacy groups are essential for advancing our understanding of SRED and developing effective interventions to support affected individuals.

Sources

1. American Academy of Sleep Medicine. (2014). The International Classification of Sleep Disorders – Third Edition (ICSD-3).
2. Stunkard, A. J., & Allison, K. C. (2003). Eating Disorders: Overview of Epidemiology, Clinical Features, and Course. In D. M. Garner & P. E. Garfinkel (Eds.), Handbook of Treatment for Eating Disorders (2nd ed., pp. 183–194). Guilford Press.
3. National Institute of Mental Health. (2020). Eating Disorders.