Q: Is nocturnal binge eating a problem that needs to be treated?
A:The occasional late-night snack is nothing to worry about. But nightly bingeing merits a closer look. Experts debate the value of creating a specific diagnostic category for nocturnal overeating, but they don’t debate the significance of the problem.
Sleep-related eating syndrome is a highly publicized malady, though it’s not clear how common it is. People with this problem eat while sleepwalking, or in a twilight state between sleep and wakefulness. They generally aren’t conscious of what they are doing, so they may describe waking to find the bed littered with candy wrappers — with no memory of consuming the candy itself.
A better documented problem is night eating syndrome, in which people do the majority of their eating late at night. A 1999 study in the Journal of the American Medical Association found that by 6 p.m., people with night eating syndrome consumed a little more than a third of their daily calories, while a control group had consumed almost three-quarters. Between 8 p.m. and 6 a.m., however, the night eaters consumed 56 percent of their daily calories, while controls consumed only 15 percent.
The few studies of prevalence show that night eating syndrome may affect one or two out of 100 people in the general population.
First described in the 1950s by Dr. Albert Stunkard, a psychiatrist at the University of Pennsylvania, researchers have recently explored its link to weight gain. The problem affects 9 percent to 14 percent of people seeking treatment at obesity clinics, and up to 27 percent of the severely obese.
Night eating also shows up in mental health clinics. In one study of psychiatric outpatients in Pennsylvania and Minnesota, 12 percent had night eating syndrome.
Night eaters in this study were also much more likely to be substance abusers. Other research indicates that people with night eating syndrome tend to suffer from a distinct form of depression. In contrast to the usual pattern, night eaters tend to become even more depressed during the evening.
It’s not clear what causes night eating syndrome, and why it is associated with depression or substance abuse. One theory is that night eating syndrome involves a disruption in hormones that help regulate sleep, appetite or mood. Because late-night snacking usually involves carbohydrate-rich “comfort” foods, this theory holds that night eating syndrome is a form of self-medication.
Until more is known about night eating syndrome, it’s probably best to take a broad approach to diagnosis and treatment. A general physical exam can rule out other problems. Treating any underlying mental health problems, such as depression or anxiety, can help a person improve eating patterns. A dietitian can provide advice about how to better pace meals throughout the day, which might help break the cycle of late-night eating. Preliminary studies indicate that the anticonvulsant topiramate (Topamax) or an SSRI antidepressant, such as sertraline (Zoloft), may help.
Case reports indicate some people can improve their eating patterns by being mindful of the problem and trying to identify its triggers. Stress-reduction techniques may help avert trips to the refrigerator.
Attending to underlying stress, anxiety or depression may help a person get to sleep earlier, too. Scientists note that sleeping and eating are likely to be connected, as they have discovered a link between a lack of sleep and weight gain. That’s all the more reason to replace a late-night snack with a late- night nap.
Dr. Michael Craig Miller, editor in chief, Harvard Mental Health Letter
