Night Eating Syndrome: So Much More Than Just A Bedtime Snack

It’s perfectly normal to have something to eat after your evening meal or dig into a bedtime snack. But when these habits become frequent or extreme, they could be the sign of something more serious.

Night eating syndrome (NES) is a pattern of disordered eating that involves taking in a large amount of calories at night. And while the condition is not explicitly defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM), the official list of all medically-recognized mental health disorders, it can still lead to a number of medical complications, and should be appropriately treated.

What is Night Eating Syndrome?

Night eating syndrome (NES) is a sleep-related eating disorder, technically classified under the umbrella term other specified feeding or eating disorder (OSFED). (1)

People with this condition frequently eat a large proportion of their daily food intake at night, either after their evening meal or during intermittent periods of snacking throughout the night. (2) There’s currently no official diagnostic criteria for NES, but some have proposed the consumption of at least 25% of daily calories after dinner, at least twice a week, as a benchmark. (3)

To diagnose night eating syndrome, doctors generally look for a pattern of these night eating episodes over at least three consecutive months, and consider them to be a primary symptom, as opposed to a characteristic of another mental health condition. (3)

Overall, it’s estimated that 1.5% of the general population—and anywhere from 6% to 16% of those in larger bodies—are living with NES. (5) Yet, it’s possible those numbers are actually even higher, as NES shares many overlapping symptoms with the much-more-commonly diagnosed binge eating disorder (BED).

Signs and Symptoms of Night Eating Syndrome

While they can vary from person to person, common signs and symptoms of NES may include: (8)

• A strong desire or urge to eat after dinner and before going to sleep
• The belief that eating is necessary to fall asleep
• Compensatory behavior for eating at night, such as skipping breakfast or feeling reluctant to eat in the morning (sometimes called morning anorexia)
• Trouble falling asleep and/or staying asleep
• Lowered mood or depressed mood, particularly in the evening and at nighttime

Importantly, people with NES are conscious or aware of their night eating episodes, and can recall them afterword. (8) This can help distinguish NES from other sleep-related issues and/or disordered eating patterns, including BED, which frequently involves “blacking out” during binge eating episodes.

What Causes Night Eating Syndrome?

Like most other eating disorders, night eating syndrome is generally attributed to a combination of biological, social, and psychological factors.

Biological and Psychological Causes of NES

• Other eating disorders: Research has shown that NES frequently co-occurs with other eating disorders. Anywhere from 15-50% of individuals with NES are thought to have binge eating disorder, and approximately 35% have comorbid, or co-occurring, bulimia nervosa. (7, 8)
• Depression and anxiety: Studies indicate that NES is linked to higher levels of depression and anxiety. (4) However, more research is needed to determine if depression and anxiety are the cause of NES or a resultant effect.
• Neuroendocrine factors: Studies have shown that people with NES have mismatched circadian rhythms for their sleep cycle and food intake cycle. These discrepancies were linked to abnormal levels of key hormones that dictate hunger, satiety, and sleepiness. (9)
• Genetics: Research has shown that first-degree relatives of those with night eating behaviors had a greater probability of also having NES, suggesting the condition can be inherited. (10)
• Personality traits: Research into the personality traits associated with NES is still in the early stages, but studies have indicated that those with NES have high scores for harm avoidance, impulsivity, and alexithymia, which is a personality trait linked to an inability to identify one’s own emotions. (4)

Social/Environmental Causes

A large proportion of studies have shown that sociodemographic factors, such as age, gender, income level, and education, are not related to a NES diagnosis. (4) However, there are some other social/environmental factors that may contribute to the onset of NES:

• Body dissatisfaction: Individuals with NES typically have higher diet, body shape, and weight concerns, which correlates with high levels of social stress. (9)
• Food environment: The ready availability of convenience stores and vending machines offering high-calorie foods and the increase of food delivery systems have improved the accessibility of food during the nighttime period, which could contribute to increased night eating. (9)

Treatments for Night Eating Syndrome

Eating disorder experts and researchers are still determining the best treatment methods for NES, but it’s generally agreed that seeking out treatment as quickly as possible is important.

Some evidence indicates that a combination of cognitive behavioral therapy (CBT) and medication—especially selective serotonin reuptake inhibitors (SSRIs)—could be helpful. (2)

CBT is the most-studied and leading treatment for many eating disorders. The therapeutic technique involves learning how to recognize and redirect unhelpful thoughts, in order to alleviate unhelpful behaviors. The method is used to help people with NES uncouple the ideas of sleeping and eating, and therapists may additionally ask them to keep sleep and food diaries to help identify potential triggers for night eating episodes. (2)

Selective serotonin reuptake inhibitors are also used to treat a variety of mental health conditions, including eating disorders. This class of drugs helps people retain more serotonin, a neurotransmitter connected to the regulation of eating, sleep, and mood.

Evidence has shown that treatment with SSRIs results in a reduction in awakenings during the night, overeating in the evenings, and calorie consumption after the evening meal. (8)

Finding Help for Night Eating Syndrome

Night eating syndrome may impact sleep quality and body weight in the long term. This can lead to a number of health consequences, including high blood pressure and cholesterol, as well as an increased risk of diabetes, cardiovascular issues, and gastrointestinal problems. (2)

These are just some of the reasons it’s important to seek out help.

If you’re concerned that you or a loved one is struggling with night eating syndrome, you should speak with your doctor or therapist as soon as possible. Eating disorders are not something that will go away on their own, and when left untreated, they generally tend to get worse.

You should know that you have nothing to be ashamed of and that you’re deserving of help. It may feel difficult or intimidating to make that first step, but seeking the help and treatment you need can be the first step toward a healthier and happier future.

Resources

1. Other specified feeding or eating disorder. National Eating Disorders Association. (2018, July 30). Accessed May 2023.
2. Pacheco D. (2023, February 22). Night eating syndrome: Symptoms, causes, and treatments. Sleep Foundation. Accessed May 2023.
3. Allison KC, Lundgren JD, O’Reardon JP, Geliebter A, Gluck ME, Vinai P, Mitchell JE, Schenck CH, Howell MJ, Crow SJ, Engel S, Latzer Y, Tzischinsky O, Mahowald MW, & Stunkard AJ. (2010). Proposed diagnostic criteria for night eating syndrome. The International Journal of Eating Disorders; 43(3):241–247.
4. Kaur J, Dang AB, Gan J, An Z, & Krug I. (2022). Night eating syndrome in patients with obesity and binge eating disorder: a systematic review. Frontiers in Psychology; 12, 6201.
5. Kucukgoncu S, Midura M, & Tek C. (2015). Optimal management of night eating syndrome: challenges and solutions. Neuropsychiatric Disease and Treatment; 11:751–760.
6. Muscatello MRA, Torre G, Celebre L, Dell’Osso B, Mento C, Zoccali RA, & Bruno A. (2022). ‘In the night kitchen’: A scoping review on the night eating syndrome. Australian & New Zealand Journal of Psychiatry; 56(2):120-136.
7. Tu CY, Tseng MCM, and Chang CH. (2019). Night eating syndrome in patients with eating disorders: is night eating syndrome distinct from bulimia nervosa? J. Formosan Med. Assoc.; 118:1038–1046.
8. Salman EJ, Kabir R. (2022, September 14). Night Eating Syndrome. StatPearls. Accessed May 2023.
9. Goel N, Stunkard AJ, Rogers NL, Van Dongen HP, Allison KC, O’Reardon JP, Ahima RS, Cummings DE, Heo M, & Dinges DF. (2009). Circadian rhythm profiles in women with night eating syndrome. Journal of Biological Rhythms; 24(1):85–94.
10. Sevinçer GM, & Allison KC. (2016). Night Eating Syndrome: Report of a family case. Eating behaviors; 22:83–86.
11. Li L. (2021). Proceedings of the 2021 4th International Conference on Humanities Education and Social Sciences. Atlantis Press. Accessed May 2023.

---

The opinions and views of our guest contributors are shared to provide a broad perspective on eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Published January 17, 2024, on EatingDisorderHope.com