Night Eating Syndrome

We all enjoy a late-night snack from time to time. Whether we’re engrossed in a movie or staying up late chatting with friends, a snack often enhances these moments. Occasionally indulging in late-night snacking may not harm you overall. However, what happens when it becomes a frequent occurrence? And how about when the quantity of food you consume starts to increase? This could be a sign of Night Eating Syndrome, which affects around 1-2% of the population.

What is Night Eating Syndrome?

Night Eating Syndrome (NES) is a type of eating disorder characterised by recurrent episodes of eating during the night. Individuals with this disorder often consume a significant portion of their daily food intake after the evening meal or even after waking up from sleep. People with Night Eating Syndrome typically feel a lack of control over their eating during these nighttime episodes and may experience distress or guilt related to their nighttime eating behaviours.

Is Night Eating Syndrome classed as an eating disorder?

Night Eating Syndrome is classed as an eating disorder, but not in the same way as other common eating disorders like anorexia. NES was included in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), in which it was categorised under the heading “Other Specified Feeding or Eating Disorder” (OSFED). This means that NES is an eating disorder that doesn’t fit the criteria for anorexia nervosa, bulimia nervosa, or binge-eating disorder.

To meet the criteria for NES according to the DSM-5, an individual must exhibit the following features:

  • Repetitive occurrences of nocturnal eating, evident through the consumption of food either upon waking from sleep or through excessive eating following the evening meal.
  • Consciousness and recollection of the eating experience.
  • Nocturnal eating cannot be attributed to external factors such as alterations in the individual’s sleep-wake cycle or adherence to local social norms.
  • Nocturnal eating results in considerable distress and/or disruption to functioning.
  • The irregular eating pattern is not more accurately accounted for by binge-eating disorder or another mental health condition, including substance use. Additionally, it is not attributed to another medical disorder or the influence of medication.

Do I have Night Eating Syndrome?

If you’re finding your night eating habits becoming more frequent recently, or you’re concerned with the way things are going, take a time out to self-evaluate. Below are questions that you could ask yourself that will help differentiate between habits and issues:

  • Have you experienced feelings of guilt or shame specifically related to eating during the night?
  • Do you find yourself consuming significantly larger portions of food than usual during your evening or nighttime meals?
  • Are you consistently eating substantial amounts of food during the evening and nighttime hours?
  • Have you noticed significant weight gain or difficulty in managing your weight, particularly in relation to your nighttime eating habits?
  • Do you feel a lack of control or find it challenging to stop yourself from eating during the night, even when you want to?
  • Do you often skip meals during the day or only eat small amounts, leading to increased eating during the night?
  • Have you experienced low energy levels and a noticeable decrease in motivation that could be associated with your eating habits, particularly during the night?
  • Do you find yourself eating during the night when you’re not physically hungry?
  • Do you have difficulty sleeping or wake up frequently during the night, specifically to eat?

Disclaimer

These questions are not a substitute for professional medical advice, diagnosis, or treatment. If you find yourself answering ‘yes’ to some of these questions, it is crucial to consult with a healthcare professional for a thorough evaluation and accurate diagnosis.

How is Night Eating Syndrome diagnosed?

NES can be diagnosed through a comprehensive assessment that typically involves a combination of clinical interviews, self-report measures and the use of diagnostic criteria outlined in the DSM-5.

In addition to the DSM-5, clinicians may also use specific assessment tools such as the Night Eating Diagnostic Questionnaire (NEDQ). The NEDQ is a self-report questionnaire designed to assess key features of Night Eating Syndrome. Patients are typically asked to provide information about their eating habits, including the timing and frequency of nighttime eating, as well as associated distress and impairment.

The NEDQ can aid in gathering detailed information about the individual’s eating patterns and the impact of those patterns on their overall well-being. It helps clinicians better understand the specific characteristics of night eating that align with the diagnostic criteria.

The goal is to gather comprehensive information about the individual’s eating behaviours, emotions and any associated distress or impairment to make an accurate and informed

What causes Night Eating Syndrome?

The exact cause of Night Eating Syndrome (NES) is not fully understood, and it likely involves a combination of genetic, biological, psychological and environmental factors. Here are some potential contributing factors:

Biological factors
  • Circadian rhythms: Disruptions in the normal circadian rhythms, which regulate sleep-wake cycles and eating patterns, may play a role in NES.
  • Hormonal imbalances: Changes in hormones that regulate sleep, such as melatonin, could contribute to NES. Studies have shown that people suffering from NES have lower levels of melatonin.
  • Serotonin and dopamine: Imbalances in neurotransmitters, such as serotonin, which play a role in mood and appetite regulation, may contribute to NES.
Psychological factors
  • Stress and emotional distress: Like many eating disorders, stress and emotional factors can contribute to NES. Some individuals may use night eating as a way to cope with stress, anxiety, or other emotions.
  • Depression: There is an association between NES and depression. Individuals with depression may be more prone to night-eating episodes.
Genetic factors
  • Family history: There may be a genetic component to NES, as individuals with a family history of eating disorders or related conditions may be more susceptible.
Environmental factors
  • Societal and cultural influences: Cultural attitudes toward food, body image and societal expectations can impact eating behaviours.
  • Irregular meal patterns: Inconsistent or irregular meal patterns, including skipping meals during the day, may contribute to disruptions in eating behaviours at night.

Is Night Eating Syndrome the same as Binge Eating Disorder?

No, these are two separate eating disorders and are not the same. With Binge Eating Disorder and NES sharing some similarities, especially the lack of control over food consumption, confusion can often arise. Below are some of the key differences between the two eating disorders:

 

Criterion Night Eating Syndrome Binge Eating Disorder
Amount of Food Consumed Usually, a small meal or snack worth of food is consumed Requires consuming large amounts
Degree of Control Varies from full control to some loss of control Little to no control; loss of control is a key aspect
Associated Mood Uncomfortable feelings in the evening (known as Evening Dysphoria) Increased depressive symptoms, not tied to a specific time
Associated Sleep Concerns Often linked with trouble falling or staying asleep Not specifically linked to sleep issues
Motivation/Precipitants Belief that eating is necessary to fall asleep Various motivations, including urges and emotional eating
Level of Weight/Shape Concern Typically lower; may increase with weight gain Often tied to worries about weight and body image
Source: NCBI

How is Night Eating Disorder treated?

While solid treatment options for NES are currently lacking in research, considerable emphasis can be placed on the behavioural aspects of treatment. Given NES’s association with various mood disorders, including depression and anxiety, addressing these issues could be a viable approach to treatment.

Here are some of the potential treatment avenues that some medical healthcare professionals may explore:

Psychotherapies
Therapies, such as CBT and Interpersonal Psychotherapy (IPT) are often considered the most effective form of psychotherapy for NES. It focuses on changing unhealthy eating patterns and addressing the underlying thoughts and behaviours that contribute to night eating. These types of psychotherapies may help individuals develop healthier coping mechanisms and improve their relationship with food.
Nutritional counselling
Working with a registered dietitian or nutritionist can help individuals establish a balanced and regular eating pattern. They can provide guidance on meal planning, portion control and making nutritious food choices.
Establishing regular eating patterns
Healthcare professionals will encourage people with NES to establish regular eating patterns, including a balanced breakfast and lunch. It’s believed that this method can help regulate their overall food intake throughout the day.
Medication
In some cases, medication may be prescribed to help manage symptoms of NES. Antidepressant medications, particularly selective serotonin reuptake inhibitors (SSRIs), have the potential to be effective for some individuals with NES.
Sleep hygiene
Improving sleep hygiene practices can contribute to better overall well-being. This may include maintaining a regular sleep schedule, creating a relaxing bedtime routine and avoiding stimulants like caffeine close to bedtime.
Stress management
Identifying and managing stressors is an essential aspect of treating NES. Stress management techniques such as mindfulness, meditation and relaxation exercises can be beneficial.

What are the next steps?

Take the first step towards reclaiming peaceful nights and improving your quality of life by reaching out to a healthcare professional. If you or a loved one suspects Night Eating Syndrome, remember that help is available, and there is every opportunity to overcome this hurdle.

Contact the professionals who understand and can guide you through this process with compassion. Your path to a better quality of life and a brighter tomorrow begins with seeking support.

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FAQ’s

Is Night Eating Syndrome dangerous?
As is the case for any eating disorder, there is always the potential for conditions to become dangerous. NES can be considered dangerous due to its potential negative impact on physical and mental health. People with NES exhibit abnormal eating patterns, and this behaviour can lead to weight gain, obesity and associated health issues.

Additionally, NES is often linked to emotional distress, sleep disturbances and an increased risk of other mental health disorders.

Is Sleep Eating Disorder the same as Night Eating Syndrome?
No, Sleep Eating Disorder (SED) and NES are different. SED involves eating during sleep arousal, while NES is characterised by overeating in the evening, after dinner. Both are sleep-related eating disorders.
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