Introduction

Night Eating Syndrome (NES) is an eating disorder that is categorised as the excessive intake of food during the evening or night, where a minimum of 25% of daily calories are consumed during the nighttime.¹ NES is usually classed by a minimum of three symptoms, which include:

1. The belief of not able to sleep without eating
2. A worse mood in the evening 
3. Depressive mood
4. A strong desire to eat food between dinner and bedtime
5. Frequent episodes of insomnia
6. Anorexia in the night and morning

NES has been found to be associated with factors such as anxiety, depression, obesity, certain medications and high levels of stress, all of which can contribute to the development and persistence of disordered eating patterns during evening and night. These eating behaviours typically begin in late adolescence, usually between the ages of 18-20 years.² Nighttime eating can significantly impact daily life and health in numerous ways:

• Gaining weight and obesity: A surge in calories from nighttime eating may lead to a calorie surplus, which ultimately leads to weight gain and obesity
• Metabolic issues: The body’s natural circadian rhythm becomes disrupted from nighttime eating, which could develop other health conditions such as insulin resistance, type II diabetes, and high blood sugar levels
• Gastrointestinal issues: Problems such as acid reflux, indigestion, and discomfort can arise from eating at night, especially before going to sleep
• Sleep disruption: Waking up during the night to eat disrupts normal sleep patterns, which can lead to fatigue and poor quality of sleep
• Mental health and disruption of social life: NES is linked to anxiety, depression, stress, and reduced self-esteem and can lead to a reduction in social interaction due to embarrassment of eating or sharing meals³

One effective method of treatment for NES is Cognitive-Behavioural Therapy (CBT). CBT is used to treat NES by addressing thoughts and behaviours that can lead to eating disorders and can help people stop the cycle of nighttime eating. Essentially, CBT identifies the thought processes of someone with NES and helps by developing mechanisms to cope with NES by establishing structured routines around sleep and eating. CBT ultimately empowers people with NES to take control of their lives and improve their emotional and physical health.⁴               

Basics of cognitive-behavioural therapy (CBT)

What is CBT?

CBT is a form of psychotherapy developed in the 1960s by Aaron Beck and has been found to be effective as a treatment for many disorders such as depression, anxiety, eating and personality disorders. CBT is based on the principle that our initial thoughts, feelings, and behaviours are all interconnected and that changing these negative thought patterns can lead to improved emotional well-being. CBT can be conducted individually with a therapist or in a group setting, and sessions vary from five to twenty minutes, with each session being a duration of one hour. During the CBT session, people learn to recognise negative thoughts, and these thoughts are then challenged. A therapist will help people with NES to recognise these negative thoughts and teach them skills on how to manage these emotions and behaviours. Some methods practised in CBT include problem-solving and relaxation techniques to help improve communication skills.⁵ 

CBT’s adaptability to NES

CBT is a suitable therapy for treating NES as it can address both the behavioural and emotional aspects of the disorder. CBT is highly effective in areas including sleep disruption, emotional distress, and disrupted eating patterns, which are all commonly found in people with NES. CBT methods can be personalised to target the craving of food at night and tackle negative thoughts such as ‘I need to eat in order to go to sleep’, and can also target the emotional triggers that lead to nighttime eating. As NES is often associated with anxiety, depression, and stress, CBT’s approach enables sufferers to manage their mood and behaviour, and decrease their reliance on food for emotional regulation by focusing on building routines, which makes it an effective and practical form of therapy for managing NES.⁶

CBT techniques for managing night eating behaviours

There are numerous techniques that can be used in treating NES through CBT. For instance:

• Self-Monitoring: In the early stages of treatment, self-monitoring can be implemented to raise awareness of eating behaviour. Keeping a track of food consumption, mood, sleep, and emotional state helps in tracking patterns and triggers that may lead to night eating⁴ 
• Cognitive Restructuring: Individuals are able to recognise negative thoughts and challenge them by replacing them with healthier thoughts⁴
• Stimulus Control: Environmental triggers should be managed and changed to decrease cues that could result in nighttime eating. For example, removing snacks and food from the bedroom and avoiding watching screens before bed. This will facilitate establishing a consistent bedtime routine 
• Behavioural Experiments: Testing out new routines to change old habits, such as going back to sleep without eating, and testing new beliefs 
• Phototherapy:⁶ Was originally a treatment solely for seasonal affective disorder; however, as NES is also considered as a circadian rhythm disorder, phototherapy has been proven to be effective in reducing NES symptoms such as depression, obesity, and night eating⁶
• Muscle relaxation: Deep breathing and progressive muscle relaxation are techniques that can be used before bed to improve the quality of sleep. Progressive muscle relaxation is particularly used for physical and mental relaxation by tensing and relaxing different muscles to reduce anxiety and stress. Studies have shown progressive muscle relaxation as a useful therapy to reduce stress, anxiety, depression, and excessive nighttime eating, whilst raising morning appetite⁶

Limitations and considerations

Importance of individualised treatment plans

Everyone responds differently to treatment plans. NES varies, and people have different severities of symptoms and triggers, so for CBT to be effective, it must be personalised, which includes changing the number of sessions required, choosing the right technique, and setting realistic goals for individuals. Personalised treatment plans have been proven to increase motivation, engagement, and improve long-term effectiveness.⁷ 

Need for professional guidance

When using CBT as a therapy for NES, a trained mental health professional who has experience with behavioural therapy and eating disorders should deliver the therapy. Performing CBT strategies without a qualified professional could lead to techniques being misunderstood, poor outcomes, and even discouragement if there is no progression. Having a qualified professional can help set a pace, provide appropriate techniques, and offer emotional support, which can lead to a more successful outcome.⁸

When CBT may not be enough

Although CBT can be effective for many people with NES, it may not be sufficient for more complex cases. People who suffer from severe conditions of depression and anxiety may need more intense treatments, including medication and psychiatric care. In this case, Dialectical Behaviour Therapy (DBT) can be used alongside CBT. DBT is helpful in developing relationship and coping strategies for emotional eating and triggers that may cause nighttime eating episodes. CBT also requires high levels of participation and engagement, which can be difficult for some people who often have low energy. Without the motivation to change habits, CBT may not be enough for a noticeable change.⁹

FAQ’s

Is nighttime eating the same as binge eating?

Nighttime eating is quite different from binge eating. Although both involve disordered eating habits, NES is more tied to eating at night and sleep disruptions, whilst binge eating is more related to consuming excessive amounts in a short period of time and can happen anytime.¹ 

Can CBT be combined with other treatments?

Yes. CBT can be more effective in combination with other therapies, such as phototherapy or with healthier lifestyle changes. In some instances where symptoms of NES are more severe, medication may be necessary alongside CBT.⁶ 

Do I need a therapist to start CBT for NES?

It is highly recommended to undergo CBT with a therapist, as there is a greater chance of having long-term success. A therapist can personalise treatment to fit your needs, monitor progression, and provide emotional support.⁸  

How does NES affect health and well-being?

NES can contribute to weight gain, ultimately leading to obesity, disrupted sleeping patterns, and increased risk of developing anxiety and depression. With time, NES can impact physical and mental health negatively and reduce energy levels, leaving people feeling lethargic, which can interfere with social interaction and fitness routines.³ 

Summary

Night Eating Syndrome (NES) is an eating disorder which is classed as an excessive intake of food during the evening or night. It can negatively affect physical and mental health, quality of life, and can co-occur with other conditions such as anxiety, stress, and depression. To combat NES, CBT can be used as an effective treatment by targeting negative thoughts and retraining behaviours which trigger nighttime eating. Techniques such as self-monitoring, cognitive restructuring, stimulus control, phototherapy, and relaxation strategies can help individuals to regain control and offer long-term success. Nevertheless, CBT is not always enough for people who have severe depression or anxiety, and the need for medication may be necessary to reduce symptoms.

Professional help is essential for CBT to be effective, as therapists can offer personalised treatment plans which are tailored to a person's specific needs and goals. Overall, CBT is a powerful technique and is effective for recovery and improving well-being for those suffering from NES.