Overview

A late-night snack may seem harmless, but if it accounts for at least 25% of your daily calories, you might be suffering from Night Eating Syndrome (NES). 

NES is a rare eating disorder defined by compulsive eating at nighttime, after dinner. It is often accompanied by waking up during the night to eat, and a lack of appetite in the morning.¹

The lack of appetite in the morning often continues throughout the day, disrupting normal daytime eating patterns and leading to nighttime hyperphagia. 

With NES, diet plays a fundamental role in symptom severity and management. 

Making considered food choices throughout the day, particularly avoiding foods that cause a flare-up, such as carbohydrates and sugars, can help manage NES and cravings. 

Understanding NES

Diagnosis 

The continuous delay of food intake, evening hyperphagia (at least 25% of the daily food intake, consumed after dinner), and mid-sleep awakenings to consume food are signs of dealing with NES. 

To be diagnosed with NES, a patient also needs to experience at least 3 out of the 5 following symptoms for 3 months or more:

1. Lack of appetite in the morning and/or skipping breakfast at least 4 times per week
2. Strong urge to eat after dinner, before bedtime, and during the night
3. Insomnia/sleep disturbances at least 4 times per week
4. A belief that food is required to fall asleep
5. Depression and mood swings, especially in the evening

History, prevalence, and risk factors 

When NES was first described in 1955, it was considered to be a stress response, most commonly observed among obese individuals. Nowadays, NES is attributed to psychological and biological factors, and individuals who deal with NES are not necessarily obese, but may suffer from obesity-related complications like diabetes.¹

In 2022, 1.5% of US citizens were diagnosed with NES.¹ Individuals dealing with NES show symptoms of depression and anxiety. The syndrome works in a vicious circle, as psychological distress can lead to NES and ultimately obesity, reinforcing depression and stress. 

The science behind NES

Disruption in circadian rhythm

Circadian rhythm, or the “body’s clock,” works in a 24-hour cycle and regulates many body functions, such as when you are going to sleep at night and wake up in the morning. A dysregulated circadian rhythm can change appetite and increase the risk for food overconsumption at nighttime. 

Hormonal imbalances

Hormones control many vital functions of the body. Circadian rhythm is controlled by hormones such as melatonin (the sleepy hormone) and cortisol (the wake-up hormone). Disregulated hormone levels may lead to an imbalanced circadian rhythm and contribute to NES. 

Leptin and ghrelin are two important hormones that regulate hunger and the feeling of satiety. Leptin tells the brain that you are full from food, while ghrelin tells your brain that you are hungry.

Individuals with NES may suffer from leptin resistance and thus not feel satiated after a meal, or from increased levels of ghrelin at nighttime, signifying that they are hungry.³

Common food cravings in NES and why they happen

Carbohydrate cravings

Carbohydrates are a macronutrient found in some foods and drinks. Based on how quickly the body digests carbohydrates, there are two types: complex carbohydrates and simple carbohydrates. 

Complex carbohydrates (e.g., whole grains, legumes) come with vitamins, minerals, and fiber necessary for the body. On the other hand, simple carbohydrates (e.g., sugary snacks, processed food) offer no nutritional value. 

The nighttime meals of individuals dealing with NES often involve high amounts of carbohydrates. Carbohydrate-rich foods and snacks, particularly the simple carbohydrate ones, have been shown to temporarily increase serotonin, also known as the “happiness hormone”.

This is how the “comfort food” mind-body connection is formed, and then onwards, the brain associates carbohydrate consumption with comfort and happiness, and craves more carbohydrates.⁴

Sugar cravings

Refined sugar, candy, and sweetened drinks trigger the brain to release dopamine. This hormone is involved in the brain’s reward system ⁵

In individuals with NES, the brain is trained to crave a quick emotional lift, and sugar consumption provides just that by overflowing the body with dopamine. This works in a self-reinforcing cycle, where the brain associates nighttime eating of sugary treats with emotional comfort. Over time, the body craves sugar consistently to achieve the same dopamine “reward” feeling, worsening NES patterns.

What happens to your body when you eat late at night

Eating high-sugar and carbohydrate snacks/meals at night leads to a quick spike in blood sugar levels. What happens after:

1. The body reacts — the body wants low levels of blood sugar, so it releases insulin to bring them down
2. The crash—insulin can drop your blood sugar levels very suddenly, leading to a crash⁶

If the crash happens when you are asleep, it can disturb your sleep, mess with your hunger sensation, and cause mood swings.

In NES, the blood sugar spikes and late-night crashes reinforce cravings for sugar and carbohydrates. 

Managing NES: food choices and beyond

To manage symptoms of NES, a comprehensive approach is required that tackles all contributing factors.

Considerate food choices throughout the day

The quantity and quality of meals throughout the day determine hunger levels at night. Skipping meals during the day will lead to food cravings at night to compensate for nutrients and energy, and possibly lead to an overeating episode.

Meals based on complex carbs, protein, and healthy fats are the building blocks of a healthy, balanced diet.⁷

What to choose: Healthy carbohydrates such as vegetables, whole grains, and nuts. 

What to avoid: Sugary snacks, beverages, and other simple carbohydrates.

 Timing of meals 

Structured, spread-out meals throughout the day are key in managing NES. Nutrients and energy acquired by distributing meals daily, including breakfast, lunch, and dinner, can regulate appetite and reduce nighttime cravings.⁷

What to do: Consume a nutrient-dense breakfast, lunch, and dinner. 

What to avoid: Skipping meals and restrictive dieting.

Mindful eating practices

Recognising what triggers the desire to eat and improving food awareness are fundamental starting points to understand the reasons behind nighttime cravings and eating habits. 

Triggers usually involve stress after a long day, loneliness or boredom, and restrictive eating during the day. 

Improving food awareness involves becoming mindful of what, when, and why you are eating. Comfort food looks different for everyone, and therefore, identifying which foods are cravings and which are of nutritional need will help distinguish true hunger from emotional hunger. Additionally, removing external stimuli while eating, such as screens, can help in intentional eating.

What to do: Understand the “why” behind nighttime eating and cravings.
Extra tip: Keeping a food/mood journal can assist in understanding behavioural patterns and links that lead to nighttime eating episodes.

What to avoid: Eating fast, in the presence of external stimuli such as screens, and avoiding obsessive tracking. Awareness is about connection and curiosity, not control or criticism. 

Professional support

Seeking support from specialists is crucial, as managing any condition starts with an accurate diagnosis. Guidance from specialists may include pharmaceutical and psychological interventions to successfully manage NES. 

Pharmaceutical treatment options

SSRIs (Selective Serotonin Reuptake Inhibitors) are a commonly used antidepressant that can increase serotonin levels and therefore regulate mood, influence appetite, and improve sleep. 

Melatonin pills can regulate circadian rhythm and improve sleep quality. Reducing nighttime wakenings can also reduce food consumption at late hours.

Lastly, topiramate is a medication that is sometimes used for managing weight loss and binge-eating in eating disorders. A healthcare provider might prescribe it to suppress appetite and reduce cravings.⁸

The suggested pharmaceutical treatment options are not necessarily a one-size-fits-all solution, they should be used under medical supervision. Further research is needed to establish these medications as front-line options for NES management. 

Psychological treatment options

CBT (Cognitive Behavioural Therapy) can help identify thought patterns that contribute to nighttime eating behaviour. Deeply rooted beliefs about food and control can be explored while learning to manage stress, emotions, and urges. 

Behavioural interventions can include keeping food out of the bedroom and meal prepping to avoid quick snacking and meal skipping. 

Lastly, learning about relaxation and stress management techniques can improve the view of food as a coping mechanism and also improve sleep quality.⁸

FAQs

Is NES the same as binge-eating?

While NES and binge-eating share some symptoms, they are two different eating disorders.

What foods make NES worse?

Simple carbohydrates and sugary snacks/drinks provide no nutritional value, and cause a dopamine surge received by the brain as a reward feeling. Overconsumption of these foods trains the brain to constantly seek the effect of dopamine, reinforcing NES symptoms. 

How can I overcome NES?

To manage NES, a combination of personal and professional input is required. Individually, recognizing what triggers cravings and practicing mindful eating can establish better self-control when eating. Specialists may recommend pharmaceutical and psychological interventions, particularly if NES has an emotional impact. 

Summary

NES is an eating disorder characterised by consuming at least 25% of daily calories after dinner, and it is often accompanied by waking up in the middle of the night to eat. Food cravings usually involve carbohydrates and sugar, and there are both biological and behavioural reasons behind them.

 The frequent consumption of these foods results in dopamine and serotonin surges, which signal to the brain that the particular food is comforting, reinforcing a circle of nighttime eating. Additionally, a disrupted circadian rhythm and imbalanced hormones can result in low sleep quality, nighttime awakenings, intense food cravings, and depressive mood.

Making considered food choices can break the cycle of nighttime cravings. In combination with the help of professionals, NES can be managed, and a balanced approach to food can be adopted to improve overall well-being.