What Is Sleep-Related Eating Disorder

Introduction

If you've ever found yourself mysteriously awake in the middle of the night, standing in your kitchen, surrounded by the remnants of an unplanned late-night feast that you don't recall preparing or consuming, you're not alone. This peculiar situation could be a telling sign of a sleep disorder known as Sleep-Related Eating Disorder (SRED).¹ Often lurking in the shadows, SRED is a condition that frequently goes unnoticed. In this article, we will shine a light on the world of SRED, breaking down its definition, symptoms, causes, and potential consequences. Additionally, we will explore the diagnosis and treatment of this disorder, offering practical guidance for those who may be affected.

What is sleep-related eating disorder?

Sleep-Related Eating Disorder (SRED) is a distinctive form of parasomnia, a category of sleep disorders that also includes sleepwalking, confusional arousals, and sleep terrors. SRED is characterized by an overwhelming compulsion to eat during sleep, typically occurring 1-3 hours after falling asleep.² During these episodes, individuals experience partial or full unconsciousness, rendering them physically incapable of returning to sleep until they've consumed food.

What distinguishes SRED from ordinary midnight snacking or sleepwalking is the pivotal factor of consciousness. Individuals affected by SRED are not consciously aware of their actions during these episodes.² It's as if their bodies are functioning on autopilot, driven by an insatiable urge to seek out and consume food, while their minds remain in the realm of sleep. This unique feature sets SRED apart from other sleep disorders and underscores the importance of recognising and addressing this condition.

Symptoms and behaviours

Episodes of Sleep-Related Eating Disorder (SRED) can manifest even when a person is not hungry or thirsty. They tend to occur when an individual is partially awake during the night. What's striking about these episodes is the nature of the food consumed. It is often sugary and high in calories, and it may include unusual food combinations, inedible items, or even uncooked food that the affected person wouldn't typically enjoy.

In some alarming instances, individuals with SRED have reported harming themselves after consuming toxic substances, causing burns, or even starting fires. The extent of these behaviours highlights the severity of SRED and the risks it poses.

A study focusing on the diagnosis criteria for SRED has identified the following common symptoms:³

• Frequent nocturnal eating: Individuals with SRED typically experience at least two episodes of nocturnal eating per week, and this pattern has persisted for a minimum of three months.
• Evening food consumption: They consume at least 25% of their daily food intake after the evening meal, often during these nocturnal episodes.
• Awareness of eating episodes: Unlike some other sleep disorders, individuals with SRED are often aware of their evening and nocturnal eating episodes, though their actions may be driven by an irresistible compulsion.
• Sleep-Induced eating: People with SRED may believe that eating is necessary for them to fall asleep, further reinforcing the sleep-related aspect of the disorder.
• Morning reluctance: This can manifest as skipping breakfast or an aversion to eating in the morning.

Causes and triggers

Sleep-Related Eating Disorder (SRED) is an intriguing condition, and like many eating disorders, it exhibits specific patterns in terms of gender prevalence. Studies have shown that SRED is notably more common in women than in men, with approximately 65% to 80% of diagnosed patients being women. Furthermore, this disorder typically manifests in individuals between the ages of 22 to 29, shedding light on its occurrence during early adulthood.¹¹

To comprehend the origins of SRED, we need to consider a blend of biological and behavioral factors. Here's a concise list of potential causes:

1. Hormonal appetite mediators: During the nocturnal phase of sleep, our hormonal appetite regulators undergo alterations that promote fasting. One such regulator is leptin, a hormone responsible for signalling fullness and satiety, allowing people to sleep through the night without feeling hungry. Intriguingly, individuals with SRED often exhibit abnormal leptin levels during the night.⁴ Additionally, other hormones linked to sleep-wake cycles, hunger, and stress, such as ghrelin, melatonin, cortisol, and thyroid-stimulating hormone, may also undergo fluctuations in those with SRED.⁵
2. Chronotype influence: A recent study has revealed that individuals who naturally lean toward being "evening people" or prefer sleeping and waking later in the day are more prone to night-eating syndrome. This association underscores the role of our internal body clocks in regulating eating patterns during sleep.⁶
3. Association with other eating disorders: SRED frequently co-occurs with other eating disorders, including binge eating disorder and bulimia. The interplay between these disorders can complicate the diagnostic and treatment processes.⁷
4. Psychological factors: Studies have identified strong links between SRED and psychological conditions, particularly depression and Seasonal Affective Disorder (SAD). These mood-related factors can intensify night eating symptoms, especially during periods of heightened stress.⁸

Potential health consequences

The impact of Sleep-Related Eating Disorder (SRED) reaches beyond mere disruptions in sleep patterns. This disorder is characterised by a range of consequences that affect various aspects of an individual's health and well-being. Some of these consequences include:

• Ingesting toxic substances: SRED can lead to the ingestion of toxic substances, such as cleaning solutions. This behaviour can have severe health implications and necessitates immediate attention.
• Allergic reactions: In some cases, SRED may lead to the consumption of foods to which the individual is allergic. This can trigger allergic reactions, ranging from mild discomfort to severe health consequences.
• Sleep-related injuries: Individuals with this syndrome are at risk of experiencing injuries during night-time eating episodes, which can range from minor accidents to more severe harm.
• Morning loss of appetite: SRED may lead to a reduced appetite in the morning, affecting an individual's overall dietary habits.
• Stomach discomfort: A person may experience stomach pain, potentially resulting from the consumption of unusual or excessive food during night-time eating episodes.
• High cholesterol: Over time, the consumption of calorie-dense, high-fat foods during SRED episodes can contribute to high cholesterol levels, increasing the risk of cardiovascular issues.
• Excessive weight gain and obesity: SRED is often associated with significant weight gain and obesity, leading to a range of health concerns and complications.

Diagnosing SRED

To determine if an individual is affected by Sleep-Related Eating Disorder (SRED), an extensive evaluation by a healthcare professional is crucial. During this evaluation, several questions will be asked, focusing on eating binge habits. These inquiries include when the first episodes began, their frequency, and their duration. Furthermore, doctors will require a comprehensive medical history, including current and past medication use.

In some cases, a sleep study known as polysomnography may be recommended. This test monitors brain waves, heart rate, and breathing patterns during sleep, and it records the movements of the arms and legs.³ Additionally, the video-polysomnographic test may involve video recording individuals during sleep to capture any unusual night-time behaviours.⁴

Treatment options

Managing SRED often requires a multi-faceted approach. Behavioural therapies and counselling can assist individuals in gaining better control over their night-time eating behaviours. Safety is a top priority, with measures such as placing locks on kitchen doors and cabinets, as well as securely storing knives to prevent night-time eating episodes. Clearing the path from the bedroom to the kitchen is also essential.

In certain cases, healthcare professionals may prescribe medications to help manage SRED symptoms. Additionally, lifestyle changes, including improvements in sleep hygiene, can play a vital role in the prevention and management of SRED.

Those affected by SRED to seek professional guidance and treatment to address this complex disorder effectively. If you or someone you know is experiencing symptoms of SRED, consulting a healthcare provider is the first step toward diagnosis and tailored treatment.

Summary

Sleep-Related Eating Disorder is marked by episodes of unconscious nocturnal eating, and it can have profound consequences, extending beyond mere disruptions in sleep patterns.

• SRED's key feature is a lack of consciousness during these episodes. Those affected are driven by an irresistible urge to consume food, all while their minds remain in the realm of sleep. What distinguishes SRED from other sleep disorders is this unique lack of awareness, making it crucial to recognise and address.
• The symptoms and behaviours associated with SRED are remarkable, as individuals may consume unusual food combinations, toxic substances, or inedible items, sometimes leading to self-harm. The diagnostic criteria involve frequent nocturnal eating, typically occurring in those who are partially awake during the night.
• Understanding the causes and triggers, we've learned that SRED is more common in women, particularly in the 22 to 29 age range. It has links to hormonal imbalances, and chronotype preferences, and often co-occurs with other eating disorders, making it a multifaceted challenge. Psychological factors, particularly depression and Seasonal Affective Disorder (SAD), can intensify SRED's symptoms.
• Beyond sleep disruption, SRED's health consequences encompass ingesting toxic substances, allergic reactions, sleep-related injuries, reduced morning appetite, stomach discomfort, high cholesterol, and excessive weight gain. These consequences emphasize the need for recognition and intervention.
• Diagnosis of SRED requires an extensive evaluation, with healthcare professionals using questions about eating habits, medical history, and sometimes polysomnography to monitor sleep patterns and behaviours. Treatment is multifaceted and may involve behavioural therapies, safety measures, medication, and lifestyle changes.
• In conclusion, understanding and addressing SRED is essential for those affected and their loved ones. Seeking professional guidance and treatment is the first step toward managing this complex disorder effectively. Awareness, early diagnosis, and tailored intervention are paramount in helping individuals regain control over their night-time eating behaviours and ensuring a better quality of life.