Sleep-Related Eating Disorder
A disorder involving recurrent episodes of eating and drinking during partial arousal from sleep, with little or no memory of the behavior.
What is Sleep-Related Eating Disorder?
Sleep-Related Eating Disorder (SRED) is a parasomnia characterized by recurrent episodes of eating and drinking during the main sleep period, with impaired consciousness during eating and partial or complete amnesia for the episodes. Individuals typically eat unusual foods or combinations (including inedible substances in some cases), often consuming high-calorie foods. SRED differs from Night Eating Syndrome (NES), where eating occurs with full awareness. SRED can lead to weight gain, injury from cooking activities, and consumption of toxic substances.
Prevalence
SRED affects approximately 1-5% of the general population but is more common in individuals with other eating disorders (10-15%) and other parasomnias. It is more common in women (60-80% of cases). Onset is typically in young adulthood, with an average age of 22-27 years. It is often associated with sleepwalking, restless legs syndrome, and use of sedative-hypnotic medications.
Causes
SRED occurs during partial arousal from deep NREM sleep, similar to sleepwalking. Contributing factors include: sedative-hypnotic medications (particularly zolpidem, which is a known trigger), other sleep disorders (sleepwalking, restless legs, sleep apnea), daytime dieting or caloric restriction, stress and psychological factors, prior history of sleepwalking, eating disorders, and genetic predisposition. The disorder appears to involve dysfunction in both sleep arousal and appetite regulation systems.
Symptoms
Eating during sleep
Recurrent episodes of eating (and sometimes preparing food) during partial arousal from sleep, typically in the first half of the night.
Unusual food choices
Consuming odd foods, unusual combinations (peanut butter on frozen pizza), raw ingredients (frozen meat, butter), or even non-food items.
Impaired awareness
Eating occurs in a state of reduced consciousness, with the person appearing 'on autopilot' and difficult to fully awaken.
Amnesia for episodes
Partial or complete inability to remember the eating episodes the next morning. Evidence (dirty dishes, missing food) reveals the behavior.
Weight gain
Consumption of high-calorie foods during episodes often leads to unwanted weight gain.
Risk of injury
Preparing food while impaired can lead to cuts, burns, or consumption of toxic substances (cleaning products, frozen foods).
Morning nausea or fullness
Waking up feeling nauseated, overly full, or with no appetite for breakfast may indicate nighttime eating.
Diagnosis
Self-Assessment Questions
If you answer yes to any of these questions, consider consulting a sleep specialist:
- 1Do you find evidence of eating (missing food, dirty dishes) that you don't remember?
- 2Have you gained weight unexpectedly without daytime overeating?
- 3Do you eat unusual foods or combinations during these episodes?
- 4Do you have difficulty fully waking during eating episodes?
- 5Have you started taking a new sedative medication (like zolpidem) before episodes began?
- 6Do you have a history of sleepwalking or other parasomnias?
Diagnosis is based on history of recurrent eating during sleep with impaired awareness and amnesia. Polysomnography can capture episodes and rule out other conditions. Medication history is important as sedatives frequently trigger SRED.
Clinical History
Detailed history of eating behaviors, timing, awareness, memory, food choices, and any injuries. Bed partner reports are valuable.
Video Polysomnography
Extended sleep study with video may capture eating episodes, document the sleep stage of occurrence, and rule out seizures.
Medication Review
Careful review of all medications, particularly sedative-hypnotics (zolpidem), is essential as these are frequent triggers.
Evaluation for Related Conditions
Assessment for sleepwalking, restless legs syndrome, sleep apnea, and eating disorders.
Treatment
Treatment involves discontinuing triggering medications, treating underlying sleep disorders, safety measures, and sometimes medication. Response to treatment is generally good.
Discontinue Triggering Medications
If zolpidem or other sedative-hypnotics trigger SRED, discontinuing or switching medications often resolves the disorder.
Treat Underlying Sleep Disorders
Treating sleepwalking, restless legs syndrome, or sleep apnea when present can reduce SRED episodes.
Topiramate
This anticonvulsant has shown effectiveness in reducing SRED episodes, possibly through effects on both sleep and appetite regulation.
Dopaminergic Agents
Pramipexole and other dopamine agonists may help, particularly when restless legs syndrome is present.
Safety Measures
Locking the kitchen, removing dangerous foods and utensils, installing alarms on kitchen doors.
SSRIs
Sertraline and other SSRIs have helped some patients, particularly when there is concurrent depression or anxiety.
Lifestyle Adjustments
- •Avoid sedative-hypnotic medications when possible
- •Lock the kitchen or install door alarms
- •Remove easy-to-grab high-calorie foods from the kitchen
- •Maintain a regular sleep schedule
- •Ensure adequate sleep to reduce arousal triggers
- •Avoid alcohol before bed
- •Don't go to bed hungry (have a light snack if needed)
- •Treat any underlying eating disorder or dieting behaviors
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