What is night eating syndrome?
According to the Diagnostic and Statistical Manual of Mental Illness (DSM-5), night eating syndrome (NES) falls under the category of OSFED (other specified feeding or eating disorder).
Night eating syndrome is characterized by recurrent episodes of night eating, defined as eating late at night either prior to bed or actually awakening at night to eat. Night eating is not explained by changes in the sleep-wake cycle (night shift work), medication effects, binge eating disorder, substance use disorders, or other general medical disorders. (1) Those with night eating syndrome have episodes of eating more than 25% of their daily caloric intake at night, or when they wake up in the middle of the night. He or she will do this often a few times per week. (5)
NES can look and feel like binge-eating disorder (BED), but they have some notable differences. Those with NES eat fewer meals during the day and eat primarily at night. Studies show that those with BED eat more during the day and tend to have more objective bulimic and overeating episodes, shape/weight concerns, disinhibition, and hunger cravings than NES. (2)
Men are more likely to have NES than BED, and those with NES tend to have a higher body mass index than those with BED, but do not necessarily have to be overweight to meet criteria for the diagnosis. (3) People who suffer from NES are associated with mood, anxiety, and sleep problems. (4)
Although NES was first described in 1955, research has progressed slowly on its etiology, diagnosis, and treatment. The current recommended treatments include medication and cognitive behavioral therapy, but not many of the proposed treatment options for NES have been promising, or illustrated any long-term efficacy. (6)
More research needs to be done to characterize if NES is a sleep disorder, delayed circadian eating rhythm, or a metabolic condition. (6) Adolescents that struggle with depression, high levels of stress, and insomnia are at risk for developing NES as adults. (8) When battling with mental illness and ruminations at night, eating brings a form of comfort. Food triggers pleasure areas within the brain, which temporarily relieve pain from distressing thoughts. Ultimately, this helps people to fall asleep.
How to stop eating at night?
The best way to stop eating at night, if you believe there’s an underlying disorder, is to speak to your doctor and seek out treatment for night eating syndrome. Some strategies for treating NES include avoiding daytime restriction, practicing good sleep hygiene, and developing mindful, or intuitive, eating habits.
1. Avoid restriction throughout the day
NES can emerge when people heavily restrict themselves throughout the day (i.e. diet), which can lead to binging at night, as part of the binge/restrict cycle. While intermittent fasting is one recommended way to lose weight, it may cause some individuals to have extreme rebound hunger after restricting all day and then binging at night.
2. Practice good sleep hygiene
Principles of good sleep hygiene include: (9)
- Optimizing a sleep schedule. Try to go to bed and wake up at the same time each day, to align the body’s natural circadian rhythm. If someone suspects that he or she may have a circadian rhythm disorder, it’s important to see a neurologist or sleep specialist.
- Limit taking naps to the early afternoon and no longer than 30-40 minutes.
- Develop a night time routine. Eat dinner no less than two hours before bedtime.
- Limit bright lights and phone/computer screens one hour before bed.
- Use your bed only for sleep and sex.
- Do not toss and turn. It’s better to get out of bed and do a light activity like reading than to lay in bed for hours.
- If someone snores, it’s recommended to be screened for sleep apnea.
- Until symptoms resolve, avoid consuming alcohol and marijuana, as these lower inhibitions and stimulate hunger.
3. Practice “mindful” eating
Mindful Eating is just one philosophy on how to maintain a healthy psychological relationship with food. It focuses on making peace with all types of food, while dissolving the stigma of “good” and “bad” foods.
In 1995, dietitians Evelyn Tribole and Elyse Resch outlined and published The 10 Principles of Intuitive Eating to guide patients on their mindful road to recovery. The principles include: (10)
- Reject the “diet” mentality: There is no universal diet that will allow everyone to lose weight quickly, easily, and permanently. Dieting is often not sustainable sustainable. It’s better for someone to adopt a new lifestyle of eating, as this brings lasting change.
- Honor your hunger: The brain sends hunger cues out of necessity, so it is important to provide the body with adequate energy and carbohydrates. If someone goes through periods of starving, then excessive hunger leads to overeating. It is a process to learn how to trust and respond to hunger cues.
- Make peace with food: There is no such thing as a purely “good” or “bad” food. By making certain foods “off limits”, it creates feelings of guilt when you do partake.Tribole and Resch recommend that people give themselves permission to eat any food, just in moderation.
- Challenge the food police: The inner negative dialogue where you tell yourself that you are good or bad for eating certain foods stems from diet culture. Openly disobey and disagree with the inner voice deep in your psyche. With time, the voice will become quieter, and eventually fade away entirely.
- Discover the satisfaction factor: Eating can bring immense pleasure. Learn to fall in love with eating again. When done in a healthy way, eating does not have to feel like a battle stepped in guilt and shame.
- Feeling of fullness: Practice mindfulness to know when you are no longer hungry. Become attuned to feeling satiated as opposed to “stuffed,” and respect that boundary. Pause at regular intervals while eating and notice if you’re still hungry and how the food tastes.
- Cope with your emotions with kindness: Food restriction triggers feelings of loss of control, which can lead to emotional eating. Many eat to assuage anxiety, anger, and boredom. Approach your emotions with self compassion, and find other ways to deal with difficult emotions. Food can partially numb or distract you from pain, but does not solve the underlying issue.
- Respect your body: Develop a deep acceptance and appreciation for your body shape and size. Media and diet culture advertise that to be attractive, people must be muscular and rail thin. It is impossible for someone with a medium or tall body to fit into a size zero pant. Set realistic expectations and avoid being overly critical.
- Move and feel the difference: Develop a routine of being active for the love of movement. Approach exercise or a sport because you enjoy it, and not just with the intention of burning calories and losing weight. This makes movement an easy habit instead of a daily chore.
- Honor your health: Gentle Nutrition. Focus on progress, not perfection. Make the majority of what you eat nutritious, but you do not have to eat perfectly healthy 100% of the time.
Mindful eating is just one practice that can be helpful to individuals looking to re-examine their psychological relationship to food, particularly in patients recovering from NES or other eating disorders.