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Night eating syndrome (NES) is a sleep-related eating disorder where a person eats more food at night than during the day. It is defined as an "Other Specified Feeding and Eating Disorder" (OSFED) by the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5).1
Night eating syndrome doesn't always receive the same attention as other well-known eating disorders, such as anorexia and bulimia. But the lack of notoriety does not minimize the struggles of approximately 1.5% of the general population, who identify as having night eating syndrome.1
Night eating syndrome is a complex eating pattern that involves a person eating more at night than during the day. NES is not the same as snacking, which, more often than not, is an integral part of someone's recovery.
Instead, the DSM-5 defines night eating syndrome as recurrent eating patterns at night, and it's typically characterized by:2
Eating more than usual at night after a meal
Excessive food consumption after an evening meal
Awakening in the middle of sleep to eat
A lack of control or dissociation during the eating experience
Eating until feeling uncomfortably full
Eating more rapidly than usual during the episode
Since it falls under OSFED in the DSM-5, it may also meet some (but not all) of the diagnostic criteria of other eating disorders like binge eating disorder.
Diagnosing night eating syndrome
The primary identifying characteristic of night eating syndrome is eating at least 25% of
your daily food intake at night after the evening meal.1
A night eating symptom scale measures the severity of night eating syndrome.
For diagnostic purposes, it's said that a person is fully aware of their night eating and can recall it the next day, as it usually causes them significant distress.
To diagnose night eating syndrome, clinicians use the following methods:
Night Eating Questionnaire (NEQ)
Night Eating Diagnostic Scale (NEDS)
Night Eating Syndrome History and Inventory (NESHI)
Signs & symptoms of night eating syndrome
The above-mentioned DSM-5 signs are sometimes accompanied by night eating symptoms associated with other eating disorders, including:
Low self-esteem
Depression and/or anxiety
A strong need for approval
Being extremely self-critical
Stealing and/or hoarding food
Gastrointestinal symptoms
Denial about hunger
Effects of night eating syndrome
Night eating syndrome is more than a midnight "snack attack." These eating behaviors may cause many problems for the individual if it's not taken seriously or not addressed by a healthcare professional.
Short-term
The short-term effects of night eating syndrome may include:
An inability to sleep
A loss of appetite
Moodiness
Fatigue
Eating more rapidly to feel more satisfied
Long-term
When it comes to the long-term effects of night eating syndrome, patients may experience:
Night eating syndrome is not always a standalone disorder. Instead, many experts believe it is closely related to other disordered eating conditions, most notably binge eating disorder and bulimia nervosa.
42-75% of those with an eating disorder also have other psychiatric disorders.4
Many individuals with an eating disorder also struggle with co-occurring mental health or behavioral disorders. Between 42-75% of people with an eating disorder also manage a variety of psychiatric disorders, including:4
Mood disorders (e.g., depressed mood)
Obsessive-compulsive disorders
Personality disorders
Treating night eating syndrome
The behaviors associated with night eating syndrome may be caused by various internal and external factors, such as:
Other underlying eating disorders
Stress
Depression
Anxiety
Body image issues
It's essential to address and deal with the underlying factors to help the individual cope with the symptoms associated with eating disorders, especially when the symptoms are severe and persistent.
Therapies for night eating syndrome
Many therapies and techniques are helpful for those with NES.
Like all eating disorders, NES requires comprehensive biopsychosocial assessment and treatment, which is to say, an assessment of the patient's biological, psychological, and socio-environmental factors and how they relate to NES.
One of the most effective treatments for the disorder is cognitive behavioral therapy, which includes various interventions designed to help the individual develop healthier eating habits and learn new coping skills to deal with life's stressful situations.
Medications for night eating syndrome
Generally, there are no medications specifically designed to treat night eating syndrome. However, some treatments can help address related issues, including antidepressants and selective serotonin reuptake inhibitors (SSRIs).1
Some medications may exacerbate night eating syndrome, including sedative hypnotics.
When seeking out treatment for NES, remember that some medications may be associated with exacerbating night eating syndrome, including sedative hypnotics, which can cause individuals to engage in behaviors they normally engage in while awake (including eating).
Understanding night eating syndrome
Individuals with night eating syndrome may undereat during the day, feel shame around eating, and experience a sense of dissociation when eating alone at night. Not being fully aware of the behavior creates decreased inhibition, reinforcing the behavior. Additionally, the sense of security and comfort the individual might feel through eating further reinforces the behavior.
The exact reasons why people who have NES ingest more food after a meal are unclear, but researchers hypothesize that it may be related to an inability to fall asleep at night or a change in the way a person's body functions metabolically at night.
It's believed that those with NES suffer from disruption to their circadian rhythm or a circadian rhythm sleep disorder, which involves difficulty falling asleep, waking up during the sleep cycle, and/or having difficulties or the inability to fall back asleep.5
Living with night eating syndrome
The symptoms of night eating syndrome can be exhausting to endure. The person with NES may be uncomfortable because they feel bloated throughout the night, making it difficult to sleep or breathe.
In many cases, the person with NES may already be under tremendous stress and anxiety, worsening their situation. In addition, a lack of proper sleep habits due to NES can lead to insomnia, anxiety, and stress throughout the day, making them feel mentally and physically exhausted.
The most important thing to do when dealing with eating disorders is to seek treatment. Many treatment programs and therapies can be helpful for those suffering from night eating syndrome, and it's crucial to find the ones best suited for you.
There are also many ways to help with the symptoms of NES on a day-to-day basis.
Patients can do things like:
Develop a plan to eat consistently and adequately throughout the day
Practice mindfulness during the day
Keep a food journal
Explore if there are underlying rigid beliefs about eating and/or internalized shame related
to eating alone or with others
Create a night-time routine that includes relaxation techniques, a mindfulness practice,
or other forms of self-care
Learn to differentiate the different types of hunger
Explore relationships with food and body
Get adequate sleep
History of night eating syndrome
Discussion of night eating syndrome dates back to 1955 when psychiatrist Albert Stunkard, a leading specialist in eating disorders, first described it as a behavioral issue amongst those with a higher-than-average weight.6
It wasn't until 2013 that it was given its clinical entry into the DSM-5 as one of many Other Specified Feeding and Eating Disorders.
How to help someone with night eating syndrome
Not everyone can cope with night eating syndrome on their own, nor should they have to hide their condition. As the disorder can cause serious health problems, getting support from friends and family and seeking professional help is essential.
Here are a few ways to help your loved ones with NES:
Support them regardless if they night eat or not
Help them identify and utilize their coping skills
Be objective and don't give advice unless asked for it (e.g., "You seem tired today. How can I support you?")
Provide emotional support during the times when the person feels most vulnerable and let them know when you can and cannot be of support
Know you aren't responsible for fixing anything
Help is just a phone call away
Within Health works with you,
wherever you are, to provide compassionate treatment for eating disorders like night eating
syndrome. Call our admissions team to start your healing process and rebuild a healthy
relationship with food.
Disclaimer about "overeating": Within Health hesitatingly uses the word "overeating" because it is the term currently associated with this condition in society, however, we believe it inherently overlooks the various psychological aspects of this condition which are often interconnected with internalized diet culture, and a restrictive mindset about food. For the remainder of this piece, we will therefore be putting "overeating" in quotations to recognize that the diagnosis itself pathologizes behavior that is potentially hardwired and adaptive to a restrictive mindset.
Disclaimer about weight loss drugs: Within does not endorse the use of any weight loss drug or behavior and seeks to provide education on the insidious nature of diet culture. We understand the complex nature of disordered eating and eating disorders and strongly encourage anyone engaging in these behaviors to reach out for help as soon as possible. No statement should be taken as healthcare advice. All healthcare decisions should be made with your individual healthcare provider.
Night eating syndrome (NES) is a condition that affects your ability to control your eating habits at night.
What are the most common characteristics of someone with NES?
People who suffer from NES often experience periods of excessive eating during the night. The person may then wake up feeling hungrier than usual in the morning. The stomach may also feel bloated.
A person with NES is often extremely tolerant of hunger and may often go without eating for long periods. In addition to hunger, the individual with NES may feel extremely thirsty. Feelings of faintness may also be experienced.
How is NES treated?
There is no sure-fire cure for NES, and it is a recurring disorder that may require ongoing medical and psychological interventions. Psychiatric care may help address any underlying psychiatric conditions that the night eating compensates for. At the same time, psychotherapy can begin to address underlying beliefs and/or patterns related to food, weight, and eating.
Nutritional therapies can help the person unlock beliefs and habits around food that can lead a person to be vulnerable to NES. Medical treatment may include a combination of lifestyle modifications, medication, and some form of therapy.
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