Night Eating Syndrome

Foods eaten during these episodes are often high in caloric content and unhealthy. These eating episodes usually occur in secret and any evidence of them is often hidden from others.
Studies have proven that this behavior seems to be totally beyond the effected individual's control. People who suffer from Night Eating Syndrome are often caught in the vicious cycle of binge eating during the night and eating less during the day and are unhappy with their weight.

Triggers for Night eating syndrome

Triggers for Night Eating Syndrome include:

• depression,
• anxiety,
• interpersonal stressors,
• boredom,
• prolonged dieting,
• body image dissatisfaction

Several studies have proven that this night eating may temporarily relieve the stress, but in most cases these episodes are followed by feelings of guilt, shame, disgust, and further depression.

Nature of the condition

Night eating syndrome is now recognized as a specific type of eating disorder. To be more precise, it is considered a parasomnia, and is a rare type of sleepwalking, a disorder of arousal. It is also recognized as a mood disorder.

Night eaters are much more likely to suffer from insomnia, and wake up on average 10-12 times more often than people without this condition. There is a strong connection between the Sleep eating syndrome and Sleep walking. The people suffering from this disorder are not conscious during their night eating episodes. They cannot recall the eating incidents because these episodes occur in a state which is somewhere between sleep and wakefulness.

Incidence of the condition

Night eating syndrome was first described in 1955 and, similar to anorexics, bulimics, and compulsive overeaters, it is estimated that up to one percent of the population may be suffering from Night Eating Syndrome. A very big study suggested that more than a 27% of people who are overweight by at least 100 pounds have the problem.

Signs and symptoms

There are many symptoms which are characteristic only to this condition and the most common are:

• little or no appetite for breakfast.
• delaying the first meal for several hours after waking up.
• eating more food after dinner than during the meal.
• waking up and leaving the bed to snack at night usually without being aware of what’s going on - foods ingested are often carbohydrates: sugary and starchy
• feeling tense, anxious, upset, or guilty while eating normally during the day.
• trouble falling asleep or staying asleep

What kind of food do they eat?

Food consumed during Night eating syndrome episodes tends to be high-fat, high-sugar comfort food that people deny themselves while awake. Some researches have shown that in some cases these people eat bizarre combinations of food or non-food items like soap.

Possible causes of Night Eating Syndrome

The underlying causes are being identified step by step although the exact nature of the condition is still unknown. The research done so far has shown that it seems likely that the causes of this condition are a combination of

• biological,
• genetic,
• emotional factors

Stress as a possible cause

There are several theories which have postulated that people with this condition are under stress, either recognized or hidden. The patient who’s under stress is flooded with cortisol, a stress hormone. This night eating may be the body's attempt to neutralize cortisol or slow down its production, and indirectly relieve stress. Stress-reduction programs, including mental health therapy, seem to help people with Night eating disorder! Another proof that the people with this disorder eat because they’re under stress is that they usually choose food rich in carbohydrates which produce the feeling of happiness when consumed.

Heredity as a possible cause

Several researches have proven that Night eating syndrome may run in families.

Dieting as a possible cause

Many of those affected by the syndrome diet during the day. This is leaving them hungry and very weak to binge eating during the night when their control gets weakened by sleep.

Other conditions as a possible cause

Some people have medical histories of drug abuse, alcoholism, and other sleep disorders such as restless legs, sleep apnea, and sleep walking.

Biochemical and behavioral changes

The typical behavioral characteristics of the night eating syndrome are:

• morning anorexia,
• evening hyperphagia
• insomnia

What really happens in the brain of those affected with this condition? The neuroendocrine characteristics have been described as changes in the circadian rhythm by attenuation in the nocturnal rise of the plasma concentrations of melatonin and leptin. Leptin, the "hunger hormone" which rises at night to suppress appetite, was also lower in the Night eating syndrome patients, partly explaining their nocturnal food cravings. There is also an increased circadian secretion of cortisol.

These people also have disbalance in the expression of hypothalamic-pituitary-adrenal axis with an attenuated response to stress. It is proven that the mechanisms behind the increased CRH stimulation may involve alterations in the neurotransmitter systems, causing increased nocturnal appetite and disruption in the sleep pattern.  
 

Treatment of Night eating syndrome

Medical interview and examination
Treatment starts with a medical interview as well as spending a night or two in a good sleep. Patient should be scheduled for a complete physical exam and also an evaluation with a counselor experienced in the treatment of eating disorders and sleep disorders.

Making a good diet plan
A qualified dietitian can help develop meal plans that distribute the food intake more evenly throughout the day so that a patient is not so vulnerable to caloric loading in the evening.

Evaluation in a sleep laboratory
Several researches have proven that evaluation in a sleep laboratory could be worthwhile. The problem is that it is not yet clear whether night eating is an eating disorder, sleep disorder or both.
In these laboratories the sleep patterns are monitored for a whole night and so that any abnormalities may be evaluated.

Medications
Although medications are sometimes helpful, patients should avoid taking sleeping pills because they can aggravate sleep disorder by adding to the clumsiness and confusion upon waking up and may cause them injury. Some researches have came to the conclusion that patients respond well to the treatment with the SSRI sertraline (a prescription medication).
 
Hormones and amino-acids
Therapy which has shown to be beneficial is based on next principles:

• to increase the natural nocturnal rise in melatonin,
• to reduce the body's adrenal stress response
• to raise leptin levels or improve leptin sensitivity

Some experts say that tryptophan, an important amino acid in the body, could have the major role. More than 70% of food consumed in Night eating syndrome episodes consist of carbohydrates - foods which are believed to increase the amount of tryptophan available for conversion to serotonin, the calming neurotransmitter in the brain.

Some useful Tips

• Try to eat a complete breakfast, even though may not feel hungry.
• Choose high fiber, filling foods such as salads, beans, nuts, lean meats, and whole grains for lunch.
• Have a small, but healthy meal such as soup and salad, or a bean salad and a slice of whole grain bread at the dinner time
• Refrain from desserts after dinner as much as possible, since this may restart the cycle of late night eating. Instead try to choose fruit or herbal tea after dinner if you’re still looking for something with a little sweetness.
• If you have feelings of depression, anxiety, or overwhelming stress, you should seek professional help.