Why would someone eat buttered cigarettes? Maybe they’d do it as a prank, or to pledge at a sorority. But who would do this at night in the kitchen with nobody watching? You’d do it if you had sleep-related eating disorder (SRED).
What is sleep-related eating disorder?
SRED was not described in the medical literature until 1991. Up to then, experts only recognized “night eating syndrome” (NES). NES is now considered an eating disorder, like anorexia and bulimia. In contrast, sleep-related eating disorder is now considered to be a parasomnia, similar to sleepwalking.
The difference is important. People with NES are awake and aware of what they are doing. They may be unable to sleep because of hunger. Often they are struggling with weight issues and the difficulties of dieting. By contrast, people with sleep-related eating disorder are actually asleep.
Most people diagnosed with SRED are women in their 20s or 30s. But when you ask the right questions, you find that almost all of these had been sleep-eating since childhood. Substantial number of sleep-eaters also have other eating disorders. It’s a shame that sleep-eating is not recognized sooner. By the time the correct diagnosis is made, the majority of sufferers are already obese, with all the health problems that go along with it.
Sleep-eaters most often do not remember any of the details of what they do at night, though most people with the disorder sleep-eat every night, sometimes more than once per night. The episodes have nothing to do with hunger or thirst. This is another important difference between SRED and NES.
Sleep-eaters will often eat more than half their daily calorie intake at night. And it tends not to be the healthiest food: Typically, sleep-eaters chow down on foods high in sugar and complex carbohydrates. It’s not unusual that sleep-eaters will become obese, mostly because of food they don’t remember eating.
Some of the things sleep-eaters indulge in are not exactly delicacies. They’ve been known to eat buttered cigarettes and frozen food (meaning food that is actually frozen when they eat it!)
And sleep eaters risk harming themselves in the kitchen. They’ve been known to cut themselves on sharp cans, or burn themselves on stovetops or toasters. I’ve read reports of sleep-eaters waking in the morning with their hands and face covered in chocolate. And sleep-eaters tend not to clean the kitchen either.
Who gets sleep-related eating disorder?
Like other parasomnias, SRED often happens in conjunction with other unwanted sleep behaviors, like sleepwalking and restless legs syndrome. Like NES, it’s more common in people with eating disorders. Episodes are more likely to happen during periods of stress. It’s possible that some sleep-eaters are struggling with some psychological conflict, having to do with control and loss-of-control. It’s possible these conflicts are played out in sleep.
Also like other parasomnias, SRED occurs in the midst of “sudden partial awakenings“. These events are defined by rising quickly out of very deep sleep, but not completely. The sleep-eater is then caught between sleep and wakefulness, and is for all intents and purposes unconscious. Though some people are prone to sudden partial awakenings, others can be induced if their sleep-wake cycle are disrupted. Sometimes the disruptions are purposeful, as with college students who keep irregular hours. Others experience disruptions because of sleep medications (!) like Ambien.
Diagnosing sleep-related eating disorder
The first step in diagnosis is recognizing that something is going on. The sleep-eater will probably not remember what she has done. The evidence may be found in a messy kitchen. Sometimes the only evidence is a child gaining weight for no apparent reason. If the child is known to sleepwalk, or there is a family history of parasomnias, you might suspect sleep-eating.
The clincher for a diagnosis is a sleep study. This is an overnight test performed in a laboratory. The sleeper is observed with all kinds of monitors attached. The key part of the test is an EEG. This will indicate if the sleeper is having sudden partial awakenings.
Treating sleep-related eating disorder
Once the correct diagnosis is made, the key is to identify the underlying triggers. For many sleep-eaters, this means locating sources of stress and anxiety. Easier said than done, I know, but you don’t do a child any favors by treating a symptom and ignoring the causes.
In the meantime, it’s important to make the kitchen as safe as possible. Keep cabinets locked. Secure cooking devices that could cause burns. Hide away or otherwise secure sharp objects.
Some medications have been used successfully in the treatment of SRED. These are psychiatric medication, so we do not know how or why they work. I counsel clients to resort to medications only if the weight problem is threatening health problems that are worse than the side-effects of medication.
Finally, the basic rules apply: make the child’s day as regular and predictable as possible. Have a consistent bedtime. Make sure she is eating a healthy diet during the day. This will help reduce night-time sub-conscious urges. And make sure she gets plenty of vigorous exercise.
Once any potential medical problems have been ruled out, a sleep coach can help you fix the sleep problem. I’d be happy to help you! Check out our sleep packages.