The Midnight Munchies: Understanding Night Eating Syndrome
Although night eating syndrome (NES) can have a significant impact on mental and physical health, it is possible to treat this eating disorder.
While it’s common for people to enjoy a midnight snack occasionally, if excessive nighttime eating starts affecting daily life, it may indicate NES.
Individuals who consume a large portion of their daily meals during the night or use food to cope with sleep difficulties may have night eating syndrome. Additionally, they may not feel hungry in the morning and delay eating until late afternoon.
However, it can be difficult to determine if someone should be concerned about their late-night eating habits.
What is night eating syndrome?
Night eating syndrome (NES) is a disorder that is characterized by excessive food consumption at night or after awakening, with individuals often feeling a strong urge to eat from dinner until bedtime. Additionally, people with NES may experience difficulty staying asleep and may wake up throughout the night to eat.
In 1955, NES was initially characterized by symptoms such as not feeling hungry and skipping breakfast, consuming around 25% of daily food intake after the evening meal, and experiencing insomnia.
However, NES is currently classified as a subtype of Other Specified Feeding or Eating Disorders (OSFED) by the DSM-5. Other subtypes of OSFED include atypical anorexia nervosa, low frequency or limited duration binge eating disorder (BED), low frequency or limited duration bulimia nervosa, and purging disorder.
According to surveys conducted in the 1990s, it was found that NES may impact about 1.5% of the general population and between 9% to 27% of individuals with obesity.
Individuals who have NES may be susceptible to other health issues such as high blood pressure and diabetes. According to a study conducted in 2014, 7% of individuals with type 2 diabetes met the diagnostic criteria for NES.
Signs of night eating syndrome
Night eating syndrome symptoms can overlap with other eating disorders and mental health conditions. However, if you or someone you know experiences the following signs, it may indicate NES:
- A strong urge to eat between dinner and bedtime
- Difficulty sleeping and feeling the need to eat to fall asleep again
- Increased anxiety or depression in the evening
- Consuming more than one-quarter of your daily food intake at night
- Not feeling hungry or skipping breakfast, and eating only in the late afternoon
- Experiencing shame and guilt related to eating patterns.
Diagnosis
To diagnose NES, medical professionals may use tools such as the Night Eating Diagnostic Questionnaire (NEDQ) or the Night Eating Diagnostic Scale (NEDS). Additionally, doctors may reference the DSM-5 criteria for NES and ask about your medical history and any preexisting mental health or physical conditions.
The DSM-5 outlines specific criteria for diagnosing NES, which typically include:
- Consistent episodes of consuming food after dinner or waking up from sleep and consuming food
- Awareness and memory of the eating episodes
- The behavior is causing significant distress or impairment in daily functioning
In order for a diagnosis of NES to be made, the symptoms cannot be attributed to underlying medical or mental health conditions, the presence of binge eating disorder (BED), the effects of certain medications, changes in the sleep-wake cycle, or cultural or social norms.
Related conditions
Excessive food consumption may also be caused by depression, anxiety, and stress. Moreover, these mental health disorders commonly coexist with NES. Furthermore, night eating syndrome shares certain symptoms with other eating disorders.
Binge eating disorder (BED)
Night Eating Syndrome (NES) and Binge Eating Disorder (BED) have similarities in terms of increased food consumption, but there are also differences. BED is characterized by consuming a large amount of food during the day and experiencing more hunger than individuals with NES. The motivation for eating may also vary between the two disorders.
Bulimia nervosa
People who have bulimia nervosa may struggle with controlling their urge to eat large amounts of food, similar to those with NES. However, individuals with bulimia often resort to purging behaviors such as vomiting or excessive exercising to compensate for the effects of their food intake.
Sleep-related eating disorder (SRED)
While NES and SRED share similarities in that they both involve eating during the night, SRED is a sleep disorder where individuals eat during a state of partial arousal, similar to sleepwalking. On the other hand, people with NES are fully awake and conscious when eating at night.
Possible night eating syndrome causes
There is limited research on the causes of NES, but multiple factors may contribute to the development of the disorder.
Circadian rhythm disorders
In 2020, a study found that individuals with NES may experience notable alterations in their circadian rhythm and the internal mechanisms that control metabolism and eating behavior.
Although circadian rhythm differences have been suggested as a factor in NES, a 2019 study found that this may vary among individuals. Specifically, researchers found that some individuals with NES may have the same rhythm of clock gene expression as those who do not have the condition.
Mental health conditions
A bidirectional relationship may exist between NES and depression or anxiety, with each potentially contributing to the development of the other.
A cross-sectional study conducted in 2021 found that individuals who consumed more food in the evening or throughout the night had higher scores for anxiety and depression compared to those without NES.
However, it is important to note that symptoms of anxiety and depression may also contribute to the development of NES.
Other eating disorders
A study from 2019 suggests that a significant percentage of people with NES also have another co-occurring eating disorder, ranging from 5% to 44%. Specifically, around 15% to 20% of people with NES also have BED.
Substance use disorders (SUD)
Substances can affect brain chemicals, leading to increased urges to binge eat at night in individuals with NES. This is particularly noticeable when the individual abstains from the substance.
For instance, during smoking cessation, a smoker may experience an increase in food consumption.
Overcoming night eating syndrome
If you are experiencing NES, it is important to know that you are not alone and the condition is not a result of a lack of willpower or personal fault.
Effective treatment options are available for NES, and it is possible to learn how to manage its symptoms. The first step towards getting help is usually to speak with a doctor about your symptoms.
Treatment options
A review conducted in 2019 found that there is a lack of long-term data regarding the effectiveness of different treatment options for NES, which may be due to a low level of awareness about the condition. Stigma surrounding eating disorders could also be a contributing factor in the underreporting of symptoms.
While the effectiveness of various treatments for NES is not well-established due to low awareness and underreporting, a multifaceted approach to treatment is often used. This approach may include medications, such as antidepressants, as well as various therapies, such as progressive muscle relaxation therapy and phototherapy.
Bariatric weight loss surgery may also be considered as a treatment option in some cases.
A doctor and therapist can work with you to find the best possible treatment plan. It’s common to try multiple strategies before finding the right combination.
What’s Next
If you find yourself eating a significant amount of food after dinner or experiencing difficulty sleeping due to nighttime eating urges, you may be exhibiting symptoms of NES.
While eating at night is common for many people, a visit to a doctor is necessary to diagnose NES, which involves screening for DSM-5 criteria.
If diagnosed, treatment options are available, and a healthcare professional can help determine the best approach.
Typically, NES treatment involves a combination of therapies and medications, and it may require trying various strategies before finding the most effective one.
Resources for eating disorders
For more information on NES or for help with navigating this condition, you can contact the National Eating Disorders Association (NEDA) helpline via online chat, or call or text (800)-931-2237. For urgent help, you can text “NEDA” to 741741 to reach their Crisis Text Line.
The National Alliance for Eating Disorders has an interactive database to find options near you.
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