Eating Disorders and Sleep: Understanding the Connection

Eating disorders and sleep are closely intertwined, suggesting that individuals with eating disorders often experience disruptions in their sleep patterns. These disorders can significantly impact an individual's physical and mental well-being.

Individuals with eating disorders frequently report sleep disturbances, such as difficulty falling asleep, frequent awakenings, and poor sleep quality. Understanding the relationship between eating disorders and sleep is crucial for developing effective treatment strategies and improving overall patient outcomes.

What’s the relationship between sleep and eating disorders?

What are sleep-related eating disorders?

Sleep-related eating disorders (SRED) are a group of conditions characterized by abnormal eating behaviors during sleep. People with SRED will consume food and beverages while asleep, often in large quantities and without any recollection of the event upon waking.

How do sleep-related eating disorders affect sleep?

Types of eating disorders, such as sleepwalking or night terrors, can accompany SRED episodes, which occur during the non-rapid eye movement stage of sleep. SRED can have detrimental effects on a person's physical and mental health, leading to weight gain, nutritional deficiencies, and disrupted sleep patterns.

Common Eating Disorders Types

Binge Eating Disorder (BED)

A serious eating disorder known as binge eating disorder (BED) is characterized by recurrent episodes of consuming a lot of food in a short period while frequently feeling out of control.

• Symptoms: BED symptoms include eating rapidly, eating until uncomfortably full, eating alone due to embarrassment, and feelings of guilt or disgust after a binge. Individuals with BED may also experience weight gain, poor body image, and low self-esteem.
• Health Risks: The frequent consumption of large amounts of food can lead to obesity, which in turn increases the risk of developing various health problems such as high blood pressure, diabetes, heart disease, and certain types of cancer. BED can also have a significant impact on mental health, leading to depression, anxiety, and social isolation.

Bulimia Nervosa

An eating disorder known as bulimia nervosa is characterized by recurrent episodes of binge eating and purging behaviors. Individuals with bulimia often feel a loss of control during these binge episodes and resort to methods such as self-induced vomiting, excessive exercise, or the use of laxatives to compensate for their overeating.

• Symptoms: The symptoms of eating disorders such as bulimia include a preoccupation with body image, a fear of gaining weight, and a distorted perception of one's body shape. Other signs may include frequent weight fluctuations, dental problems, and scars on the back of the hands from induced vomiting.
• Health Risks: The constant cycle of bingeing and purging can lead to electrolyte imbalances, which can cause heart problems and even cardiac arrest. Frequent vomiting can also lead to damage to the esophagus and throat, as well as dental problems due to exposure to stomach acids.

Anorexia Nervosa

Anorexia nervosa is an eating disorder that causes people to have an excessive fear of gaining weight and a distorted body image. Individuals with this disorder often have an intense desire to be thin, leading them to restrict their food intake and engage in extreme dieting behaviors.

• Symptoms: Common symptoms of anorexia nervosa include a relentless pursuit of thinness, a refusal to maintain a healthy body weight, and a preoccupation with food, calories, and body shape. Other signs may include excessive exercise, social withdrawal, and a distorted perception of one's body size or shape.
• Health Risks: Extreme food intake restriction can lead to extreme weight loss, causing the body to enter a state of starvation. This can result in a range of physical complications, such as organ damage, bone loss, and hormonal imbalances. Additionally, individuals with anorexia nervosa may experience psychological symptoms such as depression, anxiety, and obsessive-compulsive behaviors.

Avoidant/Restrictive Food Intake Disorder (ARFID)

Avoidant/Restrictive Food Intake Disorder (ARFID) is a complex eating disorder characterized by a persistent and severe lack of interest in or avoidance of certain foods. Individuals with ARFID often have a limited range of preferred foods, which can result in significant nutritional deficiencies and poor overall health.

• Symptoms: ARFID symptoms include refusing to eat certain foods based on their texture, taste, or appearance. Individuals may also experience anxiety or distress when faced with new or unfamiliar foods.
• Health Risks: Individuals with this disorder often have a limited range of accepted foods, so they may not consume enough calories or essential nutrients to support proper bodily functioning. This can result in malnutrition, a weakened immune system, impaired growth and development, and an increased risk of developing other medical conditions.

Pica

Pica is a disorder characterized by the persistent and compulsive consumption of non-food substances. Individuals with pica often crave and ingest dirt, clay, hair, paper, or even metal objects. People of all ages can suffer from this disorder, but children and pregnant women are the most commonly affected.

• Symptoms: Pica symptoms can vary depending on the substances consumed, but common signs include persistent cravings, the ingestion of non-nutritive substances, and the presence of nutritional deficiencies.
• Health Risks: Pica can lead to various complications, such as gastrointestinal blockages, poisoning, infections, and malnutrition.

Rumination Disorder

Rumination disorder is an eating disorder characterized by the regurgitation and re-chewing of previously swallowed food. This disorder typically occurs in infants, children, and individuals with intellectual disabilities.

• Symptoms: Rumination disorder is characterized by repeated regurgitation of food, re-chewing of food, weight loss, and bad breath.
• Health Risks: If left untreated, rumination disorder can lead to serious health risks such as malnutrition, dehydration, and dental problems.

Types of Sleep-Related Eating Disorders

Night Eating Syndrome (NES)

Night Eating Syndrome (NES) is a relatively rare eating disorder characterized by a disrupted eating pattern at night. Individuals with NES often consume a significant portion of their daily calorie intake after dinner and have difficulty falling asleep without eating.

• Symptoms: NES symptoms include recurrent episodes of waking up at night to eat, consuming an excessive amount of food during these episodes, and feeling distressed or guilty afterward.
• Health Risks: Excessive nighttime eating can lead to weight gain and obesity, as the consumption of high-calorie foods during the night can easily exceed daily energy requirements. This can increase the risk of developing other health conditions, such as diabetes, cardiovascular diseases, and sleep disorders. Additionally, the disrupted sleep patterns caused by NES can lead to fatigue, decreased productivity, and mental health issues.

Medication-Induced Sleep-Related Eating Disorder

Medication-induced sleep-related eating disorder is a rare but potentially serious condition that occurs as a side effect of certain medications. It is characterized by episodes of compulsive eating during sleep, often involving the consumption of large quantities of food that the individual has no recollection of the next day.

• Symptoms: This disorder may include frequent waking up at night, weight gain, and feeling out of control during nighttime eating.
• Health Risks: Sleep disturbances caused by these episodes can harm overall sleep quality and daytime functioning, in addition to consuming large amounts of high-calorie foods during these episodes, leading to weight gain and potential complications such as obesity, diabetes, and cardiovascular problems.

Nocturnal Sleep-Related Eating Disorder (NS-RED)

Nocturnal sleep-related eating disorder (NS-RED) is a sleep disorder in which individuals eat while asleep. The individual and their sleep partner may experience excessive food consumption and nighttime disturbances due to this disorder.

• Symptoms: NS-RED symptoms include waking up at night to eat, consuming large amounts of food while asleep, and feeling guilty or ashamed about the behavior. Individuals with this disorder may also experience weight gain due to their nighttime eating, which can contribute to excessive calorie intake.
• Health Risks: Excessive calorie intake during the night can contribute to weight gain and obesity. This can increase the risk of developing other health conditions, such as diabetes, heart disease, and high blood pressure. Additionally, NS-RED can disrupt sleep patterns, leading to daytime sleepiness and reduced overall quality of life.

Sleep-Related Eating Disorder Due to Another Medical Condition (SRED-MC)

Sleep-related eating disorder due to another medical condition (SRED-MC) is a rare sleep disorder characterized by abnormal eating behaviors during sleep. Individuals with SRED-MC may consume food and drink without any recollection of the events upon waking up. This disorder typically occurs in individuals who have an underlying medical condition such as restless leg syndrome, sleep apnea, or nocturnal seizures.

• Symptoms: SRED-MC symptoms may include nocturnal eating, consuming unusual or non-nutritive substances during sleep, and experiencing significant distress or impairment due to these episodes.
• Health Risks: Consuming large quantities of food during sleep can lead to weight gain and related health issues such as obesity and diabetes, and individuals with SRED-MC might experience daytime fatigue due to not being able to get a restful night’s sleep.

Eating Disorders Causes

Genetic Predisposition

Usually, individuals with a family history of eating disorders are more likely to develop one themselves. This suggests that there may be certain genes that increase the risk of developing an eating disorder.

However, it is important to note that genetics alone do not determine whether or not someone will develop an eating disorder.

Psychological Factors

Psychological factors also play a significant role as one of the causes of eating disorders. Many individuals with eating disorders struggle with low self-esteem, perfectionism, and a negative body image.

These psychological factors can contribute to a distorted perception of one's body and lead to an obsession with food, weight, and shape.

Additionally, individuals with eating disorders often use food as a way to cope with difficult emotions or to gain a sense of control in their lives.

Stressful Life Events

When individuals experience traumatic events or significant changes in their lives, they may turn to disordered eating as a coping mechanism. These events could include the loss of a loved one, divorce, or financial difficulties.

The stress and emotional turmoil that accompany these events can lead to a distorted relationship with food and body image.

Mental Health Disorders

Conditions such as depression, anxiety, and obsessive-compulsive disorder can increase the risk of developing an eating disorder. These mental health disorders often contribute to a negative self-image and a preoccupation with weight and appearance.

Food Intake Patterns

People with eating disorders often have disturbed eating behaviors, such as restrictive eating or binge eating. These patterns can develop as a result of various factors, including societal pressures, low self-esteem, and emotional distress. Individuals may use food as a way to cope with their emotions or to exert control over their lives.

Sleep

There is a link between poor sleep quality and an increased risk of developing an eating disorder. Sleep deprivation can disrupt the regulation of hormones involved in appetite and metabolism, leading to changes in food intake and weight regulation.

Additionally, a lack of sleep can impair cognitive functioning and emotional regulation, making it more difficult for individuals to make healthy decisions regarding food and body image.

Disruptions of Circadian Rhythm

Our circadian rhythms are the internal biological clocks that regulate our sleep-wake cycles and other bodily functions.

Disruptions in these rhythms, such as irregular sleep patterns or night eating syndrome, can affect our appetite and metabolism, leading to disordered eating behaviors.

To know more about circadian rhythm and how to regulate it, check out the article “Circadian Rhythm”.

Some Medications

Some medications, particularly those used to treat mental health conditions like depression or anxiety, can have side effects that affect appetite and weight.

For example, certain antidepressants may increase feelings of fullness or reduce appetite, leading to weight loss or changes in eating patterns.

Sleep-Related Eating Disorder Risk Factors

Restless Legs Syndrome

RLS sufferers report having uncomfortable, tingling, or creeping sensations in their legs that go away when they move. These sensations can disrupt sleep and lead to episodes of sleep-related eating.

Sleepwalking (Somnambulism)

While asleep, sleepwalkers engage in a variety of activities, including eating. The combination of impaired consciousness during sleepwalking and a lack of control over actions can contribute to SRED development.

Narcolepsy

Narcolepsy is a neurological disorder characterized by excessive daytime sleepiness and sudden loss of muscle control, known as cataplexy.

People with narcolepsy often experience disrupted sleep patterns and may engage in abnormal behaviors during sleep, including sleep-related eating.

Snoring

When the mouth and nose partially block the flow of air during sleep, snoring occurs, causing vibrations in the throat.

It can disrupt sleep and lead to fragmented sleep patterns, increasing the risk of engaging in sleep-related eating behaviors.

Obstructive Sleep Apnea

Repeated episodes of partial or complete blockage of the upper airway during sleep characterize obstructive sleep apnea (OSA), a condition associated with an increased risk of SRED.

OSA can cause frequent night awakenings and excessive daytime sleepiness, both of which can contribute to SRED development.

Learn More: Treating OSA with CPAP.

Treatments for Sleep-Related Eating Disorders

Behavioral Therapy

Behavioral Therapy is one of the most common treatments for eating disorders. This type of therapy focuses on identifying and modifying the behaviors and thought patterns that contribute to the disorder.

Behavioral therapy can help individuals develop healthier eating habits, establish regular sleep schedules, and address any underlying psychological factors that may be contributing to the disorder.

Individuals who work with a therapist or counselor can learn coping mechanisms and strategies to prevent nighttime eating episodes.

Medication

To help regulate sleep patterns and reduce eating disorder symptoms, physicians may use medications like selective serotonin reuptake inhibitors (SSRIs) or benzodiazepines.

However, for optimal results, it's crucial to use medication in conjunction with other treatments like behavioral therapy or sleep hygiene practices.

Improving Sleep Hygiene

Sleep hygiene refers to a set of habits and practices that promote healthy sleep patterns. This can include maintaining a consistent sleep schedule, creating a relaxing bedtime routine, avoiding stimulating activities before bed, and creating a comfortable sleep environment.

By implementing these practices, individuals with sleep-related eating disorders can improve their overall sleep quality and reduce the likelihood of nighttime eating episodes.

Dietary Management

Dietary management is often used as a treatment for eating disorders. This involves creating a structured eating plan that focuses on providing balanced and nutritious meals throughout the day. This can help regulate blood sugar levels and reduce the likelihood of nighttime cravings.

It is important to avoid trigger foods that may worsen the symptoms of SREDs, such as high-sugar or high-fat snacks.

Addressing Underlying Causes

Identifying and addressing any underlying medical conditions, such as sleep disorders or mental health issues, is crucial to managing SREDs effectively. Treating conditions like insomnia or anxiety can help improve sleep quality and reduce the occurrence of sleep-related eating episodes.

FAQs

How Can People With Eating Disorders Improve Their Sleep?

Establishing a consistent sleep routine is crucial. Going to bed and waking up at the same time each day helps regulate the body's internal clock. In addition, practicing relaxation techniques such as deep breathing or meditation before bed can promote better sleep quality.

How common are sleep-related eating disorders?

Sleep-related eating disorders (SRED) are a relatively rare condition, affecting only a small percentage of the population. SRED affects between 1% and 5% of the general population. However, it is important to note that these estimates may be conservative, as many cases of SRED go undiagnosed or misdiagnosed.

When do sleep-eating episodes happen?

Sleep-eating episodes typically occur during the night when an individual is in a state of sleepwalking or experiencing a sleep disorder known as sleep-related eating disorder (SRED).

Can sleep-related eating disorders be treated?

Eating disorder treatment varies depending on the severity of the symptoms, as there are many types of eating disorders. Behavioral therapies, such as cognitive-behavioral therapy, can be effective in helping individuals gain control over their nighttime eating behaviors. Medications, such as sedatives or antidepressants, may also be prescribed to help regulate sleep patterns and reduce episodes of SRED.

What are the warning signs of sleep-related eating disorders?

One common warning sign is finding evidence of food consumption during the night, such as empty food wrappers or crumbs in the bed or around the sleeping area. Another warning sign is waking up with unexplained weight gain or feeling bloated in the morning. Sleep-related eating disorders may also cause individuals to experience feelings of shame or guilt about their nighttime eating habits

Are sleep-related eating disorders more common in certain age groups?

Sleep-related eating disorders may be more common in certain age groups. These disorders are more prevalent in adults, particularly those in their late 20s to early 40s. However, it is important to note that sleep-related eating disorders can occur at any age, including in children and older adults.

Can medications cause sleep-related eating disorders?

Medications such as sedative-hypnotics, antidepressants, antipsychotics, and anti-seizure drugs have been associated with SRED. These medications may affect the brain's regulation of sleep and appetite, leading to abnormal eating behaviors during sleep. However, it is important to note that not everyone who takes these medications will develop SRED, and other factors, such as genetics and underlying conditions, may also play a role.

Conclusion

There is a clear link between eating disorders and sleep disturbances. The disruption of normal sleep patterns can have detrimental effects on the physical and mental health of individuals with eating disorders. Recognizing this connection is essential for healthcare professionals to provide comprehensive care for patients.

By addressing both eating disorders and sleep disturbances, clinicians can improve treatment outcomes and enhance the overall well-being of individuals struggling with this condition.