How to Recognize & Treat Night Eating Syndrome

We all snack in the evening from time to time. Popcorn while watching a movie, a slice of cake after a celebratory dinner, or a bowl of ice cream to satisfy a sweet tooth craving—a little nighttime snack is normal. In fact, 60 percent of Americans ages 18 to 80 report snacking after 8 p.m, so snacking after dinner is actually quite common. 

There are some individuals, however, who live with an eating disorder called night eating syndrome (NES), and for these people maintaining a healthy eating schedule is extremely difficult. They don’t just snack at night on occasion—they actually eat the majority of their caloric intake during evening and nighttime hours.

A lot of people hear about this condition and think it’s simply an unhealthy lifestyle choice. They view night eating as a bad habit, and believe it can be broken with a little determination and self-discipline. That isn’t always the case.

Studies show that approximately 1.5 percent of people in the United States experience night eating syndrome. That’s approximately 500,000 people who struggle to regulate their eating schedule to the point where it impacts their overall health.

So what is night eating syndrome? What are the signs and symptoms? And what does NES treatment look like?

We’ll be answering these questions in today’s blog. Keep reading for all the details.

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What is Night Eating Syndrome (NES)?

Night eating syndrome is a diagnosable eating disorder caused by an irregular circadian rhythm cycle, a natural internal process which controls how and when signals are sent from the brain that trigger automatic functions like sleep, thirst, and hunger.

Symptoms of Night Eating Syndrome

Before being diagnosed with a night eating disorder, a patient has to meet several diagnostic criteria, as defined by the DSM-5. These criteria include:

1. Nocturnal Eating Patterns

This is the primary symptom of nighttime eating syndrome. The person must either consume 25 percent or more of their daily caloric intake at night (after their evening meal) or they must experience nocturnal eating at least two evenings per week.

As per the DSM-5, any meal consumed after 5 p.m. is considered to be the evening meal. If the person doesn't eat a full evening meal, the first snack consumed after 5 p.m. is considered the evening meal (and all food consumed thereafter is considered “after dinner”). 

It’s important to note, however, that late-night eating that is justified by an uncontrollable external factor (such as working during the day and getting home late at night) is not a sign of night eating syndrome.

2. Insomnia or Interrupted Sleep

In addition to nocturnal eating patterns, those living with a night eating disorder also have trouble maintaining a regular sleep schedule. If the person experiences insomnia for a minimum of four nights per week over the course of three consecutive months, they meet the criteria for a medical diagnosis.

The prevalence of insomnia amongst night eating syndrome patients is also a result of irregular circadian rhythms. Since the body’s internal clock is off, the person may feel more alert and energetic in the evening. Many people also report feeling like they need to eat in order to induce a state of sleepiness.

3. Mood Fluctuations

Lastly, those who have been diagnosed with NES tend to experience depression, irritability, and low energy levels later in the day. They may feel a sense of hopelessness regarding their eating habits, believing they’ll never regain control or break out of their current cycle. These negative feelings can also be rooted in guilt or shame, since most people with NES are aware their eating habits aren’t healthy, but mistakenly believe their struggle is caused by a lack of willpower.

Causes of Night Eating Syndrome

If you frequently find yourself eating in the middle of the night or consuming large quantities of food after dinner, you’ve probably wondered “Why do I do this?” or “Why am I so hungry at night?”

As we mentioned above, most cases of NES are caused by an irregular circadian rhythm—but there are other health conditions and circumstances that can make a person more likely to develop a nocturnal eating disorder.

Here are some additional causes of NES:

1. Mental Health

Studies show those who are prone to binge eating at night tend to have considerably higher anxiety and depression scores—a strong indication that mental health could be an underlying risk factor. 

When our mental health isn’t well, it can be difficult to find motivation, practice self-compassion, or even complete basic daily tasks. This can cause a person to stay in bed all day (and therefore eat at night) or engage in unhealthy restrictive eating patterns in an attempt to feel better about how they look.

The exact nature of the relationship between mental health and NES isn’t fully understood but, hopefully, with more research we’ll learn more soon.

2. Hormone Imbalances

People with NES have been shown to have a decreased adrenal response compared to those without the condition, which causes low cortisol levels. When the body doesn’t have enough cortisol it experiences a range of symptoms, including fatigue, decreased appetite, low blood sugar, and more. It’s possible that a person with night eating syndrome could develop the disorder because of an underlying adrenal problem which impacts their desire to eat throughout the day.

3. Daytime Food Restriction

Unhealthy dieting is another factor that must be considered when determining the cause of NES. If a person restricts their calorie intake during the day in an effort to lose weight they’ll likely experience hunger pangs and food cravings later in the day—putting them at an increased risk for binge eating behaviors.

Our bodies require a certain number of calories to function optimally. When we do not eat enough food, or fail to meet our nutritional needs, we begin to operate at a deficiency, which can lead to malnutrition and a host of other concerns. This is why it’s so critical to consult with a registered dietitian or healthcare professional prior to adopting a new diet.

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NES Diagnosis and What to Expect

Before you can tackle how to stop eating in the middle of the night you’ll need to figure out if you actually have night eating syndrome or if there’s something else causing your symptoms—and that requires a medical diagnosis.

Here’s how to get an official NES diagnosis:

1. Start Recording Your Eating Habits

It’s nearly impossible for a healthcare professional to determine if you have a night eating disorder based on a physical examination. They’ll need to analyze your eating patterns over time, review your bloodwork, and conduct other assessments before they can make a sound judgment. We encourage keeping a journal of your eating and sleeping habits for at least a week prior to seeing a healthcare professional. This will give them enough information to take your symptoms seriously and expedite your assessment process to find answers as quickly as possible. 

Be sure to write down what times you wake up throughout the night, how much food you consumed prior to going to bed, how much you ate each time you awoke, as well as any changes in your mood. The more detailed, the better!

2. Speak to a Professional

After you’ve documented your symptoms for a week or more, it’s time to schedule an appointment with a family physician, psychologist, or registered dietitian. Either of these medical professionals will have the training required to evaluate your symptoms, rule out any other possible explanations, and conclude whether or not there’s cause for concern. Explain to your healthcare provider how your eating habits are impacting your ability to function day-to-day, or how they’re making you feel. Being transparent about what you’re experiencing is the only way to receive the best possible care for your unique needs and circumstances.

3. Ask for an Assessment

It’s always best to be direct in asking for a DSM-5 assessment if you suspect you may have NES (or any eating disorder, for that matter). This will ensure your healthcare provider understands you are seeking a medical diagnosis. Remember, a family physician, psychiatrist, psychologist, or a registered dietitian are all capable of conducting this assessment. Most people start by speaking to their family physician, but you can also speak directly to a therapist or nutritionist if you so choose. Many healthcare professionals will refer a patient to these specialists for a diagnosis.

4. Request a Copy of Your Records

You have a right to access any and all paperwork regarding your health. If you receive a DSM-5 diagnosis for night eating syndrome, request a copy so you can update your personal records and also share your official documentation with other healthcare providers, should it be relevant or required. This will ensure all members of your healthcare team are basing their treatments on the same information, which means you’ll receive the highest possible quality of care.

5. Evaluate Your Treatment Options

Speak up about your personal treatment preferences. You, as the patient, should always have the final say when it comes to how your healing takes place. You may prefer to begin with talk therapy and nutritional coaching, for instance, before considering prescribed medications. This is completely okay and your healthcare team will work with you to personalize your treatment plan (while still prioritizing your safety and overall wellness).

If you’re unclear about what your options are, ask questions! There’s no such thing as an irrelevant question when it comes to your health. Gather as much information as you need until you feel confident in making a decision.

Night Eating Syndrome Treatments

You now know how to tell if waking up and eating in the middle of the night is cause for concern. You also know how to receive an official diagnosis and some of the underlying causes of NES. But what is the solution and what can you expect from the treatment process?

There are a number of night eating syndrome treatment options, which a healthcare professional can discuss with you in more detail. Here’s a quick overview:

1. Nutritional Rehabilitation

In order to successfully break the cycle of a night eating disorder, you’ll need to relearn healthy eating behaviors and introduce a meal regimen that enforces a consistent, nutritional diet. You’ll also need to address any nutrient deficiencies caused by NES, which an experienced registered nutritionist can assist you with. The key here is sustainability, as all eating disorders require long-term management and monitoring. 

2. Phototherapy

Phototherapy, or light therapy, involves exposing a person to ultraviolet (UV) light at regular intervals in order to improve mood and to reestablish a healthy circadian rhythm. In one study, 70 percent of people treated with UV therapy for 4-6 weeks experienced a remission from depressive symptoms—a very promising result. It has also been shown to help reset sleep schedules in those with insomnia, making it a worthwhile treatment option for those experiencing NES. 

3. Prescribed Medications

There are a number of serotonin selective reuptake inhibitors (SSRIs) that have been approved for the treatment of night eating syndrome. A physician will review medication options with you, inform you of any possible side effects, and help you make the best decision based on your unique needs and medical history.

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Nourish is Here to Help

Our nutrition plays a major role not just in our day-to-day life, but our nighttime routines as well. By establishing a healthy diet specifically designed around your needs, you’re giving your body what it needs to thrive. Nourish is the easiest way to find a registered nutritionist covered by your insurance. Our network of registered nutritionists offer comprehensive eating disorder treatment to help you build a life you love.

To get started, find a dietitian who accepts insurance through Nourish.