Jacquelyn Ekern used to wish someone would lock her in her bedroom. She didn’t trust herself once the lights went out.
“You lay there and try to fall asleep and try to fight this urge to get up and eat,” Ekern says. But several times a week, she’d give in, sneaking to the kitchen to binge on Oreos, salty potato chips and other high-calorie treats. “It would always feel like trying to put a dragon back in a cage as soon as you started eating,” she says.
For more than 10 years, Ekern, now 49 and the founder and CEO of Eating Disorder Hope, struggled with symptoms of multiple eating disorders, including anorexia, bulimia and binge eating disorder. Throughout it all, she experienced what’s now referred to as night eating syndrome, or eating excessive amounts of food at night.
“I was just horribly insecure and completely out of control with food and weight,” Ekern says. “I didn’t have the maturity or the insight to be able to negotiate with myself that there’s a better way to do things.”
Most people with night eating syndrome overeat unhealthy foods at night, often feeling like they can’t fall asleep until they do so. “[Food] is a big sedative — it would just knock you out,” Ekern says. “You get this serotonin release that’s really a comforting chemical.” The condition, which affects about 1.5 percent of adults, isn’t a formal psychiatric diagnosis, but it’s mentioned for the first time in the most recent American Psychiatric Association Diagnostic and Statistical Manual as an eating disorder not otherwise specified, says Dr. Timothy Walsh, a professor of psychiatry at Columbia University Medical Center who chaired the Eating Disorder Workgroup for the DSM-5. “There’s still some flux about exactly what the best way to define it is,” he says.
For example, calling it a condition in which you eat the majority of the day’s calories after dinner could unintentionally implicate night shift workers or even college students splurging on 3 a.m. pizza, Walsh says. There are also medications, like those for attention deficit hyperactivity disorder, which can make people lose their appetite during the day and become ravenous at night, Ekern says.
“It’s not black and white,” she says. “Most people overeat at Thanksgiving, most get excited about ice cream, it’s OK to sometimes overindulge.” It’s how people react to their behavior that can indicate an eating disorder, she says. People less prone to eating disorders might remember the indulgence as a fun splurge, while people with less healthy outlooks are often riddled with guilt.
For Ekern, depression, trouble concentrating and bloating — in addition to guilt — came after late-night binges. She’d compensate by starving herself, swimming laps for two hours straight, taking laxatives and diuretics, and even staying home from high school because she was afraid her classmates would notice she’d gained weight. Those reactions “only further compounded the whole emotional instability,” she says. She moved out of her parents’ house and had trouble staying in college. For many years, Ekern says, “I looked like a lost cause.”
Night Eating Syndrome Versus Sleep Eating
Night eating syndrome isn’t the only condition characterized by nighttime eating. Nocturnal sleep-related eating disorder, or NSRED, is a sleep condition that causes people to rouse from their sleep, often eat and drink — often excessively — and then return to bed. One 2006 article, citing research from 1999, found it affected nearly 5 percent of the population and up to 17 percent of people with eating disorders. But unlike people with night eating syndrome, when people with NSRED wake up in the morning, they have little or no recollection of the meal because they’re not entirely conscious when eating.
“They see evidence of the fact they’ve done this, but they don’t have the recall,” says Dr. Timothy Morgenthaler, director of the Mayo Clinic Center for Sleep Medicine and past president of the American Academy of Sleep Medicine.
For example, they may find crumbs and wrappers in their beds, feel sick to their stomachs in the morning without knowing why and rarely crave breakfast. The condition can be dangerous, too, since about one-third of people with it have hurt themselves during food prep (think cuts and burns) and 65 percent have eaten nonedible items such as frozen foods or buttered cigarettes, studies suggest. There have even been reports of people consuming toxins like ammonia, Morgenthaler says. In rare cases, people unknowingly eat the night before a surgery, when they’re supposed to be fasting.
A more common consequence, though, is weight gain or lack of weight loss despite diligent efforts when the sun is out. “They can be dieting very religiously during the day and gain weight very relentlessly at night,” Morgenthaler says. That can lead to other metabolic complications, including diabetes and high cholesterol, he says.
Treating nocturnal sleep-related eating disorder usually means identifying and treating its underlying cause. In some people, the culprit may be a sleep medication like Ambien, which has been linked to unusual nighttime behaviors, including sleep eating, Morgenthaler says. Often, sleep eaters have another sleep condition, such as obstructive sleep apnea or restless leg syndrome, that disrupts their sleep and launches them toward the kitchen, the same way disruptive sleep disorders might cause others to sleep walk or sleep smoke.
Fortunately, Morgenthaler says, “treating the underlying condition is often very effective at eliminating the disorder.” That’s why it’s important that people who think they might sleep eat see a board-certified sleep specialist who can help diagnose and treat the condition. While plenty of facilities can diagnose sleep apnea, for instance, fewer are aware of and screen for night eating problems.
Putting Night Eating Syndrome to Rest
While treatments for NSRED mirror treatments for sleep disorders, treatments for night eating syndrome — Ekern’s condition — tend to mimic those used for eating disorders, says Walsh, who also directs the Division of Clinical Therapeutics at New York State Psychiatric Institute. For example, therapists and nutritionists might help patients develop and stick to a healthy meal plan during the day so they don’t go to bed famished. Practical techniques like keeping tempting foods out of the house and keeping a healthy snack on your bedside table can help too, he says.
For Ekern, who admitted herself to a treatment facility for eating disorders at age 28, one of the most helpful routes to recovery was establishing soothing non-food-related nighttime habits, such as taking a bath, reading a book or calling a friend. “Initially, it feels like, ‘Give me a break — that’s not going to cut it, I need Twinkies,'” she says. But eventually, the new routines stuck.
Through therapy, which she continued for four years after leaving the treatment facility, Ekern also learned to listen to her body’s hunger cues and not obsess over her weight. That helped her to eat reasonably during the day, rather than save up her day’s allotted calories for the night.
Today, she eats well, exercises moderately and has maintained a stable, healthy weight for 15 years. She earned her bachelor’s degree at age 35 and her master’s degree in counseling psychology a few years later so she could help other people with eating disorders. She’s been married for 14 years and has an 11-year-old son.
“I’m like ‘boring stable woman’ — you would have never thought,” Ekern laughs. “There’s a lot of hope for people with all of these different eating disorders.”
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Eating After Dark: A Bad Habit or Medical Condition? originally appeared on usnews.com
