Sleep-related eating disorder Pharmacotherapy

Sleep-related eating disorder (SRED) is treatable and a reversible cause of obesity. The choice of medication depends on:

  • which form of Sleep-related eating disorder (SRED) the patient exhibits (drug-induced or idiopathic)  
  • whether the patient has treatable comorbid conditions.

Temazepam. Switch patients whose Sleep-related eating disorder (SRED) is triggered by zolpidem or another hypnotic to a different agent. We have had excellent success with temazepam, 15 to 30 mg at bedtime.

Clinical Point
Self-induced emesis or other purging behavior usually is not seen in Sleep-related eating disorder (SRED)

Topiramate. For idiopathic Sleep-related eating disorder (SRED) or the sleepwalking variant of Sleep-related eating disorder (SRED), trials from 2 academic institutions suggest that off-label use of topiramate, 25 to 150 mg at bedtime, may be the treatment of choice.

Start topiramate at 25 mg, and increase in 25-mg increments every 5 to 7 days until the night eating episodes are eliminated. Paresthesias, visual symptoms, and (rarely) renal calculus are reported side effects.

Other medications. Other agents that have shown at least some benefit in patients with Sleep-related eating disorder (SRED) include dopaminergic agonists, opiates, and clonazepam. Patients with Sleep-related eating disorder (SRED) and a history of chemical dependency may respond to combined levodopa, trazodone, and bupropion (dopaminergic/noradrenergic antidepressant) therapy at bedtime. Also focus treatment on any coexisting sleep disorder, such as RLS or OSA.

Drug brand names

    Bupropion • Wellbutrin
    Clonazepam • Klonopin
    Levodopa/carbidopa • Sinemet
    Lithium • Eskalith, Lithobid
    Olanzapine • Zyprexa
    Risperidone • Risperdal
    Temazepam • Restoril
    Topiramate • Topamax
    Trazodone • Desyrel
    Triazolam • Halcion
    Zolpidem • Ambien


Drs. Howell and Schenck report no financial relationships with any companies whose products are mentioned in this article or with manufacturers of competing products.

Dr. Crow has received grants or research support from Bristol-Myers Squibb and Pfizer Inc. and served as a consultant to Eli Lilly and Company.

Michael J. Howell, MD
Minnesota Regional Sleep Disorders Center, Hennepin County Medical Center, Assistant professor, department of neurology


Carlos Schenck, MD
Minnesota Regional Sleep Disorders Center, Hennepin County Medical Center, Associate professor, department of psychiatry

Scott J. Crow, MD
Director, Clinical Populations/Assessment Core, Minnesota Obesity Center, Professor, department of psychiatry

University of Minnesota, Minneapolis

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