Curbing nocturnal binges in sleep-related eating disorder

Sleepwalking-like behavior is a frequently undiagnosed cause of patients' obesity.

Ms. G, age 39, has a body mass index (BMI) >35 kg/m2 and is pursuing bariatric surgery to treat obesity. She is frustrated with dieting and describes a decade of unconscious nocturnal eating, including peanut butter and uncooked spaghetti.

This behavior began after her divorce 10 years ago. Initially she had partial recall of the nocturnal binges, but now describes full amnesia. Treatment for a depressive episode did not control her nocturnal eating.

Sleep-related eating disorder (SRED) can be associated with disrupted sleep, weight gain, and major chronic morbidity. In Sleep-related eating disorder (SRED)—involuntary eating while asleep, with partial or complete amnesia—the normal suppression of eating during the sleep period is disinhibited. The disorder can be idiopathic, associated with medication use, or linked to other sleep disorders such as somnambulism (sleepwalking), restless legs syndrome (RLS), periodic limb movement disorder (PLMD), or obstructive sleep apnea (OSA).

Sleep-related eating disorder (SRED) is more common in women than men; it usually begins in the third decade of life but can begin in childhood or middle age. About one-half of Sleep-related eating disorder (SRED) patients also have a psychiatric illness, usually a mood disorder. Unremitting Sleep-related eating disorder (SRED) may lead to psychopathology, as the onset of sleep-related eating usually precedes the onset of a psychiatric disorder by years.

Sleep-related eating disorder (SRED) often is unrecognized, but it can be effectively identified and treated. This article examines how to:

• distinguish Sleep-related eating disorder (SRED) from nocturnal eating syndrome (NES) and other disorders
  
• identify precipitating causes
  
• select effective pharmacologic therapy.
  

Differentiating Sleep-related eating disorder (SRED) from NES

Eating and sleeping—and disorders of each—are closely linked (Box). Sleep-related eating disorder (SRED) and night eating syndrome (NES) are 2 principal night eating disorders. Sleep-related eating disorder (SRED) is characterized by inappropriately consuming food after falling asleep, whereas NES is characterized by hyperphagia after the evening meal, either before bedtime or after fully awakening during the night.

To meet diagnostic criteria for Sleep-related eating disorder (SRED), patients must experience involuntary nocturnal eating and demonstrate at least 1 other symptom, such as:

• eating peculiar, inedible, or toxic substances
  
• engaging in dangerous behavior while preparing food ().