Curbing nocturnal binges in sleep-related eating disorder

Sleep-related eating disorder (SRED) can be associated with disrupted sleep, weight gain, and major chronic morbidity. In 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).

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 SRED patients also have a psychiatric illness, usually a mood disorder. Unremitting SRED may lead to psychopathology, as the onset of sleep-related eating usually precedes the onset of a psychiatric disorder by years.

SRED often is unrecognized, but it can be effectively identified and treated. This article examines how to:

* distinguish SRED from nocturnal eating syndrome (NES) and other disorders
* identify precipitating causes
* select effective pharmacologic therapy.

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.

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

Sleeping and eating: Closely linked activities

Because hormones that regulate appetite, food intake, and body weight also play a role in sleep regulation, patients with eating disorders often have associated sleep disorders. For example, obesity is related to obstructive sleep apnea (OSA)—weight gain is a risk factor for OSA, and weight loss often is an effective treatment. Moreover, patients with anorexia nervosa frequently demonstrate sleep initiation and maintenance insomnia.

Conversely, epidemiologic studies have demonstrated that sleep duration is inversely correlated with body mass index. In particular, individuals with shorter sleep times are more likely to be overweight. The nature of this association is unclear; however, hormones that normally regulate appetite are disrupted in patients with sleep deprivation. For instance, leptin is an appetite suppressant that is normally released from adipocytes during sleep, so sleep deprivation may promote hunger by restricting its secretion.