Sleep-related eating disorder - Chain of consequences

Repeated nocturnal binge eating episodes can have multiple adverse health effects. Patients often wake up with painful abdominal distention. Weight gain and subsequent increased BMI may compromise the control of medical complications such as diabetes mellitus, hyperlipidemia, hypertriglyceridemia, hypertension, OSA, and cardiovascular disease. Patients with Sleep-related eating disorder (SRED) also report dental problems such as tooth chipping and increased incidence of caries.

Clinical Point
Sleep-related eating disorder (SRED) patients with partial awareness often describe the experience as being involuntary, dreamlike, and 'out-of control'

Failure to control nocturnal eating can lead to secondary depressive disorders related to excessive weight gain. Moreover, Sleep-related eating disorder (SRED) patients' nighttime behaviors may disrupt their bed partners' sleep and cause interpersonal and marital problems.

Untreated Sleep-related eating disorder (SRED) is usually unremitting. In our experience, most patients describe suffering for years before seeking treatment. Many report that their symptoms have been dismissed by other physicians or wrongly attributed to a mood disorder. Not surprisingly, patients in obesity clinics and eating disorder groups regularly report Sleep-related eating disorder (SRED).

Multiple causes

Medication-induced. The commonly prescribed hypnotic zolpidem can induce Sleep-related eating disorder (SRED). Sporadic cases of Sleep-related eating disorder (SRED) have been reported with other psychotropics, such as tricyclic antidepressants, anticholinergics, lithium, triazolam, olanzapine, and risperidone.

Life stressors. For a subgroup of patients, such as Ms. G, a life stressor such as a death or divorce precipitates the disorder. Others report Sleep-related eating disorder (SRED) onset with cessation of cigarette smoking, ethanol abuse, or amphetamine/cocaine abuse. Thus, Sleep-related eating disorder (SRED) can be viewed as a “final common pathway disorder” that can be triggered by a variety of sleep disorders, medical-neurologic disorders, medications, and stress. It also can be idiopathic (Table 3).

Sleep disorders and medications associated with Sleep-related eating disorder (SRED)

Sleep disorders

Sleepwalking, obstructive sleep apnea, restless legs syndrome, circadian rhythm disorder, narcolepsy

Medications

Zolpidem, lithium, triazolam, olanzapine, risperidone, anticholinergics