Night eating syndrome: much more than a bad habit
When the classification of mental disorders was updated in 2013, a relatively unknown eating disorder was identified, while binge eating disorder was recognized as a distinct condition. This disorder is nocturnal hyperphagia, or night eating disorder , first described in 1955.
This is an eating disorder that falls somewhere between eating problems and sleep disorders, as we will see. It affects both sexes equally, all ages, and populations with genetic diversity, without differences. It is estimated to affect between 0.5% and 1.5% of the general population.
People with night eating syndrome are characterized by:
- Having a predilection for feeding mostly at dusk or during the night.
- They often have little or no appetite in the mornings.
- They have trouble sleeping, with poor nighttime rest.
- They experience mood swings, which are usually in the form of depressive or irritable moods.
Why is it considered a disorder? First, because of the accompanying symptoms: insomnia, anxiety-depression; also because it can lead to binge eating; and finally, because of the health consequences that can result.
Binge eating disorder in adults
Typically, the person often feels a greater desire to eat in the late afternoon or evening, after dinner, or during the night . It doesn't necessarily mean overeating; overindulgence may or may not be present. It could simply be a matter of having a bite, often with a preference for a particular food.
Meal times are also influenced by other factors, including the climate. In Nordic countries, for example, people eat dinner and go to bed earlier than in Mediterranean countries. It's not so much a matter of timing as it is of balancing food intake.
This need for food may also appear once the person is already in bed, or the person may wake up in the middle of the night and get up to eat; since it is often accompanied by problems falling or staying asleep.
Eating calms anxiety and makes it easier to fall asleep, and sometimes sleep is maintained uninterrupted. However, the rest is often of poor quality , leaving a lingering feeling of tiredness and drowsiness during the day. Other sleep disturbances may also occur, such as restless legs syndrome or sleepwalking. But, unlike in these phenomena, a person with nocturnal overeating remains aware of what they are doing, which can lead to feelings of guilt or shame and potentially result in depression.
Weight may increase or remain normal, depending on the amounts ingested and the frequency of episodes.
Causes of nocturnal hyperphagia
No single cause of nocturnal hyperphagia has been identified; it is considered a multifactorial disorder. Other family members may have similar habits, a physiologically delayed circadian rhythm, with the brain centers that respond to food being more active at night than during the day. In other words, their body's activation rhythm is later than that of most people.
Laboratory tests have detected some hormonal changes: increased cortisol, insulin, and glucose levels, and lower levels of serotonin, melatonin, ghrelin, and leptin in people with nocturnal hyperphagia compared to healthy individuals. Melatonin is a hormone that promotes sleep, and when found at lower levels, sleep becomes difficult.
It may all be a temporary pattern, related to situations that disrupt the normal sleep-wake cycle or hormonal balance. At-risk populations include, for example, university students, pregnant women, and probably people who work shifts. It has also been linked to traumatic childhood experiences.
Much more than a problem with food
It can coexist with other eating disorders: one-third of people with night eating syndrome also have binge eating disorder. In some cases, it can also appear alongside bulimia, and even anorexia nervosa, although this is not common.
Physical and emotional complications of the disorder
The main problem with this approach is the physical complications it can cause. It can lead to overweight and obesity , with the likelihood increasing the longer the condition persists. And if this occurs, the prognosis is worse. One study has identified that more than half (55%) of obese individuals who opt for gastric reduction meet the criteria for nighttime overeating disorder or binge eating disorder (Succurro et al., 2015). Diabetes, elevated cholesterol, and high blood pressure can also develop over time.
On an emotional level, nocturnal hyperphagia also has repercussions, because it is often associated with anxiety and especially depression , a sad or irritable mood that worsens as the day progresses because tiredness accumulates.
Some people with this problem have an impulsive character, which can manifest itself in other areas, for example, the consumption of tobacco and other substances.
Therefore, it is important to diagnose and treat this condition.
It's considered a disorder, not just a simple eating style, when it negatively impacts daily functioning. For example, morning sleepiness can affect performance at school or work. Diagnosing it requires distinguishing it from other disorders such as bulimia, sleepwalking, or sleep apnea syndrome, with which it can overlap.
Regarding treatment , some medications that regulate serotonin levels (antidepressants) have shown efficacy, as have some anti-impulsive drugs (topiramate), light therapy, and muscle relaxation techniques. The best approach is to individualize treatment, combining psychotherapy that addresses thoughts related to eating habits with sleep hygiene measures and dietary habit re-education (cognitive-behavioral therapy), along with the regular practice of a relaxation technique, light therapy, or medication, depending on the case.
Let's remember that we're talking about dealing with a habit that has become a problem affecting normal functioning, not just a preference for meal times.
In short, nighttime eating disorder is an eating problem that falls somewhere between binge eating and sleep disorders. It is a disorder that needs to be more precisely classified within the spectrum of eating disorders. To achieve this, more specific studies are needed to evaluate targeted treatments and provide follow-up care. Most importantly, we must try to detect this problem earlier and offer evidence-based treatment to prevent the resulting physical and psychological complications and thus restore healthy functioning and a balanced mood.
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