Sleep-Related Eating Disorders

What is a sleep-related eating disorder (SRED)?

Sleep-related eating disorder (SRED) is a type of parasomnia (abnormal behavior that happens during sleep). It causes people to prepare and eat food while they’re sleeping. When they wake up, they have little or no memory of what they did.

SRED can result from certain medications, such as sedatives that help you sleep. It can also happen to people who have other sleep disorders, such as restless legs syndrome (RLS). SRED is dangerous because it can lead to injuries during the cooking process, such as burns and cuts. Some people with this condition also eat non-food substances that may be poisonous.

Healthcare providers treat SRED by stopping medications that cause it. Your provider may also prescribe medications to treat other sleep disorders or recommend lifestyle changes to improve your sleep.

What are the types of sleep-related eating disorders?

There are two types of SRED:

• Drug-induced sleep-related eating disorder: Drug-induced SRED results from taking certain medications, such as drugs to treat insomnia.
• Primary sleep-related eating disorder: Primary SRED affects people who have other sleep disorders. This type of SRED does not result from taking medications. But using sedatives and other drugs may make primary SRED worse.

SRED is not the same as night eating syndrome (NES). Night eating syndrome is an eating disorder that causes people to wake up and eat several times a night in order to fall back asleep. Unlike SRED, people with NES eat while they’re fully awake and remember eating in the morning.

How common is SRED?

Also called nocturnal sleep-related eating disorder (NS-RED), this disorder is most common in women under 20. But it can affect people of all genders and ages. Between 1 and 5% of adults have parasomnias (unusual behaviors during sleep).

What are the symptoms of SRED?

Symptoms of sleep-related eating disorder include:

• Frequent sleep eating: Episodes usually happen every night but may only occur three or four times a week. They can also happen multiple times a night.
• No memory of episodes: If you have SRED, you probably have little or no memory of getting out of bed and eating.
• Eating toxic or non-food substances: Sometimes, people with SRED eat or drink things that aren’t food, such as coffee grounds, bleach or cigarette butts. They may also eat frozen or raw food, which can cause food poisoning.
• Accidental injuries: Because you’re asleep or partially asleep during an episode, you may cut or burn yourself. You may also start a fire or turn the oven too high while cooking.
• Health consequences: Many people with SRED experience weight gain, fatigue, depression and other health problems.

When do sleep-eating episodes happen?

Sleep-related eating disorder is a non-rapid eye movement (NREM) sleep disorder. This means the sleep eating usually occurs during the first few hours of sleep. Episodes typically happen when people are transitioning from one sleep cycle to the next.

During an episode, people with SRED may seem confused or in an altered state. It’s often difficult or impossible to wake them up.

What causes SRED?

Drug-induced SRED results from taking sedative-hypnotic drugs to treat insomnia, especially zolpidem (Ambien®). These drugs slow down brain activity to help you fall asleep and stay asleep. Some antipsychotic and antidepressant medications can also cause SRED.

Because they change brain activity, these drugs can cause some people to do activities while they’re asleep. They may prepare food, eat uncontrollably, drive a car or have sex. Most times, people don’t remember doing these activities when they wake up.

Experts do not know the exact cause of primary SRED. But people with primary SRED often have other sleep problems, such as sleepwalking or restless legs syndrome. These sleep disorders run in families. You may be more likely to have SRED if you or one of your family members has a sleep disorder.

What are the risk factors for sleep-related eating disorder?

You have a higher risk of SRED if you also have other sleep disorders, including:

• Restless legs syndrome (RLS).
• Sleepwalking.
• Narcolepsy.

SRED episodes are more likely to happen when you don’t get enough sleep. So, conditions that disturb your sleep may also put you at risk, including:

• Snoring.
• Obstructive sleep apnea.

You’re more likely to have SRED if you:

• Are closely related to someone who sleepwalks.
• Feel stressed out or sleep-deprived during the day.
• Have an eating disorder like bulimia nervosa.
• Have anxiety or depression.
• Take certain medications, including some sedatives to help you sleep, antidepressants or antipsychotic drugs.

How do healthcare providers diagnose SRED?

To diagnose SRED, your provider will ask you about your symptoms. They may ask a family member, partner or roommate about your sleep habits since you may not remember sleep eating if you have SRED. Your provider will examine you to see if a health condition might be causing symptoms.

To get more information about your sleep habits, your provider may ask you to keep a sleep diary for a few weeks. You may also need to spend the night in a sleep study center to check for abnormal sleep behaviors.

How do providers treat SRED?

If you have drug-induced SRED, your provider may recommend stopping the medication or taking a different one. If you have other sleep disturbances (such as RLS or sleep apnea), your provider will treat the condition.

Treatment for primary SRED includes selective serotonin reuptake inhibitors (SSRIs). SSRIs are antidepressant medications that increase the levels of serotonin in the brain. Serotonin is a hormone that performs many different functions in the body, including regulating your mood.

Your provider may also recommend lifestyle changes, including:

• Managing stress levels and practicing relaxation techniques, such as yoga and meditation.
• Practicing good “sleep hygiene,” which includes avoiding caffeine, screens and too much alcohol before bed. It also involves taking steps to get more sleep.
• Placing locks on the refrigerators, cabinets or the oven — or putting an alarm on your bedroom door.
• Moving furniture and other hazards out of your path so you don’t fall while you sleepwalk to the kitchen.

Can I prevent SRED?

You can lower your risk of drug-induced SRED by not taking sedatives to help you sleep. If you take antipsychotic drugs, ask your provider if that medication may cause SRED.

It may not be possible to prevent SRED and other parasomnias that have no known cause. If you have a history of sleepwalking, RLS, sleep apnea or narcolepsy, talk to your provider. Treating these sleep disorders can lower your risk of SRED.

What is the outlook for people with SRED?

Lifestyle changes and medications can help people with SRED stop eating while they’re asleep. If you have SRED, you should see your provider for a checkup a few times a year. Regular checkups allow your provider to monitor your health and adjust treatments or medications.

Untreated, SRED can cause injuries, food poisoning and illness from eating non-food items. It can lead to obesity, weight gain and health problems that result from carrying excess weight (such as diabetes). Without treatment, SRED episodes will likely continue and may happen more often.

When should I see my healthcare provider about SRED?

See your provider right away if you suspect you’ve had episodes of uncontrolled sleep eating. Sleep-related eating disorder can be dangerous to your health and the health of your family.

A note from Cleveland Clinic

If you have a history of sleep-related eating disorder, talk to your provider about how to stop eating while you’re asleep. Untreated, this abnormal sleep behavior can lead to a range of serious injuries and health problems. But treatments can help. Tell your provider if you have other sleep issues, such as RLS, snoring or narcolepsy. Your provider will work with you to treat these conditions, which may relieve symptoms of SRED and help you rest easier.