Night Eating Syndrome (NES)

What is NES?

Night eating syndrome (NES) is an eating disorder that occurs along with interrupted sleep (insomnia). NES causes people to wake up during the night to eat, usually several times throughout the night. Untreated, NES makes it difficult to maintain a healthy weight. It also increases the risk of health problems like diabetes and high blood pressure.

If you have NES, you may feel like you won’t be able to fall asleep if you don’t eat. You might feel as if you have no control over your urge to eat in the middle of the night. Many people with NES also have depression or anxiety that is often worse at night.

To help people with NES, healthcare providers usually recommend a combination of treatments. These include antidepressant medications, cognitive behavioral therapy and techniques to correct the sleeping and eating cycle.

How common is NES?

About one in 100 people have NES. Night eating syndrome is more common among people who:

• Carry extra weight or have obesity.
• Have depression or anxiety.
• Abuse drugs or alcohol.
• Have another eating disorder, such as bulimia nervosa or binge eating disorder.

What is the difference between NES and sleep-related eating disorder (SRED)?

NES is not a type of sleepwalking or other abnormal sleep behavior (parasomnia). It’s different from sleep-related eating disorder (SRED) because people who have NES are fully awake while eating.

People with NES remember waking and eating during the night. But people with SRED eat while they’re asleep and have no memory of it the next day.

What are the symptoms of night eating syndrome?

Symptoms of NES usually last for several weeks or months. They include:

• Waking up to eat: People with NES usually have insomnia more than four times per week. They wake up to eat (sometimes multiple times a night) for several weeks or months. They feel like they have to have a full stomach to get back to sleep.
• Eating many calories at night: People with this disorder eat more than 25% of their daily food intake at night. They may eat late at night before they go to bed, during the night or both. Instead of eating one big meal, many people with NES eat smaller meals or snacks throughout the night. They usually crave foods that are high in calories, carbohydrates or sugar.
• Decreased appetite during the day: Hyperphagia (intense hunger and overeating) happens later in the evening and during the night. People with NES may not be hungry for breakfast. Some people don’t feel hungry until later in the afternoon.
• Depression and anxiety: Mental health conditions such as depression and anxiety often occur along with NES. People with NES tend to feel like they have no control over their eating. They may feel ashamed, sad or embarrassed.

What causes NES?

Healthcare providers don’t know exactly what causes NES. They believe it results from several factors, including:

• Circadian rhythm disorders: The circadian rhythm is the body’s natural “clock” that controls when you feel tired, alert and hungry. If you have NES, your internal clock doesn’t work like it should. Your body releases hormones that make you feel hungry and alert at night rather than during the day.
• Genes: NES can run in families, so providers think genes may play a role in who gets the disorder.
• Mental health: Many people with NES also have mood disorders such as depression and anxiety.
• Other disorders: People with NES are more likely to have other eating disorders and substance abuse disorders. They’re also more likely to have obesity. But the connection between these disorders and NES isn’t clear.
• Daytime dieting: NES can sometimes result from not getting enough calories during the day. People who restrict their food intake during the day may be more likely to binge at night.

How do healthcare providers diagnose NES?

Your provider will ask about your symptoms, including how often you wake up at night and what helps you get back to sleep. They will examine you to check your physical health and ask questions about your mood, emotions and mental health.

Your provider may ask you to keep a sleep diary. Keeping track of when you wake up and what you eat at night can help your provider plan treatment. You may also need to spend the night in a sleep study center to check for abnormal sleep behaviors.

How do providers treat NES?

To treat NES, your provider may recommend one treatment or a combination of several. Treatments include:

• Cognitive behavioral therapy (CBT), a type of talk therapy that can help you change troubling behaviors and adopt healthier habits. CBT might help you eat more during the day and control nighttime hunger.
• Antidepressant medications, such as selective serotonin reuptake inhibitors (SSRIs), to boost your mood and regulate your emotions.
• Mind-body exercises, such as progressive muscle relaxation, to help you calm down and fall back asleep.
• Light therapy (phototherapy), using a special light for about 15 to 30 minutes every day. This lamp helps to change your circadian rhythm, so you’ll feel sleepy at night.
• Melatonin, a hormone that regulates and controls the sleep-wake cycle. Your provider may recommend taking melatonin supplements to help you get to sleep and stay asleep at night.
• Weight management program, so you can maintain a healthy weight, choose nutritious foods and feel better.

Can I prevent NES?

You may not be able to prevent NES. But you can take steps to improve your health and get restful sleep by:

• Choosing healthy foods: Make sure you only have healthy foods at home. Getting rid of foods that are high in fat and sugar can help you avoid indulging in them at night.
• Practicing good sleep hygiene: Keep your bedroom at a comfortable temperature, and try to go to sleep at the same time every day. Avoid caffeine and electronics before bed.
• Keeping an eye on your mental health: Try to manage stress with meditation and deep breathing. If you feel sad or anxious, talk to your provider. Counseling and therapy can help you manage emotions and improve your mood.
• Staying active during the day: Regular exercise and physical activity during the day helps you sleep better at night.

What is the outlook for people with NES?

Untreated, NES can cause health problems and emotional challenges. It can lead to diabetes, high cholesterol, high blood pressure and other issues that result from carrying excess weight.

But healthcare providers can treat NES with a combination of therapy, medications and lifestyle changes. Many people with NES find relief from symptoms by sticking to a comprehensive treatment plan.

When should I see my healthcare provider about NES?

Call your provider if you have symptoms of NES. It’s important to see your provider for an evaluation and check for health conditions that might be causing you to wake up at night. Talk to your provider if you’re sad or anxious.

If you have thoughts of suicide, get help right away. Talk to your provider or call the National Suicide Prevention Lifeline at 800.273.8255. This national network of local crisis centers provides free and confidential emotional support to people in suicidal crisis or emotional distress 24 hours a day, 7 days a week.

A note from Cleveland Clinic

Night eating syndrome can have a major impact on your health and wellbeing. In addition to weight gain and excessive daytime sleepiness, NES can cause you to feel out of control. But treatments can help. Be honest with your provider about your symptoms, including when you feel the need to eat and what helps you fall back asleep. Tell your provider if you feel sad, anxious or embarrassed. These details help your provider plan the most effective treatments.