Sleep Related Eating Disorders: Symptoms, Types, Causes and Treatment

Sleep Related Eating Disorders (SRED) are a complex category of conditions that blur the boundaries between sleep and eating behaviors. These disorders are not simply about late-night snacking or occasional midnight cravings—they are characterized by episodes of compulsive eating that occur during partial or full arousals from sleep, often accompanied by little or no memory of the event. Understanding SRED is crucial, not only because it can lead to significant health risks such as weight gain, injury, and metabolic disturbances, but also because it frequently goes undiagnosed and misunderstood. In this article, we’ll explore the symptoms, types, causes, and treatment options for sleep related eating disorders, drawing on the latest clinical research to provide a comprehensive overview.

Symptoms of Sleep Related Eating Disorders

Sleep Related Eating Disorders present with a unique constellation of symptoms that distinguish them from both typical eating disorders and sleep disturbances. These episodes are often marked by confusion, lack of awareness, and a sense of being "out of control." Sufferers may wake to find evidence of nocturnal eating—such as food wrappers or messes in the kitchen—without clear recollection of the event.

Symptom	Description	Frequency/Severity	Source(s)
Nocturnal Eating	Eating during partial or full arousal from sleep	Nightly or several times/week	1,2,3
Amnesia	Little to no memory of episodes	Occasional to consistent	2,3
Lack of Control	Compulsive, "out of control" eating	Nearly all cases	3,6
Associated Risks	Choking, injury, weight gain	Significant in many patients	1,6

Table 1: Key Symptoms

Nocturnal Eating Episodes

The hallmark symptom of SRED is involuntary eating during the night, typically following an arousal from sleep. Patients may consume unusual combinations of foods, large quantities, or even inedible items, sometimes preparing elaborate meals while still partially asleep. This often occurs nightly, with some individuals experiencing multiple episodes in a single night 1,3,6.

Amnesia and Altered Awareness

A striking feature is the partial or complete amnesia for eating episodes. Most sufferers describe their state during the event as "half-awake, half-asleep," and over 90% report at least occasional amnesia 3. This distinguishes SRED from other forms of nocturnal eating, such as night eating syndrome, where awareness is preserved 7.

Sense of Being "Out of Control"

During episodes, individuals often feel unable to control their behavior. Many report compulsive urges to eat and describe actions as being "out of control." This compulsion contributes to both psychological distress and increased risk of accidents 3,6.

Associated Health and Safety Risks

SRED is linked to significant health risks, including excessive weight gain (over 40% of patients in some studies), risk of choking, injuries from preparing food while impaired, and even starting fires 1,6. The chronic nature of these behaviors further exacerbates health concerns.

Types of Sleep Related Eating Disorders

Sleep related eating behaviors are diverse and can be classified into several types, often based on underlying causes or associated sleep disorders. Understanding these distinctions is key for accurate diagnosis and management.

Type	Defining Features	Common Associations	Source(s)
SRED	Involuntary eating during sleep; amnesia common	Sleepwalking, PLM disorder	1,3,6
NES	Conscious nocturnal eating, often with insomnia	Mood disorders, delayed sleep	7,9
Secondary	SRED due to medication, substance withdrawal, or OSA	Drugs, OSA, stress, RLS	4,6

Table 2: Types of Sleep Related Eating Disorders

Sleep-Related Eating Disorder (SRED)

SRED is characterized by unconscious or semi-conscious eating episodes during sleep, frequently associated with other parasomnias like sleepwalking and periodic limb movement disorder. Amnesia or partial memory loss is typical, and episodes often involve hazardous behaviors 1,3,6.

Night Eating Syndrome (NES)

NES, though sometimes confused with SRED, is a distinct entity. Individuals with NES are fully awake during their nocturnal eating episodes, which are typically associated with insomnia and mood disturbances rather than parasomnias. Awareness and memory are preserved, but the behavior is similarly chronic and disruptive 7,9.

Secondary or Mixed Forms

Some cases of sleep-related eating are secondary to other conditions or triggers, such as:

• Medication side effects (e.g., triazolam, amitriptyline)
• Withdrawal from substances (e.g., alcohol, opiates, nicotine)
• Medical sleep disorders (e.g., obstructive sleep apnea, restless legs syndrome)
• Acute stress or psychiatric comorbidity

These mixed forms can present unique challenges and may require a tailored diagnostic approach 4,6.

Causes of Sleep Related Eating Disorders

The origins of sleep related eating disorders are multifactorial, involving a complex interplay between neurobiology, sleep regulation, psychological stress, and sometimes medication effects.

Cause	Mechanism/Trigger	Notable Associations	Source(s)
Parasomnias	Sleepwalking, confusional arousals	SRED, mixed cases	1,3,4
Sleep Disorders	Obstructive sleep apnea, PLM, restless legs	Secondary SRED	4,6
Psychiatric	Depression, anxiety, dissociation	Co-morbidity, risk factor	2,5
Medications/Substances	Triazolam, withdrawal from drugs, migraines	Induced SRED	1,4
Stress	Acute life events, chronic stress	Onset/exacerbation	4

Table 3: Main Causes

Parasomnias and Primary Sleep Disorders

Most cases of SRED are closely linked to parasomnias, especially sleepwalking and periodic limb movement disorders. The underlying mechanism appears to involve partial arousals from deep sleep, resulting in complex, automatic behaviors like eating, often without full consciousness 1,3,4. Obstructive sleep apnea can also precipitate confusional arousals leading to eating episodes during the night 4.

Psychiatric and Psychological Factors

SRED is more prevalent among individuals with psychiatric comorbidities, particularly affective (mood) disorders and anxiety. Depression and dissociation are commonly reported, and the interplay between psychological stress and sleep disruption may increase vulnerability to SRED 2,5. However, SRED is distinct from primary eating disorders such as anorexia or bulimia, though overlap can occur 8.

Medication and Substance Effects

Certain medications—most notably sedative hypnotics like triazolam, or antidepressants such as amitriptyline—have been implicated in triggering or exacerbating SRED. Withdrawal from substances including alcohol, opiates, and nicotine may also provoke episodes 1,4.

Acute and Chronic Stress

For some, the onset or worsening of sleep-related eating is closely linked to stressful life events, such as concerns over family safety or relationship difficulties. Chronic stress may further destabilize sleep patterns and increase risk 4.

Treatment of Sleep Related Eating Disorders

Effective treatment of SRED requires a multifaceted approach, often targeting both the underlying sleep disorder and any associated psychological or medical contributors. Recent advances in pharmacotherapy have offered promising new options.

Treatment	Approach/Medication	Effectiveness	Source(s)
Pharmacotherapy	Dopaminergic agents, codeine, clonazepam	High efficacy in SRED	1,4,6
Topiramate	Anti-seizure medication	Reduces episodes, weight	7,11
Pramipexole	Dopamine agonist	Improves sleep/activity	10
CPAP Therapy	For OSA-related SRED	Reduces nocturnal eating	4
CBT/Sleep Hygiene	Limited efficacy unless comorbid	May help insomnia	6,9

Table 4: Treatment Approaches

Pharmacotherapy

The mainstay of SRED treatment is pharmacological. Dopaminergic agents (such as carbidopa/L-dopa, bromocriptine, and pramipexole) have shown high effectiveness, especially when combined with codeine and/or clonazepam for cases associated with sleepwalking or periodic limb movement disorder 1,4,6,10. These treatments often lead to a rapid reduction in nocturnal eating episodes and can help with weight loss.

Topiramate, an anti-seizure medication, has been reported to significantly reduce nocturnal eating and promote weight loss in patients with both SRED and NES, even when other treatments have failed 7,11.

Treatment of Underlying Sleep Disorders

For patients whose SRED is linked to obstructive sleep apnea, nasal continuous positive airway pressure (CPAP) therapy can be highly effective. Controlling the primary sleep disorder frequently eliminates the eating episodes 4.

Behavioral and Cognitive Interventions

While cognitive-behavioral therapy (CBT) and sleep hygiene improvements are standard for many sleep and eating disorders, their efficacy in pure SRED is limited. However, CBT for insomnia may be beneficial for individuals with comorbid insomnia or mood disorders 6,9.

Management of Triggers and Comorbidities

Treating underlying psychiatric disorders, reducing stress, and carefully managing medications are also important. In some cases, addressing substance withdrawal or modifying problematic medications can resolve SRED symptoms 4.

Conclusion

Sleep Related Eating Disorders represent a unique intersection of sleep and eating pathology, with significant consequences for health and quality of life. Early recognition and targeted treatment can dramatically improve outcomes. To summarize:

• SRED is characterized by involuntary, often amnestic, nocturnal eating episodes, typically linked to parasomnias.
• Distinct types include SRED, NES, and secondary forms triggered by sleep disorders, medications, or stress.
• Causes are multifaceted, involving neurobiological, psychological, and environmental factors.
• Pharmacotherapy—especially dopaminergic agents and topiramate—shows the greatest efficacy, while treating underlying sleep disorders (e.g., OSA) is essential for secondary cases.
• Behavioral interventions may help in comorbid cases but are not first-line for pure SRED.

With continued research and awareness, SRED can be more effectively identified, managed, and even prevented, greatly improving the lives of those affected.