As Many As 4 Million Americans May Be Sleep Eaters

May 24, 2002

Perhaps as many as four million Americans have eaten in their sleep. Most, says Lea Montgomery, know they have a problem but are afraid to discuss it.

"During sleep eating, patients typically eat quickly and chaotically," reports Montgomery, a faculty member at Texas Christian University's Harris School of Nursing in Fort Worth. "There are some reports of people eating nonfood items such as cat food or cigarettes. This is not the norm, however."

She is co-author of an article on sleep eating and how to diagnosis it in the April 1, 2002 issue of RN, a professional publication for nurses.

The official term for the affliction is Nocturnal Sleep-Related Eating Disorder (NSRED). First diagnosed in 1955 and the subject of a 1999 article in the Journal of the American Medical Association, NSRED is often misdiagnosed as anorexia, bulimia or depression, Montgomery says. That's because it impacts a small percentage of the population and some victims are too ashamed to report their activities even when they are dimly aware of them.

The cause of the malady is not understood but there are theories.

"One suggests that sleep apnea or restless legs syndrome may partially arouse the individual during non-rapid eye movement sleep and prompt a nocturnal eating episode," says Montgomery. "Another is that low levels of melatonin and cortisol may play a role. Stress may also be a factor."

Sleep eating can be dangerous. Its victims may walk into walls or countertops, cut themselves on can openers, burn themselves with hot food or liquids or even accidentally ingest poison. Sleep eaters typically go for the sugar and the fat. Pasta or peanut butter are typical fare. One study suggests that two thirds of the persons with the disorder are women. Other studies reveal no gender discrimination with this disorder.

Montgomery and her co-authors, Linda Haynes and Linda Gardner, both of Baylor University School of Nursing in Dallas, have suggestions for nurses trying to diagnose NSRED and for victims and their families who would like to do the same.

She advises nurses to ask patients about their bedtime hour, how long it takes to fall asleep and their duration of sleep. Also inquire whether they have ever found unexplained remnants of food in the kitchen when they wake up. Other symptoms include discrepancies between a person's account of daytime eating and weight gain, lack of morning appetite, and chronic fatigue.

Some victims realize what they've done and take steps to prevent eating in their sleep but their solutions do not address the basic problem. They install motion detectors in the kitchen, lock the refrigerator door, limit the amount of food they keep in the house, and chow down extra hearty at dinner to avoid being hungry later.

"These behavioral methods may help interrupt the behavior but not address the underlying cause," Montgomery says.

The approved treatments for NSRED, Montgomery advises, include:

• Establishing a routine bedtime.
• Exercising regularly.
• Avoiding caffeine after lunch.
• Avoiding sedatives and alcohol three to four hours before bedtime.
• Losing weight, if the person needs to do that.

Persons with sleep apnea, a condition where restricted air intake leads to irregular breathing during sleep, may wear an oral device to keep the airway open. Surgery also is an option.

Some drugs have proven effective in treatment of NSRED, Montgomery says. Restless leg syndrome can sometimes be curbed by use of drugs such as Sinemet and Parlodel in combination with Darvon or Klonopin. Anti-seizure medications also can help. All medicines have side effects, she notes.

"The scope of the problem of nocturnal sleep-related eating is only beginning to be understood," says Montgomery. She urges nurses to be vigilant in their patient assessments so that they are able to spot persons suffering from sleep-eating problems.

If you would like to see a copy of two articles she has co-authored on sleep-eating, ("An Unusual Sleep Disorder," RN, April 1, 2002; and "What Every Nurse Needs To Know About Nocturnal Sleep-Related Eating Disorder," Journal of Psychosocial Nursing, August 2001), please let Dick Jones Communications know. To reach Lea Montgomery directly, contact her at 817-257-6732 or at L.Montgomery@tcu.edu.