Nocturnal Eating Syndrome: A Dramatic Parasomnia

By Alexander Golbin, MD, Ph.D.

In the middle of a bitter divorce, a 49 year-old physician suddenly found himself awakening in his kitchen in the middle of the night, consuming large amounts of food from his refrigerator. He had no memory of awakening and walking to the kitchen. He had normal dinners at night and was not hungry.

The described episodes happened with increased frequency and eventually became nightly. He was consuming food, which he did not like, or food that was not completely cooked. When he would awaken and discover what he was eating, he would feel sick. Within the last 6 months, he gained 35 pounds and became depressed.

This person is suffering from a sleep-related disorder called Nocturnal Eating Syndrome (NES).

According to the recent International Classification of Sleep Disorders, NES was first described in 1995 by Stunkord, Grace, and Wolff in a group of obese adult patients with nocturnal hyperphagia (overeating), insomnia and daytime anorexia. These researchers believe that the disorder could be linked to the cause of the patients' obesity and represents a response to stress factors.

However, in spite of increasing worldwide interest in eating disorders in general and the disease's relevance to obesity, NES is still largely unknown to the public.

Recently, large studies on NES were performed in Italy by the University of Rome as well as by a Minnesota group of scientist. They discovered that, on average, patients with NES have onset of the disorder at about 37 years of age and have 3 to 4 episodes per night. The ratio of men to women is about equal. Possible factors include transitional life events such as divorce or other stress such as night work.

Most people with NES awakened during nocturnal episodes and exhibited compulsive behavior to obtain food. Sometimes they were not completely awake which is evidenced by their display of unrestrained compulsive and aggressive behavior in contrast to their daytime personality. The food seeking drive was described as an urgent abnormal need to swallow food with an absence of real hunger. Large amounts of food could be ingested during the night. One person described her typical nocturnal meal as consisting of 6 slices of cake, 2 fruits, 1 large chunk of cheese and 2 large cups of milk.

Dr. Shenk and his group described thirteen noticeable features of Nocturnal Eating Syndrome:

1. No complaints of abdominal pain or nausea.
2. Rapid (automatic) arising from bed and rapid running to the kitchen with wide range in the level of consciousness.
3. No expression of hunger.
4. A tendency to drink thick fluids or consume thick food.
5. Never drink alcohol.
6. Eat foods that are not of their preference during the daytime.
7. Never purge.
8. Only 20% are smokers.
9. Eating did not change during the weekends or on vacation.
10. Usually this disease develops from occasional nocturnal eating to nightly events.
11. Medical and neurologic evaluations usually were unremarkable.
12. Psychiatric problems including bulimia or anorexia were not typical except for some kinds of depression.
13. All patients are well functioning adults.

Evaluation in the sleep laboratory discovered that all episodes arise from so-called non-REM sleep (80% from stage 1 or 2). In about 40% of the cases, patients displayed chewing and swallowing movements in REM sleep as well as periodic limb movements. It is important to emphasize that Nocturnal Eating Syndrome does not mean that the person is mentally sick or weak.

NES is mostly a medical problem associated with sleep disorders, such as parasomnias. 30-60% of patients have other sleep disorders including somnambulism, for example. An identified part of the brain is responsible for NEW, the hypothalamus. Ways to control the disease have been found, and treatment is available. In particular, some medications are found to be very useful. Positive results were obtained by using medications that calm down the hypothalamus from different angles: Serotoninergic (D-fenfluramine), benzodiazepines (Clonazepam), dopaminergic (Sinemet), or other mixed medication.

If you, or a family member, or a friend display nocturnal eating be aware of the possibility of sleep related Nocturnal Eating Syndrome. Seeing a doctor is highly recommended under these circumstances.

Source: Reprinted with permission

By: Alexander Golbin, M.D., Ph.D.
Sleep and Behavior Medicine Institute
9700 N. Kenton Ave, Ste. K 205
Skokie, IL 60076
Tel: (847) 673-8005
Fax: (847) 673-8719