Sleep Related Eating Disorder (SRED): What Is It?
Sometimes referred to as sleep eating or a nocturnal sleep eating disorder (meaning it happens at night), sleep related eating disorder (SRED) is classified as a non-REM sleep parasomnia—an involuntary, abnormal behavior that occurs at some point during the four non-REM stages of sleep.
SRED is exactly what it sounds like: it involves eating and drinking food or other substances while asleep. This behavior can begin at any stage in your life, and it can last for a short period (up to a few months at a time) or it can be chronic and escalating. Sleep eating can also go away temporarily but recur during periods of stress.
It’s important to distinguish the difference between sleep related eating disorder and nocturnal eating syndrome (NES), as they’re not the same thing:
- SRED happens during sleep; those who have it are completely unaware of what they’re doing (and why), and often have amnesia about the event afterward.
- NES is a waking activity, characterized by overeating before bed or waking up in the night and feeling one cannot get back to sleep without food or drink. People with NES are aware of their actions and remember them later.
Signs & Symptoms of Sleep Related Eating Disorder
How do you know if you or someone in your life has sleep related eating disorder?
The biggest giveaway, of course, is that the person engages in eating while asleep. If you live with someone who’s a sleep eater, you may witness this behavior firsthand. Typically, someone with a sleep eating parasomnia awakens—but only partially— in the middle of the night to binge eat or drink.
“Binge” is just as important a distinction as “awakens partially.” A sleep eater doesn’t wake up, prepare and eat a light snack, then go back to sleep. (That would be a midnight snacker.)
Rather, a nocturnal, sleeping binge eater experiences a partial arousal during any one of the stages of non-REM sleep, then consumes a vast amount of high-calorie food in a short period of time (often as little as ten minutes). The eating session is out of control and can sometimes involve consuming uncooked foods (like raw spaghetti), inedible items (like cigarettes), or toxic substances (like cleaning agents).
If you witness a bout of sleep eating, you’ll recognize it by the following:
- Dazed or “sleepwalking” behavior. A sleep eater may have glazed eyes and a vacant demeanor. They may answer questions in a nonsensical manner. In fact, sleep eating is closely related to both confusional arousal and sleepwalking, two other non-REM parasomnias. Some people start out simply sleepwalking, but once food enters the picture, the sleep eating tends to take over and be the predominant behavior.
- Binge eating of weird things. Sleep eaters engage in out of control eating. Typically they consume huge amounts of food or other items in unappealing or bizarre combinations they’d never try when awake. (For example, mayonnaise with toaster tarts; pet food; coffee grounds or other items out of the garbage; frozen foods straight from the freezer.) Sleep eaters may eat toxic items too, like household cleaners. They may consume piping hot foods without waiting for them to cool down, scalding their lips, mouths, and throats.
- Cooking while sleeping. Preparing foods while still asleep is a serious danger. Sleep eaters sometimes prepare simple foods like sandwiches, but often they’ll cook entire meals. They may try to cook food on the stovetop or in the oven, resulting in burns or kitchen fires.
If you’re the one experiencing the parasomnia, the clues may be more subtle. In all likelihood, you will not remember sleep eating, or if you do, it’ll be a vague, foggy memory. You may think you dreamed you ate in the night.
Absent any witnesses or actual memory of the event, you’ll need to pay attention to clues. Is your kitchen or any part of your home a mess when you wake up? Is the trash open or spilled? Is the oven on? Is the microwave door open?
Pay attention to your body, too. Do you have any unexplained cuts, bruises, or burns? Are there food stains on your pajamas? Do you wake up feeling strangely full, with no interest in eating breakfast? Are you gaining weight for no apparent reason?
Keep track of these symptoms. If you notice them for two months, tell your doctor.
Dangers of Sleep Eating
This sleep disorder can be very risky to your health. Adverse effects of sleep eating can include:
- Burns or knife cuts from preparing food while sleeping, spilling hot foods on oneself, or eating scalding soups, reheated foods, or boiling hot beverages
- Poisoning, gastrointestinal illness, or chemical burns from consuming household cleaners or other toxic items
- Dental damage (such as chipped teeth) from chewing hard items: for example, hard candies or frozen foods
- Food poisoning from eating uncooked foods like beans, meat, or seafood
- Kitchen fires from cooking while asleep
- Weight gain or obesity
- High cholesterol, high blood pressure, cardiovascular disease, Type II diabetes, and other obesity-related conditions
- Fatigue from not having restful sleep
- Insomnia—people with this parasomnia often fear going to sleep
- Allergic reactions to foods (including anaphylaxis)
- Depression and anxiety stemming from the weight gain and loss of control over one’s eating
- Eating or exercise disorders stemming from the desire to restrict daytime eating to compensate for nighttime binges
Causes of Sleep Eating
Sleep eating can be idiopathic, meaning it arises out of nowhere, with no discernible cause. It can also be closely connected with having another sleep disorder or condition.
Medication may also be a cause (certain sleep drugs have been known to list sleep eating as a side effect).
Though SRED can happen to anyone, there are some known risk factors:
- The presence of another sleep disorder or parasomnia (for example, restless leg syndrome, confusional arousal, obstructive sleep apnea, or a circadian rhythm disorder). This is one of the major predictors of SRED: more than half of all patients who sleep eat have another parasomnia, too.
- If you’re a woman with a history of eating disorders, you are more likely to develop SRED.
- A childhood history of sleepwalking
- Family history—if someone in your family sleep eats, you may too
- Gender—women are more prone than men
- Medications—sedative hypnotics can cause this behavior
- Dieting or restricting your daytime eating—being very hungry in the daytime can drive some to sleep eat
- Quitting smoking or drinking
- Certain autoimmune illnesses
Treatment of SRED
If you have the symptoms and signs of SRED, the first step is getting a diagnosis. Your doctor may refer you to a sleep medicine physician with an expertise in parasomnias and sleep disorders.
After an initial physical and discussion, you’ll be scheduled for an overnight sleep test in a sleep lab, where your brain activity can be monitored for diagnosis.
If you receive a diagnosis of SRED, treatment approaches vary depending on whether your parasomnia is idiopathic (spontaneously occurring on its own, with no definitive cause) or related to some other cause, such as drug and alcohol use, nicotine withdrawal, stress, an eating disorder, or another sleep disorder or parasomnia.
Your physician will design a treatment plan tailored to your needs, based on the root causes of your problem.
- For example, if your doctor determines that quitting smoking is triggering your nocturnal sleep eating, treatment may focus on giving you tools to better manage your withdrawal symptoms.
- If sleepwalking and sleep eating episodes are caused by sleep medications, your doctor may switch you to a different drug or have you taper off.
- If an eating disorder or dieting is setting off a cycle of sleep eating, your doctor may work with you to redesign your eating plan so you get more calories during the daytime.
Medication is often prescribed, as well. Treatment of SRED usually involves some or all of the following:
- Treating the underlying stress and anxiety (for example, with stress management classes, counseling, or talk therapy)
- Limiting alcohol, drug, and caffeine intake
- Medication (often, SSRIs, hypnotics, or anticonvulsants)
If you have any questions or if you think you might suffer from Sleep Related Eating Disorder, please call us at (425) 279-7151 today!