Night Eating Syndrome Explained: Health Impact and Treatment

Get the facts on night eating syndrome, an often under-recognized disorder affecting 1.5% of adults in the US. Learn how it impacts your health and find out how you can get help to manage it.

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by
Caitlin Beale, MS, RDN
— Signos
Health & Nutrition Writer
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Updated by

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Science-based and reviewed

Published:
April 16, 2024
March 30, 2023
— Updated:

Table of Contents

The hours between dinner and bedtime are notorious for many people's food cravings and mindless snacking. Who doesn’t crave something sweet or salty after dinner every once in a while? But for some, night eating is more than occasionally overeating. It’s an actual medical disorder called night eating syndrome (NES).

NES affects around 1.5 percent of US adults (although some research suggests this number could be even higher).¹ ² In this article, you’ll learn what night eating syndrome is, how it can impact your health, and how to find support.

What is Night Eating Syndrome?

NES is an eating disorder characterized by excess nighttime food intake. People with NES eat most of their calories—at least 25 percent—after dinner and in the hours leading up to bedtime. They may even wake up to eat in the middle of the night before going back to sleep

People with NES are more likely to struggle with weight concerns or have a history of disordered eating and food restrictions, although not everyone with NES is overweight.³NES is often seen with other eating disorders and can have overlapping symptoms. Still, it’s not the same as two seemingly similar conditions: binge eating disorder (BED) or sleep-related eating disorder (SRED).

NES vs. SRED vs. BED

BED is characterized by episodes of eating large amounts of food in one sitting, followed by feelings of guilt or shame. With NES, calorie intake is spread throughout the evening or night. Someone with NES may binge and eat a lot at once, but not always. That said, there is a lot of overlap between BED and NES. It’s estimated that between 18 and 50 percent of people with BED also meet the criteria for NES.²

SRED is a nocturnal eating disorder where someone wakes to eat in the middle of the night but doesn’t remember doing so. It’s not uncommon for someone with SRED to wake up with wrappers or food by the bedside and no recollection of eating. People with NES will remember when and what they ate (and often feel shame or guilt).⁴

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Symptoms of Night Eating Disorder

At least three of the following symptoms are and are needed to diagnose NES:¹ ²

  • The urge to eat between dinner and bedtime.
  • Eating at least a quarter of daily calories at night after dinner. Sometimes this shows up as grazing throughout the night, and other times it can look like night binges.
  • Lack of appetite in the morning (called morning anorexia) and skipping breakfast at least four mornings each week.
  • Difficulty falling or staying asleep at least four nights a week.
  • Low mood or depression that gets worse in the evening
  • Unable to fall asleep (or return to sleep after waking) without eating.

Shame, guilt, or remorse often accompanies NES, where someone feels helpless to control their eating habits or make changes. Secret eating or hiding evidence of nighttime eating is also common.

What Causes the Night Eating Syndrome?

The causes of night eating syndrome aren’t entirely understood, but the following factors may play a role:

  • Circadian rhythm disorders. Dysregulation of circadian rhythms may play a significant role in influencing NES. Your circadian rhythm is like an internal clock that helps regulate various functions, including appetite and sleep. People with NES may have altered signals that affect when they feel hungry and sleepy. However, some researchers believe it’s night eating that interrupts sleep and not a disruption of circadian signals, so more research is needed.⁵
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  • Genetics. Genetics may play a role in many eating disorders, including NES. Studies show that people with a specific genetic makeup may be especially vulnerable to both NES and BED.⁶
  • Chronic dieting and calorie restriction. People with NES may restrict calories during the day, leading to nighttime cravings and binge eating. Not eating enough during the day makes someone more likely to binge or overeat at night, wake up feeling guilty or even full, and repeat the cycle.⁷
  • Hormone disruption. Cortisol, leptin, and melatonin are hormones managed by circadian rhythms. Low levels of leptin, a hormone involved in appetite regulation, may cause nighttime cravings and night eating. People with NES have been found to have higher levels of cortisol, the “stress hormone,” at night. Elevated nighttime cortisol paired with dysregulated melatonin, a sleep-promoting hormone, may influence night eating.⁸
  • Mental health conditions. Nighttime Eating Syndrome is often associated with mental health conditions like stress, anxiety, or depression. Studies suggest that these conditions may trigger the onset of NES.²

What are the Health Effects of NES?

As with any situation where overeating is a concern, NES could impact health beyond nighttime binges. Research suggests that people who eat more calories at night are at a higher risk for developing metabolic health conditions like obesity, type 2 diabetes, or heart disease.⁹

Part of this relationship is once again related to natural circadian rhythms in the body. The body is generally better equipped to process food when you’re more active, so you’re more insulin sensitive in the morning. Insulin is the hormone that helps your body process, use, or store glucose (aka sugar) from food. As the day goes on, your body’s sensitivity to insulin decreases, which could impact blood sugar and fat metabolism.¹⁰

Sleep disruptions are also linked to metabolic health problems. Studies on night shift workers, who typically eat later at night and have irregular sleep cycles, suggest that night eating could disrupt natural circadian rhythms. Those disruptions can lead to higher rates of metabolic syndrome linked to chronic conditions such as type 2 diabetes, heart disease, and strokes.¹¹

How to Diagnose NES

A healthcare provider diagnoses NES, so you must reach out to your primary care doctor if you are concerned about yourself or someone you love. Symptoms must be present for at least three months for an NES diagnosis.²

Providers may use validated questionnaires analyzing some of the symptoms listed above and such as the Night Eating Questionnaire (NEQ), the Night Eating Diagnostic Scale (NEDS), or the Night Eating Symptom Scale (NESS). These tools ask questions about eating behavior to determine if night eating is a problem.²

NES is a listed condition under “Other Specified Feeding or Eating Disorder (OSFED)” in the “Diagnostic and Statistical Manual of Mental Disorders, 5th Edition” (DSM-5). The DSM-5 is used for diagnosing mental health conditions and classifying symptoms.²

Night Eating Syndrome Treatment

  • Cognitive behavioral therapy (CBT). CBT teaches skills to cope with emotions, thoughts, and behaviors.¹² It may help with NES by bringing awareness to episodes of night eating, questioning and addressing triggers, and helping with prevention techniques.²
  • Antidepressants. Serotonin selective reuptake inhibitors (SSRIs), a type of antidepressant, have been studied as a night eating syndrome treatment. Since serotonin is involved with mood, sleep, and appetite, and people with NES may have dysregulated levels, SSRIs may help mental health and reduce evening eating episodes.²
  • Progressive muscle relaxation. This relaxation technique involves tensing and relaxing one muscle group one at a time, which may be a tool to help night eaters to relax. While more studies on this technique are needed specifically for NES, some research has found it beneficial for reducing associated symptoms.³
  • Phototherapy. Exposure to certain types of light can help regulate circadian rhythms. Phototherapy involves sitting in front of a lightbox to support mood or sleep disorders. It supports melatonin and serotonin regulation. Night eaters may benefit from exposure to regulate their sleep and wake cycles.²
  • Melatonin supplements. Since people with NES may have issues with melatonin production, melatonin supplementation may help night eaters to regulate their sleep cycles. There aren’t many studies on using melatonin alone, but one study examined the effect of a medication analog (chemically similar) to melatonin and noted improvements in mood and NES symptoms.¹³
  • Nutrition guidance. It takes time to relearn eating regularly spaced meals and paying attention to hunger cues. Even learning to eat breakfast again can feel tricky if you aren’t used to it. A dietitian or nutritionist can help night eaters to learn how to fuel their bodies in the morning and throughout the day to help reduce nighttime eating.

4 Tips to Stop Night Eating Syndrome and Avoid Binge Eating at Night

Given NES isn’t just about food, taking steps to manage your stress and emotions can help. Here are some tips that may help night eaters reduce nighttime binges: 

  • Create a soothing nighttime ritual. Sleep hygiene, or how you prepare for sleep, can be an essential step to support NES. Create a nighttime routine that helps to relax your body and mind. This might include dimming the lights, taking a warm bath or shower, reading a book, or stretching. Whatever feels calming to you.
  • Exercise during the day. Movement helps with mood regulation and can help night eaters to manage stress.¹⁴ It also helps with insulin sensitivity, which can help regulate blood sugar and hunger cues.¹⁵
  • Address mental health. Recognizing that NES may be part of a bigger overall picture can help you find compassion and understanding for yourself. It’s not about willpower or being “good” or “bad.” Professional support is critical to help you identify and address why it’s happening in the first place.
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  • Practice mindfulness. Mindfulness can help night eaters become aware of their thoughts and emotions without judgment. It also can help you tune into biological hunger cues, which can help you make food choices that feel good for your body.

Learn More About Your Nutrition and Improve Your Eating Habits with Signos

NES is complex, so seeking professional help to identify the underlying causes and develop an effective treatment plan is important. If you struggle with night eating syndrome, nutrition counseling can help you develop healthier eating habits and make positive lifestyle changes. 

As you make changes, using a continuous glucose monitor (CGM) paired with Signos’ personalized real-time feedback can show you exactly what’s happening in your body when you eat more at night. Seeing your blood sugar response can motivate you to make positive changes. 

With Signos, you get insight into your nutrition choices and behaviors that can help you learn more about your body. Find out if Signos is a good fit by taking a quick quiz here.

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References

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About the author

Caitlin Beale is a registered dietitian and nutrition writer with a master’s degree in nutrition. She has a background in acute care, integrative wellness, and clinical nutrition.

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