The man battling to lose weight was reaching the point of frustration for himself and his physician, who told him, in no uncertain terms, “You’ve got to lose weight because your health is at risk if you don’t.”
During the day, the young man carefully monitored his meals, counted his calories, looked at how he could make substitutions for items, read menus with a vengeance, and prepared himself to hit the scale the following day.
The battle of the bulge for him had been going on since his early 20s, and he had seen experts in weight control who had put him in group therapy and provided individual therapy to explore why he didn’t seem able to lose weight. The bottom line for him was that no one believed him.
No matter what he said or how carefully he monitored his food intake and maintained an exercise regimen, they all looked at him as though he were secretly sneaking high-calorie foods. If anyone looked at the calorie counters he kept during the day and perused the meals he claimed he had eaten that day and any soft drink he had had, they all concluded that he wasn’t telling the truth.
The grilling went on as they believed he was resistant to revealing what he was secretly doing and which they knew he had to be doing because he never seemed to lose weight. It appeared that he was gaining weight each month.
One behavioral therapist had a moment of incredible insight. When he got up in the morning, she asked if he noticed anything odd in his bedroom, his kitchen, or his living room. What a strange question, he thought.
Now she thinks I don’t know how to keep my apartment neat and clean, in addition to being someone who can’t control their appetite?
When he inspected his home as she had suggested, he went into the kitchen the following day. He discovered a high-calorie dessert half-eaten on the table, and a half-eaten sandwich near the refrigerator. Sure, he’d seen some of this before, but he thought nothing of it and cleaned the mess up.
Of course, he knew he shouldn’t have these things in the house or any other high-calorie drinks or food around, but he kept them to test his resolve to maintain his diet. He went back to the therapist and told her what he had discovered. He brought photographs he had taken so that she could share the information that he had.
A Strange Diagnosis
The diagnosis was clear, and to whom did she refer him? Writing on a notepad, she gave him the name of a sleep medicine physician because it appeared that he had what is known as a sleep-related eating disorder (SRED).
The man wasn’t alone in this unusual sleep disorder because the therapist had heard of other men and women who found themselves, after they had gone to sleep, in extraordinary situations where they were eating entire loaves of bread and stuffing their mouths full.
One man awakened to find himself sitting in his bed with a large bowl of cereal and ice cream, which he was gorging on even though he was asleep. Fortunately, it awakened him, and he began to wonder why he, too, was having a problem maintaining a healthy weight.
Some individuals with this unusual sleep disorder can find themselves in hazardous situations where they begin trying to prepare foods on the stove or in the microwave and may go back to bed after eating and leave the stove on.
All of these people experienced what is known as a parasomnia, in which they have no recollection of what they did while they were asleep. Typically, we might hear about people sleepwalking, also known as somnambulism, another highly dangerous activity. Still, not enough people or enough individuals in the healthcare field know about sleep-related eating disorders.
The literature points to the disorder being more prevalent in women, and 66 to 75% of those with SRED are females who develop the condition in their 20s.
The Evidence Is There
One of the problems with diagnosing sleep and eating disorder (ED) is the lack of literature available to professionals. The paucity of research publications on sleep-related eating disorder (SRED) is curious since researchers know two main drives in our lives are eating and sleeping. Wouldn’t that seem to indicate that these two areas should receive more attention, especially when they are combined in a disorder such as sleep-related eating disorder, but that’s not the case.
Research points to the fact that persons with eating disorders, such as anorexia nervosa, bulimia nervosa, and binge eating disorder, also have additional problems. Up to 57% of those with eating disorders also show disorganized sleep patterns and an inability to maintain or initiate sleep.
And the combination of disrupted eating and sleeping can have serious consequences. EDs are associated with significantly higher mortality rates than other DSM-5 diagnoses ranging from 5 to 6%.
Another related condition, known as nocturnal eating syndrome (NES), is the disorder where the person wakes up during the night and needs to eat something to get back to sleep. The difference between this disorder and SRED is that the person is wide awake and knows they are eating while the SRED person eats and has no memory of it.
One question currently needing additional attention when there is problematic weight gain with accompanying futility related to dieting may be the consideration of a sleep-eating-related situation. How often have persons manifesting obesity been referred for a sleep study?
We know there is a strong association between sleep disorders and individuals having an accompanying problem maintaining weight. Once we note the relationship between these two exists in the individual, would it seem reasonable to continue psychotherapy for unconscious conflict or some other psychological disorder? Wouldn’t it seem appropriate for a referral?
Possible Causes of SRED
Even though there is a relationship between sleep disorders and eating while sleeping, there doesn’t appear to be one specific cause for this disorder. There is evidence that specific sleep-related medications for insomnia may cause this type of behavior, as can medications for various other problems, including restless legs syndrome, obstructive sleep apnea, narcolepsy, and periodic limb movement disorder. Stress may also have a role in this disorder, and that, too, must be investigated.
The patient’s symptoms include waking up with little or no memory of eating, weight gain, not feeling hungry in the morning, or feeling fatigued during the day.
Once the person has been assessed at a sleep laboratory, a treatment plan can be prescribed, and the appropriate healthcare personnel will become involved.
Patients need to be honest with themselves regarding any weight difficulties they are experiencing and are advised not to jump to the conclusion that it must be a sleep disorder. It might be a sleep disturbance that adds to daytime issues, but not necessarily SRED.