Eating disorders affect over 30 million people in the United States and can cause significant physical and mental distress. Eating Disorder Awareness Week, an annual event held the last week of February, has been recognized for over 30 years as a way to raise awareness and provide hope and resources to people affected by eating disorders.
Sleep plays a vital role in both emotional and physical health, and a growing amount of evidence shows a connection between sleep and eating disorders. Although the exact nature of this link is unknown, most research points to a complex, multifaceted relationship.
Knowing about the ties between sleep and eating disorders can help people affected by these disorders better understand their condition. In some cases, enhancing sleep may provide an opportunity to feel better and even reduce eating disorder symptoms.
Improving sleep is just one of many avenues for people with eating disorders to get help. For direct assistance, the National Eating Disorders Association (NEDA) helpline provides phone and online chat services to connect people who have eating disorders and their loved ones with the information and support they need.
Eating disorders are mental health conditions that involve abnormal eating behavior. These behaviors are frequently associated with problematic thoughts or feelings about food, weight, and/or body image.
There are many types of eating disorders. The most common eating disorders are binge eating disorder, bulimia nervosa, and anorexia nervosa. Night eating syndrome is the eating disorder that most directly affects sleep, although all eating disorders can interact with sleep.
People with binge eating disorder experience out-of-control eating. Episodes often involve eating large amounts in a short time and continuing to eat despite feeling full. Binge eating can cause discomfort and feelings of shame and guilt. Binge eating disorder can occur in people of any size, but is most common in people who are overweight or obese.
Like people with binge eating disorder, people with bulimia nervosa have episodes of out-of-control consumption of large amounts of food. Afterward, people with this disorder use purging behavior — vomiting, exercising excessively, using laxatives or water pills, or fasting — to try to counteract the binge eating.
Bulimia nervosa is believed to affect about 1% of people during the course of their life. It can cause serious health consequences resulting from consistent vomiting and other purging behaviors. Depending on their specific circumstances, people with bulimia nervosa can be somewhat underweight, average weight, or overweight.
Anorexia nervosa is an eating disorder that involves significant reduction of food consumption related to an extreme pursuit of being thin. Even when they are considerably underweight, people with anorexia commonly think of themselves as overweight.
There are two types of anorexia nervosa. The restrictive type involves major restrictions on food intake. The binge-purge type also involves restricting intake but includes behaviors like vomiting or using laxatives to try to maximize weight loss.
Insufficient food consumption can lead to serious and life-threatening malnourishment. Among all mental health disorders, anorexia nervosa has the highest death rate. Studies estimate that around .6% of people experience anorexia nervosa at some point during their life.
Night eating syndrome is a disorder that is believed to affect around 1.5% of people. People with this condition eat between 25-50% of their daily calories after dinner. They are normally not hungry in the morning but feel a strong urge to eat at night.
Night eating syndrome is associated with obesity. It often causes emotional distress, such as shame or guilt, and its sleep interruptions can cause daytime drowsiness and impairment.
Night eating syndrome is believed to be connected to a misaligned circadian rhythm. Circadian rhythm is a person’s internal clock that helps control a broad range of bodily functions.
The exact cause of eating disorders is unknown, but they are believed to be linked to a combination of genetic, environmental, social, and other factors.
It is important to emphasize that eating disorders are not a result of lifestyle choices. Instead, they are medical conditions with complicated biological underpinnings.
Some eating disorders appear to run in families, which suggests a possible genetic predisposition in certain cases. Social and cultural pressures, concerns about body image, and other emotional struggles may influence the risk of developing an eating disorder.
Many research studies have identified a significant overlap between sleeping problems and eating disorders. Not everyone with poor sleep has an eating disorder, and not all people with eating disorders have problems sleeping. Nevertheless, these issues arise together at a rate that strongly indicates an association between them.
Many experts believe that eating disorders and sleep have a bidirectional relationship. This means that eating disorders can negatively affect sleep and that sleep disruptions can contribute to the symptoms of eating disorders.
Some examples of this bidirectional relationship include:
Although more studies are needed to expand the scientific understanding of the relationship between sleep and eating disorders, the existing body of research points to numerous connections that can be of importance to both patients and health care providers.
There is still much that is unknown about sleep, eating disorders, and the connections between them. The mental and physical processes underlying sleep, nutrition, and mental health are extremely complex, which makes it challenging to definitively know what drives their relationship.
That said, researchers have advanced several ideas for how sleep and eating disorders may influence one another:
Many of these factors could be involved in any individual’s case, and additional research is needed to clarify the central elements that drive the link between eating disorders and sleep.
In addition to eating disorders that are tied to sleep, there are some sleep disorders that affect eating.
Sleep-related eating disorder (SERD) is a condition in which a person rises from bed and eats during sleep. In these episodes, the person remains in a sleep-like state and is not aware of their behavior. As a result, they may consume rancid food or hazardous materials.
Like sleepwalking or sleep talking, SERD is a type of abnormal behavior sleep disorder known as a parasomnia. Although it may be confused with night eating syndrome, SERD is distinguished by the person’s lack of awareness when eating.
Other sleep disorders may also influence eating patterns. Disorders involving sleep deprivation may interfere with hormones that control appetite. Not getting the sleep you need can also influence brain function in ways that alter impulse control and food choice.
There is hope for people with eating disorders. Various types of treatment can reduce or even eliminate symptoms, and steps to enhance sleep may boost the effectiveness of those treatments.
Treatment for eating disorders is usually coordinated by a doctor and/or psychiatrist. Treatment can be tailored to fit the patient’s situation and may involve one or more different approaches.
Counseling is frequently a core element of treatment. For example, cognitive behavioral therapy (CBT) is a method that helps examine and reorient negative thinking that can give rise to unwanted behavior. Other types of behavioral therapies can involve family members and establishing new routines that promote healthier eating habits.
Medications may also be prescribed that can help treat the symptoms of mental health disorders that often arise with eating disorders. Reducing depression and/or anxiety in this way can have positive effects on the severity of eating disorders.
People with eating disorders can also get support from family members, friends, and through organizations and support groups. For many patients, support can reduce the stigma associated with eating disorders and enable them to more effectively cope with or address the condition.
Because sleep is fundamental to virtually all aspects of health, it’s almost always beneficial to commit to getting better sleep. For people with eating disorders, improved sleep may offer even more benefits through a positive effect on their symptoms.
An initial step is to describe any sleeping difficulties to your doctor or psychiatrist. Some symptoms could be a sign of an underlying sleep disorder that can be directly addressed to enhance sleep.
Another step to obtaining better sleep is upgrading your sleep hygiene. This means building healthy sleep habits and designing your bedroom to be conducive to high-quality sleep. Although there are many ways to step up your sleep hygiene, some important elements include:
For people with night eating syndrome, early-stage studies have shown potential benefits from light therapy, which uses a special lamp to mimic daylight and provide a dose of concentrated light in the morning.
The goal of light therapy is to positively affect circadian rhythm, which is closely linked to light exposure. Light therapy is also used to treat some mood disorders, such as seasonal affective disorder.
More research is needed to establish what role, if any, light therapy has in treating night eating syndrome. For this reason, anyone interested in this approach should talk with their doctor about the benefits and risks before beginning light therapy.