Sleep-Related Eating Disorder | Why Do I Binge Eat in My Sleep?

Sleep-Related Eating Disorder (SRED) is classified as a parasomnia, a category of sleep disorders characterized by abnormal behaviors during sleep. Individuals with SRED experience recurrent episodes of involuntary eating and drinking while in a state of partial arousal from non-REM sleep. The key feature of SRED is a dissociation of consciousness: the brain is sufficiently awake to execute complex tasks like navigating to the kitchen, opening containers, and preparing food, yet remains asleep enough that the individual has little to no memory of the event upon waking. This distinguishes it from Night Eating Syndrome (NES), where individuals are fully awake and conscious during their nighttime eating episodes. The foods consumed are often high in calories, sugar, or fat. In some cases, individuals may ingest bizarre or dangerous combinations of food or even non-edible substances, posing significant health risks. This behavior is not driven by hunger but is a compulsive action emerging from a dysfunctional state between sleep and wakefulness, often co-occurring with other parasomnias like somnambulism (sleepwalking).

The neurobiological basis of SRED is understood as a disorder of arousal regulation. During normal sleep, the brain cycles through different stages. In SRED, an abrupt and incomplete arousal occurs, activating motor systems and primitive drives like appetite while higher cortical areas, such as the prefrontal cortex responsible for judgment and memory formation, remain offline. This neurological disconnect explains the compulsive, uninhibited, and amnesic nature of the eating episodes. Several factors can trigger these arousals. Stress and sleep deprivation are significant contributors, as they disrupt normal sleep architecture. Furthermore, SRED can be induced or exacerbated by certain medications, particularly sedative-hypnotics used to treat insomnia (e.g., Zolpidem) and some antipsychotic drugs. It also has a high rate of comorbidity with other sleep disorders, including restless legs syndrome and obstructive sleep apnea, as the frequent arousals caused by these conditions can provide a window for SRED behaviors to manifest.

The primary indicator of SRED is the indirect evidence of nighttime eating, such as finding kitchen messes, food wrappers in the bedroom, or food missing, without any recollection of having eaten. Individuals often report a lack of appetite in the morning (morning anorexia) and may experience persistent fatigue and daytime sleepiness due to fragmented, poor-quality sleep. The main health consequence is unintended weight gain, which can lead to metabolic complications like elevated cholesterol, hypertension, and type 2 diabetes. There is also a substantial risk of physical injury. While partially asleep, individuals may cut themselves while preparing food, sustain burns from using kitchen appliances, or consume toxic substances, leading to poisoning or internal damage.

A professional diagnosis of SRED is established through a comprehensive clinical evaluation. This process begins with a detailed patient history, focusing on sleep patterns, nocturnal behaviors, and medication use. Often, input from a bed partner or family member who has witnessed the episodes is invaluable. The definitive diagnostic procedure is an overnight polysomnogram (PSG), which is a sleep study conducted in a specialized clinic. The PSG continuously monitors brain wave activity (EEG), eye movements, muscle tone, heart rate, and breathing. This allows clinicians to objectively document the episodes of abnormal arousal from sleep that coincide with eating behaviors and to rule out other primary sleep disorders that could be triggering the events.

Treatment for SRED requires a multi-pronged approach, starting with addressing any co-existing sleep disorders like sleep apnea or restless legs syndrome, as their successful management can reduce sleep fragmentation and, consequently, SRED episodes. If a medication is identified as the trigger, a physician will consider adjusting the dose or prescribing an alternative. Behavioral interventions are a cornerstone of management. This includes practicing strict sleep hygiene—maintaining a consistent sleep-wake schedule, creating a relaxing bedtime routine, and ensuring the sleep environment is dark and quiet. Stress management techniques are also important. For safety, it is recommended to secure the kitchen by locking food cupboards, placing alarms on the refrigerator or bedroom door, and removing dangerous items. Pharmacologically, certain antiepileptic medications, such as topiramate, have demonstrated efficacy in controlling SRED episodes by stabilizing neuronal activity during sleep. Dopamine agonists may also be prescribed, particularly if the SRED is associated with restless legs syndrome.