The below full-length version of Night Feeders, by Kelly Senyei, appears in the current issue of Gourmet Live. Download the free Gourmet Live app to get this story and more.
In the above sleep-eating episode, a woman is seen bingeing on brownies while sitting on her bed. The remarkable feature of her eating is that after each bite of brownie, the woman extends her pinky finger of the feeding hand away from the other fingers, and then uses the pinky to shove remaining brownie crumbs into her mouth. The behavior is repeated in the same manner with each bite. It is clearly not a behavior she–or anyone else–would use while fully awake, as the feat of extending the pinky far away from the other fingers is quite difficult to do. This episode is an example of state-dependent (and state-specific) feeding behavior found with Sleep-Related Eating Disorder. Video clip and caption courtesy of Slow-Wave Films, LLC
I’ve woken up mid-sprint through my living room. I’ve woken up while unlocking my front door. I’ve woken up standing stock-still in my hallway. I’ve even woken up mid–fall down the stairs. And while I’ve done all of the above—and more—unconsciously in my sleep, there is one thing I have never done: Eat.
Unlike the experiences of most people suffering from sleep-related disorders, my occasional stumble into the living room or random stop by the hallway has never really been life-threatening. Rather, my tendency to sleepwalk is an activity that doctors regard as a stress-induced behavior, and one that studies have shown may affect up to 4 percent of the adult population, according to renowned sleep disorders specialist Carlos Schenck, MD.
But what if, one morning, I woke up to a bed full of candy wrappers? Or fell asleep after doing the dishes, only to wake to a kitchen full of peanut butter–smeared knives and a skillet on the stove set ablaze?
An estimated 3 million Americans, or roughly 1 percent of the U.S. population, awake to scenarios like these every morning. They are sufferers of Sleep-Related Eating Disorder, an affliction that leads people to eat and even cook in their sleep, with little to no memory of their late-night binges. Sometimes, the only proof of their unconscious eating is the detritus they leave in their path: half-eaten bowls of oatmeal, a dozen chocolate candy wrappers, bars of soap etched with tooth marks, even chewed cigarettes slathered with butter.
What drives people to eat in their sleep, and how they know what to consume and how to consume it, are aspects of a disorder that is largely unknown and relatively unstudied in the fields of science and medicine. According to Dr. Schenck, who is a professor of psychiatry at the University of Minnesota Medical School and a senior staff psychiatrist at the Minnesota Regional Sleep Disorders Center, Sleep-Related Eating Disorder (commonly abbreviated as SRED) is a type of parasomnia that is defined as “involuntary eating during the sleep period that then results in an adverse consequence, such as weight gain or sleep disruption.”
Listed as an official diagnostic entity in The International Classification of Sleep Disorders, SRED differs from the more common Night Eating Syndrome in terms of a patient’s level of consciousness while food is being consumed. Night Eating Syndrome is considered any eating after dinner and before wake-up time the next morning, with at least 25 percent of a person’s total daily intake occurring after dinner, according to Kelly Allison, PhD, assistant professor of psychology in psychiatry at the University of Pennsylvania School of Medicine and co-director of education at Penn’s Center for Weight and Eating Disorders.
Patients diagnosed with Night Eating Syndrome are fully aware of their midnight meals, while patients diagnosed with SRED have little or no recollection of their post-bedtime feasting. It is this distinction that causes sufferers of Sleep-Related Eating Disorder to be just as likely to veer toward non-nutritive substances as to consume food during their binges.
In a typical sleep-eating episode, a sleeping person gets up from bed and then makes a beeline for the kitchen. And according to Dr. Schenck, it’s an entirely driven behavior. “The patients who are partially aware of what they’re doing don’t really have a sense of hunger, per se,” he says. “And eating and sleeping are basic instincts, so when the two become interlocked in a pathological way, then it’s all over for anything else.”
As in most sleepwalking incidents, sleep eaters’ eyes are generally open during the act of consumption. But just because they can see what they’re doing doesn’t mean they’re aware of their physical functions.
“There are people who will cook and then not have memories of that event, or they’ll use sharp knives to make a sandwich and have absolutely no recollection of it,” says Gary Zammit, PhD, executive director of the Sleep Disorders Institute in New York City and author of Good Nights: How to Stop Sleep Deprivation, Overcome Insomnia, and Get the Sleep You Need. “You can engage in a fairly complex behavior, but there are risks associated with it, because behavior can be uncoordinated.” Indeed, pairing a lack of coordination with knives, stovetop burners, 350-degree ovens and microwaves can lead to severe cuts and third-degree burns—or worse. And the simple process of swallowing becomes a dangerous act in itself, as sleep eaters themselves are often well aware.
“Sleep eaters are physiologically conscious of the fact that they’re eating,” says Joyce Walsleben, PhD, associate professor in the department of medicine at New York University’s Langone Medical Center and author of A Woman’s Guide to Sleep: Guaranteed Solutions for a Good Night’s Rest. She notes that choking is therefore not common given that when sleep eaters put food in their mouths it’s a natural behavior to swallow. But sometimes an even greater threat than choking is the ingested substance itself.
“I had a patient who ate a jar of mayonnaise, and another patient who would eat frozen foods that had not been thawed or cooked, so they’d just swallow chunks of frozen meat,” notes Dr. Zammit. Dr. Schenck has had patients who made sandwiches of cat food, sugar and salt; put napkins in toasters; or ate microwaved oatmeal so scorchingly hot that they burned the inside of their mouth severely enough to warrant a trip to the emergency room the next morning. Dr. Allison even recalls one account of a person who reported a sleep-eating episode during which she ate shaving cream off a razor.
Why sleep eaters choose the foods, or nonfoods, that they do is a question that researchers are still striving to answer. “If they’re more asleep than awake, then they’re going to make poor choices and eat things that aren’t nutritive, like soap or paper,” says John Winkelman, MD, PhD, associate professor of psychiatry at Harvard Medical School and medical director of the Sleep Health Center at Brigham and Women’s Hospital. “Or they will try to cook things that don’t need to be cooked. I think they generally just eat what’s available.”
It is sometimes possible to predict what a sleep eater will select based on what they eat—or abstain from eating—in their daytime diet. Dr. Zammit recalls one female patient who maintained a strict low-sugar, low-fat diet during the day, only to consume high-fat foods in her sleep. He speculates that this may suggest a link between “people restricting their diets and having a drive to get up and eat those [restricted] foods while sleeping.”
This correlation becomes even more pronounced when considering which portion of the population is prone to sleep eating. On the list: people with a history of anorexia or bulimia nervosa. Dr. Allison and Dr. Walsleben hypothesize that people suffering from such eating disorders may be more inclined to eat in their sleep in order to fulfill a hunger drive that is routinely suppressed during the day.
Also high up on the list of sleep eaters are women. Sleep-Related Eating Disorder is “70 percent female predominant,” according to Dr. Schenck. But this gender tie-in shouldn’t be surprising. Women are not only more likely than men to eat in their sleep but also more likely than men to suffer from daytime eating disorders.
Aside from women and individuals specifically suffering from anorexia or bulimia nervosa, SRED is most commonly triggered in people who sleepwalk, have sleep apnea (abnormal pauses in breathing during sleep) or take prescription sleep-aid medications. Ambien, one of the more popular prescription medications for insomnia, can cause sleep eating in people who have no other history of daytime eating disorders, sleepwalking or sleep apnea, notes Dr. Schenck.
This is not to say that men or normal eaters cannot be diagnosed with the disorder. The fact remains that no one is immune to it. But knowing what triggers sleep eating and who is most likely to suffer from it still won’t prevent the onslaught of physical consequences. The damage becomes far greater and longer-lasting than a cut or burn when what’s being consumed is extremely fattening. A 5,000-calorie binge on peanut butter, bacon and frozen pie in the middle of the night can mean only one thing: instant weight gain. And not just a few pounds, either.
“We’re talking a minimum of 10 to 15 pounds, and in some patients, 50 to 60 pounds,” says Dr. Schenck. Coupled with the weight gain is the emotional stress of one’s body changing for the worse. People who eat in their sleep often wake up feeling a loss of control or a tremendous amount of guilt. And as a result, they will often restrict their calorie intake during the day, only to return to their post-bedtime binges in the middle of the night. It becomes a vicious cycle as weights “yo-yo” to extreme highs and temporary lows.
With weight gain comes the possibility of outright obesity, leading to metabolic complications that include spikes in blood pressure and cholesterol levels as well as an increased likelihood of developing diabetes. And if cuts, burns and an expanding waistline aren’t enough physical evidence of the detrimental effects of the disorder, consider opening wide to a mouth full of cavities and chipped teeth.
“I had a woman who came into my office with a $2,000 dental bill,” says Dr. Schenck. “And she said, ‘This is why I’m here. I can’t afford to pay my dentist this much because I have food in my mouth all the time.’” And “all the time” includes sleeping hours, when sugary foods seep into molars and frozen beef chips away at canines.
While the many psychologists and physicians interviewed for this story were more than knowledgeable on the subject of SRED, they also didn’t hesitate to acknowledge that the disorder is not widely known. Calls inquiring about treatment for Sleep-Related Eating Disorder at six sleep disorder clinics and hospital labs across the country were met with bewilderment or even incredulity. Do we treat what?
It is possible that the fact that the disease affects only about 1 percent of the population accounts for people’s unfamiliarity with it. But a similar proportion of the population—approximately 1 percent—suffers from schizophrenia, and it is my guess that the average person has heard of schizophrenia. Furthermore, 1 percent of our current population is more than 3 million people—nearly the entire population of the state of Connecticut. Is that number not large enough to garner more attention?
It’s actually impossible to know the true number of sufferers, given that many cases are thought to go unreported due to people being too embarrassed to seek treatment. Some doctors think the 1 percent figure may actually be as high as 5 percent. “This is such a peculiar behavior. People feel out of control, and they feel shame for doing something so weird,” says Dr. Schenck. “And I also think there’s a fear of being labeled as a psychiatric patient, and now it’ll be in your medical record for the rest of your life.”
Once a sleep eater does seek help, he or she must be willing to try a variety of treatments, ranging from practical tactics to prescription medications. Dr. Walsleben and Dr. Schenck like to place an alarm on the patient’s bedroom door, which is meant to snap them into full wakefulness if they try to head for the kitchen. Other treatments include monitoring sleep eaters’ diets to ensure that they aren’t depriving themselves of nutrients during daytime hours. And if such tactics fail and a patient continues to eat in his or her sleep, doctors suggest strategically steering a sleep eater toward better options. “For some people, just removing those [unhealthy] choices is really helpful,” says Dr. Zammit. “Instead, we have them prepare a snack tray with carrots or celery or something more low-cal. We give them this ‘safe food’ tray, which is a place they can eat from if they do get up in the middle of the night.”
If further intervention is needed, doctors often prescribe Topamax, the most popular medication for treating sleep eaters, which was originally developed for the treatment of seizure disorders. Dr. Schenck reports that two-thirds of his patients have had a successful outcome as a result of taking Topamax. The drug is a mild appetite suppressant and is also known to have some effect on metabolism, according to Dr. Winkelman, who runs one of the few clinical, placebo-controlled trials in the United States that studies the effect of Topamax on sleep-related eating.
The best online source for more information about Sleep-Related Eating Disorder, or for assistance locating a sleep specialist near you, is the National Sleep Foundation. Such educational resources, along with the pioneering efforts of doctors and researchers across the United States, have begun to shed light on a disorder that comes shrouded in guilt, embarrassment and shame. “There’s a tremendous lack of education,” says Dr. Schenck. “And for many people, there’s the hope that it will just somehow go away.”
One thing that isn’t going away is my sleepwalking. While most people seem to outgrow the late-night stumbles, or in my case, midnight sprints, I’m relatively convinced it’s something that will always recur when I’m stressed. But that inevitably leaves me wondering what other mysterious things I might be doing in my sleep. Perhaps eating wouldn’t be so bad.