Is midnight snacking a bad habit or a bona fide sleep disorder?
One of the most unusual and interesting cases I have seen while practicing sleep medicine involved a man in his mid 50s, who had been sleep eating for 40 years. It was a joke in the family, as his father also had the same problem.
According to the patient, he and his father would pass each other in the hall as one had finished eating and the other was on his way to the kitchen. Neither one was aware of the other.
Sleep-related eating disorder (SRED) affects 1% to 3% of Americans. It is a sleep arousal disorder and happens mainly during non-REM sleep. Most sleep-eaters are women.
When patients get up to eat during the night, they are usually unaware of their behavior. They find the remnants of their meal the next morning and then realize what has occurred. There are reported cases where patients have cooked complete meals, totally unaware.
Patients with SRED may experience unexpected weight gain, as well as an inability to lose weight, and often feel ashamed. The potential for harm is great, not only from sleepwalking, but from eating non-food items such as cigarette butts, soap or raw meat.
If SRED is suspected, a polysomnogram is indicated to rule out underlying causes. SRED is often seen in those with obstructive sleep apnea, restless leg syndrome, sleepwalking and in those with a family history of parasomnia.
Patients that use hypnotics, such as zolpidem, are at increased risk for SRED, so be sure to counsel them about the possibility for SRED. In most cases, once the medication is stopped the SRED will also stop.
Although treating SRED often includes the medication topiramate, which helps control the desire to eat, treating any underlying sleep problems is the most important objective.
My patient responded well once we diagnosed and treated his restless leg syndrome and periodic limb movements of sleep. He was also prescribed topiramate. The patient no longer walks or eats in his sleep and lost eleven lbs. the first month of treatment.
Sharon M. O'Brien, MPAS, PA-C, works at Presbyterian Sleep Health in Charlotte, N.C. Her main interest is helping patients understand the importance of sleep hygiene and the impact of sleep on health.