Unexplained weight gain? Consider sleep-related eating disorders

Patients with sleep-related eating disorders often don't recall eating.
Patients with sleep-related eating disorders often don't recall eating.

James is a 54-year-old male who teaches English as a second language at the local community college. He is active and enjoys taking classes himself when he is not teaching them. Recently, he gained 40 pounds but assured his physician that he was not eating more than usual. His provider did the usual blood work, including checking to make sure his thyroid gland was working properly. The blood work showed no problems. His physician encouraged him to exercise more and watch his calories

Despite following his physician's advice, James continued to slowly gain weight. It wasn't until he scolded his teenage son for leaving food out on the counter at night that the real issue came to light. It was not the son who was leaving food out; it was his father. During the night, James was getting up and eating, but he had no recollection of it.

Sleep-related eating disorder (SRED) occurs during arousals from sleep and includes eating and drinking with little or no remembrance of having done so. Some patients remember some of the event but feel they have no control and can't prevent it from occurring. It is often seen in patients who have trouble with food during the day, such as patients with anorexia or bulimia, but not in all cases.

Unfortunately, there are several concerns for patients with SRED. Many patients eat non-food items, such as coffee grounds, dog food, or cleaning solutions. While attempting to prepare food, they can cut themselves, burn themselves, or start a fire. Patients with diabetes may be at risk of blood sugar spikes. Additionally, like in James's case, weight gain is seen in many patients because of the additional caloric intake.

SRED occurs more frequently in females with a mean onset of 22 to 39 years old. SRED can run in families. I once had a father and son who said they would pass each other in the hall during the night while going for their midnight snacks. SRED may also signify another sleep disorder and can be seen in patients who take hypnotics. These patients have been known to make large, elaborate meals during the night with absolutely no recollection. Sleep disorders often associated with SRED include restless leg syndrome, periodic limb movements of sleep, obstructive sleep apnea, narcolepsy, and circadian rhythm disorders.

Treatments for SRED vary, and there is limited study data on the disorder. Success has been found with a few types of antidepressants such as sertraline. However, it should be noted that if a patient has restless leg syndrome, an antidepressant can make restless leg syndrome worse. Topiramate given at bedtime has shown benefits for SRED in studies. I have prescribed this to my own patients with success.

Next time a patient says they are gaining weight without a cause, ask about their sleep history. If food seems to be disappearing or crumbs are being found in the bed, consider a consult to a sleep professional for evaluation.

Sharon M. O'Brien MPAS, PA-C, is a practicing clinician with an interest is helping patients understand the importance of sleep hygiene and the impact of sleep on health.

References

  1. Auger RR. Sleep-related eating disorders. Psychiatry (Edgmont) 2006;3:64–70.
  2. Chokroverty S. Sleep Disorders Medicine. Philadelphia: Saunders/Elsevier; 2009.
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