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You're lying in bed, and you can't sleep. If you think a little midnight snack might help to "soothe" your nerves, perhaps you should think again. While an occasional midnight raid on the refrigerator poses no threat to health for most of us, as a habitual pattern to combat sleeplessness, Night Eating Syndrome (NES) can play a powerful and destructive cyclical role in individuals battling obesity, affecting as many as one quarter of severely obese individuals.
Causes & Development
In a recent report of a collaborative effort involving behavioral and endocrine studies conducted in the United States and Norway, researchers shed new light on NES. The article, published in JAMA, suggests that NES - characterized by nightly binging to combat stress and insomnia, followed by morning-after bouts of anorexia - may be deeply rooted in stress-related hormonal imbalances.
Researchers from the Weight and Eating Disorders Program at the Department of Psychiatry of the University of Pennsylvania School of Medicine evaluated 10 individuals with NES. These individuals consumed over 50% of their food calories after 6 p.m. In addition, their sleeping and mood patterns differed greatly from controls, with mood falling steadily after 4 p.m., and nightly awakenings averaging 3.6 times per night.
Looking for possible biochemical triggers underlying this pattern, scientists from the Clinical Research Department and the Laboratory of Gastroenterology of the University Hospital in Tromso, Norway examined the hormone activity of NES patients (12 night eaters and 21 controls) over the complete light-dark cycle. They found that the night eaters - both normal and overweight - had significantly lower melatonin levels during the night than did the controls. Since melatonin levels normally rise at night to induce and sustain sleep, this may explain why NES patients wake up more frequently at night.
NES has been linked to hormone imbalances; high cortisol, low melatonin and leptin may make things worse. Leptin, the "hunger hormone" which rises at night to suppress appetite, was also lower in the NES patients, partly explaining their nocturnal food cravings. This "distinctive neuroendocrine pattern" in individuals with NES may provide the key to more successful treatment, said the researchers.
Treatment & Prevention
Therapy to increase the natural nocturnal rise in melatonin, reduce the body's adrenal stress response and raise leptin levels or improve leptin sensitivity are options that may help these patients overcome the disorder. Another key may involve the availability of tryptophan, an important amino acid, in the body. More than 70% of the nighttime eating to combat anxiety involved binging on carbohydrates. These foods are believed to increase the amount of tryptophan available for conversion to serotonin, the calming neurotransmitter in the brain that promotes an overall sense of well-being and, in turn, converts to melatonin.
NOTE: Addressing hormonal and biochemical imbalances in patients with chronic eating and mood disorders can be crucial for uncovering fundamental causes and contributing factors that underlie cyclical, habitual patterns of insomnia, overeating, and depression.
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Signs, symptoms & indicators of Night Eating Syndrome:
Risk factors for Night Eating Syndrome: | | | | | Hormones |  Low Melatonin Level | Melatonin levels were found to be generally lower in patients with Night Eating Syndrome. |
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Mental |
Stress| | Nighttime eaters have elevated levels of the stress hormone cortisol during almost all hours of the day, suggesting that they suffer from the effects of chronic stress in their daily lives. |
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Night Eating Syndrome suggests the following may be present: | | | | | Mental |  Stress| | Nighttime eaters have elevated levels of the stress hormone cortisol during almost all hours of the day, suggesting that they suffer from the effects of chronic stress in their daily lives. |
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Recommendations and treatments for Night Eating Syndrome:
KEY | | Weak or unproven link | | | Strong or generally accepted link |  | | Proven definite or direct link |  | | Likely to help |  | | Highly recommended |
GLOSSARY
Adrenal (Adrenal Gland, Adrenal Glands, Adrenals)
The adrenal glands sit on top of each kidney and consist of an outer cortex and an inner medulla. Of the 50 or so hormones the adrenals make, only cortisone and adrenaline are recognized by most people. Some of these hormones must be produced to preserve life, while others help resist stress. Other hormones from the adrenals control normal energy output (along with the thyroid) and govern the breakdown of stored energy into quick energy sources. The medulla produces epinephrine and norepinephrine, which are specifically designed to help the body deal with stressful situations. The adrenals control the body's potassium/sodium balance, which is vital for energy production. They also produce sex hormones in minute amounts, which is important for later years when the gonads drop or cease their production.
Amino Acid (Amino Acids)
An organic acid containing nitrogen chemical building blocks that aid in the production of protein in the body. Eight of the twenty-two known amino acids are considered "essential," and must be obtained from dietary sources because the body can not synthesize them.
Anorexia Nervosa (Anorexia)
An eating disorder characterized by excess control - a morbid fear of obesity leads the sufferer to try and limit or reduce their weight by excessive dieting, exercising, vomiting, purging and use of diuretics. Sufferers are typically more than 15% below the average weight for their height/sex/age and typically have amenorrhea (if female) or low libido (if male). 1-2% of female teenagers are anorexic.
Anxiety
Apprehension of danger, or dread, accompanied by nervous restlessness, tension, increased heart rate, and shortness of breath unrelated to a clearly identifiable stimulus.
Carbohydrates (Carbohydrate)
The sugars and starches in food. Sugars are called simple carbohydrates and found in such foods as fruit and table sugar. Complex carbohydrates are composed of large numbers of sugar molecules joined together, and are found in grains, legumes, and vegetables like potatoes, squash, and corn.
Chronic (Chronicity)
Usually referring to chronic illness: Illness extending over a long period of time.
Cortisol
A hormone. Its most important function is to help the body respond to stress. It also helps regulate your body's use of protein, carbohydrates and fat; it helps maintain blood pressure and cardiovascular function; it stems inflammation.
Crave (Craving, Cravings)
To have a strong desire for; to feel the need for.
Hormones (Hormone)
Chemical substances secreted by a variety of body organs that are carried by the bloodstream and usually influence cells some distance from the source of production. Hormones signal certain enzymes to perform their functions and, in this way, regulate such body functions as blood sugar levels, insulin levels, the menstrual cycle, and growth. These can be prescription, over-the-counter, synthetic or natural agents. Examples include adrenal hormones such as corticosteroids and aldosterone; glucagon, growth hormone, insulin, testosterone, estrogens, progestins, progesterone, DHEA, melatonin, and thyroid hormones such as thyroxine and calcitonin.
Melatonin
The only hormone secreted into the bloodstream by the pineal gland. The hormone appears to inhibit numerous endocrine functions, including the gonadotropic hormones. Research exists on the efficacy of melatonin in treating jet lag and certain sleep disorders. Dosages greater than l milligram have been associated with drowsiness, headaches, disturbances in sleep/wake cycles and is contraindicated in those who are on antidepressive medication. It also negatively influences insulin utilization.
Neurotransmitters (Neurotransmitter)
Chemicals in the brain that aid in the transmission of nerve impulses. Various Neurotransmitters are responsible for different functions including controlling mood and muscle movement and inhibiting or causing the sensation of pain.
Serotonin
A phenolic amine neurotransmitter (C10H12N2O) that is a powerful vasoconstrictor and is found especially in the brain, blood serum and gastric membranes of mammals. Considered essential for relaxation, sleep, and concentration.
Syndrome
A medical condition characterized by a collection of related symptoms (what the patient feels) and signs (what a doctor can observe or measure).
Tryptophan
Essential amino acid. Natural relaxant and sleep aid due to its precursor role in serotonin (a neurotransmitter) synthesis. Along with tyrosine, it is used in the treatment of addictions.
Last updated: Apr 13, 2008
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