As a young teen, Lynne Romano recalls awakening to find turned-over jars of ravioli sauce dripping down her dresser or mustard-smeared potato chips scattered around her room. How they got there was a total mystery to her. “Then my mother started getting mad at me for messing up the kitchen at night,” she says. “I had no idea I was getting up in my sleep and eating.”
The problem worsened with age. “I’ve woken up with candy wrappers all over my bedroom floor,” says Romano, now a 51-year-old mother of two living in Andover, Massachusetts. “I’ve found plates on the floor that I have to be careful not to step on when I get up.”
Except for the trail of crumbs and gooey messes that confront her in the morning—and a nauseous feeling from overeating—Romano has no memory of her nightly foraging. Once she awoke in the morning to a throbbing pain in her wrist. “I opened my eyes to see what was wrong, and I was burned,” she says. “I’d been cooking in my sleep!”
Romano suffers from a specialized form of sleepwalking called nocturnal sleep-related eating disorder (NSRED), a condition first recognized in 1991. It is a cross between a sleeping disturbance and an eating disorder. Unlike other parasomnias, NSRED often resembles a serious addiction, with sufferers frequently getting up several times a night. In this somnolent state they may scarf down voluminous quantities of food—and balloon up in weight.
For now, medical science has little to offer those whose lives are ruled by this inexplicable condition. But new research holds out hope that drugs developed to treat other neurological problems—notably epilepsy—could rein in the compulsive and blind drive to eat at the core of the disorder.
Sleep eating is often confused with the more common disorder known as night eating syndrome, in which individuals consume the bulk of their daily calories after 6 p.m. Night eating syndrome is most prevalent in people with mood disturbances and involves a disruption in the circadian rhythms that govern appetite, shifting the urge to eat into the nocturnal hours. But unlike sleep eaters, night eaters are aware of what they’re doing, gorging themselves before even going to bed. If they snack in the middle of the night, they are awake and fully conscious of their actions.
By contrast, sleep eaters have minimal or no awareness, although “they usually do manage to find a way back to bed,” says Helene Emsellem, medical director of the Center for Sleep and Wake Disorders in Chevy Chase, Maryland. The disorder is also rare: Questionnaire responses suggest that the problem affects from 0.5 to 1 percent of the population. But that’s a sketchy estimate based on a small sample, cautions John Winkelman, who conducted the survey as medical director of the Sleep HealthCenters at Brigham and Women’s Hospital in Boston. Because sufferers are often ashamed, many cases may go unreported.
“A lot of individuals with this problem start out as conventional sleepwalkers and then become fixated on food,” reports sleep expert Mark Mahowald of the University of Minnesota. “Why this happens we don’t know.” Doctors are not even sure whether it disproportionately affects people with daytime eating disorders. People seeking help for the problem at sleep clinics aren’t likely to have eating disorders while awake. But at eating-disorder clinics, many sleep eaters also suffer from daytime anorexia nervosa or bulimia.
However, hunger does not generally seem to be a motive, says David Neubauer, associate director of the Sleep Disorders Center at the Johns Hopkins University School of Medicine. “Episodes tend to occur within a few hours after they go to sleep,” he says, “and if you ask them why they do it, they don’t know.”
Sleep eaters usually make a beeline for high-calorie foods that are sweet, sticky, or gooey. Ice cream, chocolate sauce, peanut butter, and honey are favorites—even if the sleep eater shuns these foods when awake. Oddly, sleep eaters have been known to munch on buttered cigarettes, salt sandwiches, raw meat, even Brillo pads—virtually anything except vegetables. “I don’t know of any case of a sleep eater making a healthy green salad,” says Mahowald. “I guess people don’t like vegetables any more when asleep than when awake.” The attraction to inedible things, he admits, is harder to explain.
If a family member tries to stop the foraging, individuals who are not normally combative during the day may wage a major battle, thus discouraging others from intervening. Sleep eaters themselves have put bicycle locks on refrigerators or asked household members to lock them in their room or hide food. But these efforts usually fail, as sleep eaters may be persistent and resourceful in their quest for satisfaction. While still asleep, “one woman took scissors from her bedside table and chipped away at the wood around her lock,” reports Neubauer. “Or they go foraging and find the food they or others have tucked away in the garage.”
Still, Neubauer believes that sleep eaters may be able to exert some control over their compulsion. “A female patient was deathly afraid of snakes and succeeded in keeping herself from raiding the fridge at night by putting a large fake snake on the kitchen table,” he says.
Some doctors will prescribe hypnotic medications to inhibit sleep eaters from getting out of bed in the first place. But that practice has become controversial due to the Food and Drug Administration’s recent warning that some of these drugs—notably Ambien—may actually trigger sleep eating in patients who did not previously have the problem.
Better treatments may soon be forthcoming. A recent trial at Brigham and Women’s Hospital suggests that the anticonvulsant Topamax, currently used to treat everything from migraines to obesity, may offer a more effective means of controlling the compulsion. Like many anticonvulsants, Topamax promotes sleep. It has been noted that, coincidentally, epileptics treated with the drug lost weight—possibly, says Winkelman, because it may suppress appetite. “We don’t know precisely how the drug acts,” he says, “but it’s certainly plausible that it might reduce episodes of nocturnal eating, so we decided to give it a try.” In his small pilot study—it involved only 30 patients—almost 70 percent of the participants experienced a significant reduction in sleep-eating episodes, and 28 percent lost more than 10 percent of body weight.
Lynne Romano was one of them. “On the drug,” she says, “I got up less frequently to binge and I lost a good 20 or so pounds. It wasn’t a miracle cure, but it sure helped.” That’s heartening news, because sleep eaters need all the help they can get. As droves of failed dieters can attest, resisting the urge to overeat takes an iron will—something hard enough to muster when awake, much less when asleep.
