The Night Eating Syndrome Report: The Different Treatments That Work

The Night Eating Syndrome Report are a series of articles that talk about a horrible disorder with serious physical, mental, and social consequences for people who are suffering from it. This series will cover all the aspects of this disorder and give some recommendations for people who are affected by it.

This is the last part of the series (part one, part two). It will talk about the biological foundations of this illness, the treatment methods, and some easily applicable tips that can be used by people.

 

Medication

Drugs that affect the serotonergic pathway have been noted to be quite effective for this illness. In clinical trials they have used sertraline for its treatment.

The results so far suggest that there was an improvement from 2 awakenings per night to 0,2 awakenings per night, from an average of 1,5 eating episodes per night to an average of 0,5  eating episode per night, and from 52% of daily energy intake after the evening meal to 26% of daily energy intake after the evening meal. [1]

Different clinical trials have showed similar effects; reduction in the amount of food eaten after dinner, reductions in the number of awakenings, and reductions in the food eaten during awakening [2]. To put it into one sentence: the evidence so far suggests a possible serotonergic basis for night eating syndrome. This might be resolved with an SSRI, particularly sertraline [3]. People with night eating syndrome also have insufficient serotonin availability in certain brain regions, which further gives weight to the serotonergic basis of this illness [3]. Two interesting case studies even suggested improvements with bright light therapy. This exposes a person to bright light. In this case both of them had 14 morning sessions of 10,000 lx light, which is equal to full daylight. There were partial remissions for depression and night eating syndrome in both of the case studies. [4]

 

Psychological treatment

There are also different psychological treatments that are available. One intervention model has been particularly effective. Some of the following tips can be easily applied by anyone and can give some helpful insights and practices that can be used to try and help with this disorder.

  • Psych-education (educating yourself about this syndrome in general)
  • Eating changes in the form of:
    • Using a food dairy and the use of self-monitoring
    • Implementating a regular eating schedule
    • The use of structured meals and snacks
    • Establishing control of your own environment
    • The gradual increase of morning and decrease of evening food intake
    • Eating the minimum necessary to re-attain evening sleep
    • Leaving the bedroom to eat
    • The use of exposure and response prevention for craved food
  • Better sleep hygiene
  • Cognitive restructuring (what does eating mean to you, and the meaning of food in general, help with sleep, insomnia, and depressive symptoms)
  • Physical activity; walking, moving around, doing sports or just anything you can think of
  • Different relaxation strategies (deep breathing and progressive muscle relaxation)
  • Relying on your social network, counting on emotional support

 

The hormones

The hormones of interest in this case would be melatonin, leptin, ghrelin, and cortisol. All of them have different implications in this disease. People suffering from it often find themselves in a hormonal imbalance, when one or more of the following hormones is not at optimal levels, or it’s not working properly.

Melatonin: a neurohormone that gets secreted at night and helps in the regulation of other hormones and helps with the body’s circadian rhythms as well.

Leptin: this one regulates and contributes to the regulation of energy intake and expenditure, which includes regulation of appetite and your metabolism. An increase of leptin in night time suppresses appetite through the effect it has on the hypothalamus.

Ghrelin: this one stimulates appetite.

Cortisol: it gets released by the adrenal glands as a response to stress. While short-term heightened levels of cortisol are usually beneficial for the body as they prepare it for action (fight or flight response), long-term higher levels of cortisol produce unwanted effects; a weakened immune system among others. [5]

 

Take home messages

To collect the findings of these three posts shortly.

The biological viewpoint shows us that it probably runs in families, so there is probably a genetic component to it. It also involves a dysregulation in nocturnal levels of melatonin and leptin that signify hormonal disruption and/or delay the daily eating circadian rhythm which interferes with sleep. It appears to have a serotonergic basis.

From a psychological viewpoint, people with night eating syndrome are generally more vulnerable to stress and perceive life event stress as less controlable and/or predictable.

From a social perspective, night eating syndrome tends to occur during periods of life event stress. People who eat more food during such times have probably learned that it helps improve their mood. Yet this doesn’t fix the issue itself.

To put it the shortest: it most probably involves a genetic component or a hormonal predisposition that gets triggered by life event stress that results in a de-synchronization of the sleep/wake and other eating cycles amongst vulnerable people, it can be treated with SSRIs, but a psychological intervention in the above-mentioned ways can be very helpful as well.

 

The Night Eating Syndrome Report

About Author

Sebastijan Veselic

BSc in Psychology, currently doing a MSc in Cognitive science. Pursuing and interested in many academic and scientific disciplines and topics, as well as some less so. These include, but are not limited to, cute cats on the internet.

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