What Is Night Eating Syndrome?

Signs, Symptoms, and Treatment

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What Is Night Eating Syndrome?

Night eating syndrome (NES) is a specific eating disorder. People with the condition consume most of the food they eat at night, even waking up from sleep in order to eat.

People with NES often eat because they believe that it will improve sleep or help them fall back asleep. Those who have this condition often have little appetite in the morning and frequently skip breakfast. They commonly experience guilt and shame related to their eating.

NES was first described in 1955 by psychiatrist Albert Stunkard, who saw it as a behavioral variation of obesity. As a result, it has most often been studied in the context of research on obesity. Compared to other eating disorders, research on NES is scant.

It is estimated that 1.5% of the general population has NES. It is more common in certain populations, with prevalence rates of 6% to 14% among those who have lost weight and 9% to 42% among candidates for bariatric surgery.

Symptoms of Night Eating Syndrome

People who have NES or are living with someone who has the condition may notice certain clues in the home. For example, they might find messes in the kitchen or missing food, suggesting that someone has been awake and eating in the middle of the night. These are indications that someone in the home may have night eating syndrome.

The primary symptoms of night eating syndrome are:

  • Repeated episodes of eating at night—including waking from sleep to eat
  • Excessive consumption of food after the evening meal
  • Awareness and recall of night eating
  • Significant distress or impairment related to the night eating

In many cases, people with the condition consume at least 25% of their food intake after their evening meal, on average, for at least three months. These nighttime eating episodes also occur at least twice per week for three months.

People with NES may binge eat (that is, eat a large amount of food in a short period of time while feeling out of control) or they may just graze.

Diagnosis

Night eating syndrome is currently classified as an Other Specified Feeding or Eating Disorder (OSFED) by the "Diagnostic and Statistical Manual of Mental Disorders, 5th Edition" (DSM-5).

Assessment of NES can be made via the Night Eating Questionnaire (NEQ) or the Night Eating Diagnostic Scale (NEDS), two self-report measures. There is also the Night Eating Syndrome History and Inventory (NESHI), a diagnostic interview.

People can meet the criteria for NES and another eating disorder concurrently. Studies show that approximately 7% to 25% of people with NES also met criteria for binge-eating disorder. Among those with bulimia nervosa, 40% of inpatients and 50% of outpatients reported night eating symptoms.

In light of this, NES can be thought of as a specific variant of binge eating disorder or bulimia nervosa that presents a disrupted circadian pattern of eating and significant eating during the person’s sleeping hours.

A similar, but different, disorder is sleep-related eating disorder (SRED). SRED is primarily a sleep disorder, while NES is primarily an eating disorder.

The main difference is that people with SRED eat either while sleeping or while in a twilight state between sleep and wakefulness, and are not aware of what they are doing. They often wake up to find food in their bed and have no memory of having eaten. By contrast, people with NES are fully awake while they are eating and remember afterward.

People with NES often have depression and anxiety. They may also have a history of substance use.

Causes of Night Eating Syndrome

The exact cause of NES is unknown. A few different factors might play a role:

Circadian Rhythm Problems

People with NES seem to have a disruption in their circadian rhythm, the biological process that regulates sleeping and eating patterns according to the natural cycle of light and darkness.

In humans, appetite and food consumption tend to correspond closely with the primary hours of wakefulness: meals are generally consumed between early morning and early evening. Individuals with NES retain a normal sleep cycle but display a delayed food intake pattern.

One study showed that people who have NES consumed 56% of their calories between 8 p.m. and 6 a.m. People who didn't have NES only consumed 15% of their calories during this time.

Daytime Dieting

NES may also be a response to dieting. When people reduce their food intake during the day and the body is in a state of physical deprivation, the drive to eat later in the day is a normal response to the restriction. Over time, the self-soothing pattern of eating at night can become ingrained.

Other Possible Causes

Hormone imbalances that disrupt eating patterns may also contribute to night eating syndrome. It also may develop in response to a pattern of staying up and eating late at night, as can be common among college students. Once one becomes set in this habit, it can be hard to break.

Recap

While the exact causes of night eating syndrome are not fully understood, factors that might play a part include circadian rhythm problems, hormone imbalances, and daytime dieting.

Treatment for Night Eating Syndrome

Treatments for night eating syndrome may include therapy, medications, and other strategies such as psychoeducation and phototherapy.

Psychotherapy

Cognitive behavioral therapy (CBT) is one of the most successful treatments for eating disorders. CBT targets the underlying thought patterns that contribute to the condition.

Psychological treatment for NES will typically include both psychoeducation about the condition and self-monitoring to understand the disorder and maintaining factors. It will involve a reduction of dieting behavior. Behavioral interventions common to other eating disorders include meal planning and structuring of regular eating.

NES treatment adds a specific focus on shifting eating patterns to earlier in the day to align better with sleep and wake cycles. Breakfast is implemented in order to reset eating patterns.

This is a necessary step to breaking the cycle, even though it can be challenging while the night eating is continuing and the person with NES has no appetite in the morning. It can be done gradually, with a slow increase of morning meal intake until an adequate breakfast can be consumed regularly.

Dysfunctional beliefs reinforce behaviors. For example, a person with NES may feel unable to avoid food at night, be convinced they have to eat to fall asleep, and believe that evening anxiety can only be managed with food.

Cognitive Restructuring

Since unhelpful beliefs perpetuate the disorder, cognitive restructuring and behavioral experiments can help change thoughts and behaviors. When night eating episodes occur, therapists can identify strategies that target specific thoughts and behaviors.

After an episode of night eating, it can be helpful to look at when the person first started thinking about wanting to eat. Next, they would look at each step involved in getting to the food, choosing it, eating it, and then what happened as a result. Looking at these steps and thinking about where this chain of events could be changed can help people navigate future situations.

Breaking the pattern of night eating can be difficult and may require the use of psychological techniques such as making a list of reasons not to engage in the behavior (and reviewing it before bed) as well as installing physical barriers, such as blocking access to the kitchen at night.

Sleep hygiene strategies used in the treatment of insomnia, such as sticking to a consistent bedtime and morning awakening time, are also important.

Phototherapy

Other treatments for NES include phototherapy— light exposure—similar to that used to treat seasonal affective disorder (SAD). Bright light therapy is believed to affect melatonin, a hormone that helps regulate circadian rhythms.

In phototherapy for NES, patients are exposed to bright light in the morning. This treatment targets the circadian rhythm disruption by trying to reset the body clock using light. At this time, there is little formal research on the approach, although it was shown to be effective in two case studies.

Medication

Psychiatric medication has been the most researched treatment for NES. There is little evidence in support of the use of psychiatric medication for the treatment of eating disorders overall. But there is some support for doing so in the case of NES, where the circadian rhythm disruption suggests a larger biological component.

Medications that have been studied and used include selective serotonin reuptake inhibitors (SSRIs) such as paroxetine (Paxil), fluvoxamine (Luvox), and sertraline (Zoloft).

Other Resources

There are two books on night eating syndrome, one for people who have the condition and one for healthcare professionals. These books may provide more insight into the condition if you or someone you know is struggling:

  • "Overcoming the Night Eating Syndrome: A Step-by-Step Guide to Breaking the Cycle" by Allison, Stunkard, and Tier is a self-help guide for people with NES.
  • "Night Eating Syndrome: Research, Assessment, and Treatment" by Lundgren, Allison, and Stunkard (eds.) is a comprehensive overview of NES for professionals and includes a treatment manual. 

Recap

Treatments for night eating syndrome often use cognitive behavioral therapy and related techniques. Other strategies that can be helpful include phototherapy, psychoeducation, and medications.

A Word From Verywell

If you are experiencing symptoms consistent with night eating syndrome, you may be feeling ashamed and reluctant to find treatment. Please don’t hesitate to seek help; eating disorder professionals can help you recover. 

If you or a loved one are coping with an eating disorder, contact the National Eating Disorders Association (NEDA) Helpline for support at 1-800-931-2237

For more mental health resources, see our National Helpline Database.

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10 Sources
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