Understanding and Managing Night Eating Syndrome
Night Eating Syndrome (NES) is a complex eating disorder that bridges disordered eating, sleep disturbance, and mood dysregulation. First described in the 1950s, NES is characterized by a delayed pattern of food intake, with individuals consuming a significant portion of their daily calories in the evening or during nighttime awakenings. Although once considered rare, recent studies show NES may affect up to 1.5% of the general population and as much as 8-14% of individuals with obesity.
This article explores the features, neurobiological underpinnings, and treatment strategies for Night Eating Syndrome, drawing from current research and clinical insights.
Defining Night Eating Syndrome
According to the criteria developed by the International Night Eating Syndrome Diagnostic Criteria (ICSD) and supported by clinical research:
Key Features of NES:
Evening Hyperphagia: Consumption of at least 25% of daily calories after the evening meal.
Nocturnal Ingestions: Waking from sleep to eat at least twice per week.
Awareness and Recall: Unlike sleep-related eating disorder (SRED), people with NES are fully aware of their night eating episodes.
Morning Anorexia: Lack of appetite in the morning.
Sleep and Mood Disturbances: Commonly includes insomnia and depressed mood, especially in the evening.
These behaviors persist for at least 3 months and cause significant distress or impairment in daily functioning.
What Causes Night Eating Syndrome?
NES is believed to emerge from a disruption in circadian rhythms—our body’s internal clock that regulates appetite, sleep, and mood. Individuals with NES often experience a phase delay in the circadian pattern of food intake, meaning hunger and eating behaviors are shifted later into the day and night.
Neurobiological Factors:
Serotonin dysregulation: Linked to mood and appetite control; low serotonin levels are commonly observed in NES.
Melatonin and leptin abnormalities: These hormones regulate sleep and satiety, and may be misaligned in NES.
Hypothalamic-pituitary-adrenal (HPA) axis dysfunction: Increased cortisol levels can drive stress-related eating at night.
Additionally, mood disorders (especially depression and anxiety) frequently co-occur with NES, suggesting a bidirectional relationship between mood and disordered eating behaviors.
Who is at Risk?
Risk factors for NES include:
Dietary restraint or chronic dieting —NES can also emerge during weight loss attempts, particularly when caloric intake is restricted earlier in the day.
Stress or trauma
Sleep disorders (e.g., insomnia)
Depressive symptoms
Shift work or irregular sleep schedules
Obesity
Treatment Approaches
Treatment for Night Eating Syndrome is most effective when it addresses both behavioral symptoms and underlying mood or sleep issues. A multimodal approach is often necessary.
1. Cognitive Behavioral Therapy (CBT-NES)
This is considered a first-line treatment and includes:
Identifying and restructuring negative thoughts related to eating, sleep, and self-worth.
Establishing regular meal patterns, including a balanced breakfast.
Enhancing coping strategies for stress and emotional regulation.
Gradual reduction of night eating through behavioral contracts and reinforcement.
A promising study conducted by Dr. Kelly Allison and her team looked at how CBT-NES. In this study, 25 participants went through a structured CBT program that lasted 12 weeks, with a total of 10 therapy sessions. Throughout the program, participants tracked their eating habits, sleep patterns, and mood to monitor their progress.
The results were very encouraging. After the CBT program, participants reduced the number of times they woke up to eat—from nearly nine times a week to just under three. They also ate less food after dinner, dropping from 35% to about 25% of their daily intake during nighttime hours. On average, participants lost about 6.5 pounds and reported sleeping better, waking up less often, and feeling less depressed. Their overall scores measuring NES symptoms significantly improved as well.
This study suggests that CBT can be a powerful tool for treating Night Eating Syndrome. By helping individuals understand and change unhelpful thoughts and behaviors around food and sleep, CBT supports more regular eating patterns, better sleep, and improved emotional well-being. While more research is needed, this approach offers real hope for those feeling stuck in a cycle of nighttime eating.
2. Pharmacotherapy
SSRIs (Selective Serotonin Reuptake Inhibitors): Medications like sertraline have been shown to reduce night eating frequency and improve mood symptoms.
Topiramate: May help reduce binge-like episodes, although side effects need careful monitoring.
Melatonin or agomelatine: These may help re-align circadian rhythms and improve sleep regulation.
Kucukgoncu et al. (2015) note that pharmacological treatment is particularly effective when mood symptoms or insomnia are prominent.
3. Chronotherapy and Light Therapy
Bright light therapy (10,000 lux in the morning) has been explored to reset circadian timing and reduce night eating behavior. Light is the most powerful cue that influences the suprachiasmatic nucleus (SCN), the brain’s master clock.
Chronotherapy may include sleep phase advancement or structured wake/sleep cycles to realign biological rhythms. In NES, people often have a delayed circadian phase (i.e., their internal clock is "set" later).
Bright light exposure in the morning (usually 10,000 lux for 30–45 minutes shortly after waking) advances the circadian rhythm—in other words, it shifts the biological clock earlier. This helps reset hunger and sleep signals to occur earlier in the day, decreasing evening and nighttime food cravings.
4. Nutritional Counseling
Nutrition counseling is a critical and effective part of treating Night Eating Syndrome (NES) because it addresses the disordered eating patterns and nutritional imbalances that often accompany the condition. NES is not just about eating at night—it’s often connected to irregular eating throughout the day, emotional triggers, disrupted circadian rhythms, and sometimes nutrient deficiencies. Nutrition counseling helps break this cycle by guiding individuals toward more balanced, consistent eating habits that support both physical and emotional well-being.
A registered dietitian plays a central role in this process. They begin by conducting a comprehensive assessment of a person's eating patterns, nutritional intake, sleep habits, and relationship with food. Based on this, they help the individual create a structured meal and snack schedule that spreads energy intake more evenly across the day. This reduces the tendency to skip meals early on—something that often leads to increased hunger and night eating later.
Dietitians also work with clients to identify emotional or behavioral triggers for nighttime eating and help them develop alternative coping strategies. For example, if someone tends to eat in response to stress or anxiety at night, the dietitian may collaborate with a therapist to support more adaptive responses. Education is also a big part of their role—they help individuals understand how blood sugar fluctuations, delayed meals, or inadequate nutrient intake can all contribute to cravings and disrupted sleep.
In many cases, dietitians use gentle exposure techniques to help clients reintroduce foods they may be avoiding due to food rules or fear, while also helping to regulate appetite cues. Over time, the goal is to reduce the biological and psychological drivers of nighttime eating by building nourishment, routine, and trust in the body.
In short, nutrition counseling supports recovery from NES by stabilizing energy intake, improving hunger and fullness cues, reducing physiological drivers of night eating, and helping clients rebuild a positive, sustainable relationship with food. When integrated with therapies like CBT or chronotherapy, it’s a key part of comprehensive, lasting treatment.
Challenges in Treatment
Shame and stigma surrounding nighttime eating can often prevent individuals from seeking the help they need. Because of this, NES frequently goes undiagnosed or is mistaken for other conditions like binge eating disorder or insomnia. Additionally, a lack of awareness among clinicians and the absence of widely validated diagnostic tools can make it challenging to accurately assess and identify NES. For treatment to be effective and sustainable in the long term, it must address not only the disordered eating behaviors but also any co-occurring issues such as sleep disturbances, mood disorders, and body image concerns.
Night Eating Syndrome is more than just a late-night snack habit—it's a complex disorder with significant impacts on physical and emotional health. With the right combination of behavioral therapy, medication, and lifestyle support, many individuals can reduce symptoms and regain a healthier rhythm of eating, sleeping, and living.
If you are seeking eating disorder treatment or mental health therapy for you or your adolescent, Cypress Wellness Collective can help. Cypress Wellness Collective is located in the San Francisco Bay Area where they specialize in Family Based Treatment (FBT), therapy, and nutrition counseling for teens, adults, and families going through eating disorder recovery. They offer in person and virtual appointments throughout all of California. Call today for your free consultation to see if Cypress Wellness Collective is right for you!
References:
Berner, L. A., & Allison, K. C. (2013). Behavioral management of night eating disorders. Psychology Research and Behavior Management, 6, 1–8. https://doi.org/10.2147/PRBM.S31929
Kucukgoncu, S., Midura, M., & Tek, C. (2015). Optimal management of night eating syndrome: challenges and solutions. Neuropsychiatric Disease and Treatment, 11, 751–760. https://doi.org/10.2147/NDT.S70312
Allison, K. C., Lundgren, J. D., Moore, R. H., O'Reardon, J. P., & Stunkard, A. J. (2010). Cognitive behavior therapy for night eating syndrome: A pilot study. American Journal of Psychotherapy, 64(1), 91–103. https://doi.org/10.1176/appi.psychotherapy.2010.64.1.91