From the Guidelines
The treatment approach for Night Eating Syndrome (NES) and Sleep-Related Eating Disorder (SRED) differs based on their distinct underlying mechanisms, with a focus on cognitive behavioral therapy, medications, and environmental safety measures to improve morbidity, mortality, and quality of life outcomes. For NES, a combination of cognitive behavioral therapy (CBT), light therapy, and medications like selective serotonin reuptake inhibitors (SSRIs) such as sertraline (50-200 mg daily) is recommended 1. CBT focuses on normalizing eating patterns, addressing mood disturbances, and implementing stress management techniques. For SRED, treatment primarily targets the parasomnia component with medications like topiramate (25-100 mg at bedtime), clonazepam (0.5-2 mg at bedtime), or dopaminergic agents such as pramipexole (0.125-0.75 mg at bedtime) 1. Environmental safety measures are crucial for SRED patients, including securing food items, installing alarms on bedroom doors, and removing potentially dangerous objects from the kitchen. Both conditions may benefit from addressing underlying sleep disorders, maintaining regular sleep-wake schedules, and treating comorbid conditions like depression or anxiety 1. Nutritional counseling is also valuable to establish regular daytime eating patterns and ensure adequate nutrition throughout the day, which may reduce nighttime hunger and eating episodes. Key considerations in the treatment of NES and SRED include:
- Individualized treatment plans that incorporate medical, psychiatric, psychological, and nutritional expertise
- Coordinated multidisciplinary team approach
- Regular monitoring and adjustment of treatment plans as needed
- Patient education and support to improve adherence and outcomes. Overall, a comprehensive and multidisciplinary approach is necessary to effectively manage NES and SRED and improve patient outcomes.
From the Research
Treatment Approaches for Night Time Eating Syndrome (NES) and Sleep-Related Eating Disorder (SRED)
- The treatment approach for NES may include cognitive and behavioral treatment modalities, such as behavioral therapy, phototherapy, behavioral weight loss treatment, and cognitive-behavioral therapy 2.
- A pilot study on cognitive behavior therapy (CBT) for NES showed significant decreases in caloric intake after dinner, number of nocturnal ingestions, weight, and Night Eating Symptom Scale (NESS) score 3.
- For SRED, first-line treatment includes selective serotonin reuptake inhibitors (SSRIs) at mean dosages of 20 to 30 mg/day, while topiramate at 100-300 mg/day and clonazepam at 0.5-2.0 mg/day can be valid alternative options 4.
- SRED related to other parasomnias or sleep disturbances that cause sleep fragmentation may benefit from treatment of the associated sleep disorder, such as dopamine agonists for RLS-related SRED and low-dose benzodiazepines for sleepwalking-related SRED 4.
- Topiramate has been shown to be effective in reducing nocturnal eating, improving nocturnal sleep, and producing weight loss in patients with NES or SRED 5.
- Antidepressant treatments and psychological therapies can be used for optimal management of patients with NES, while other treatment options such as melatonergic medications, light therapy, and topiramate also hold promise as future treatment options 6.
Comparison of Treatment Approaches
- Both NES and SRED may benefit from cognitive and behavioral treatment modalities, as well as pharmacological interventions such as topiramate and SSRIs.
- However, the treatment approach for SRED may need to take into account the underlying sleep disorder or parasomnia, and treatment of the associated condition may be necessary 4.
- Further research is needed to fully understand the optimal treatment approaches for NES and SRED, and to develop more effective and targeted interventions 2, 6.