From the Research
Sleep-related eating disorder (SRED) should be treated with topiramate, starting at a low dose and gradually increasing to 100-300 mg daily, as it has been shown to significantly reduce nocturnal eating episodes and improve symptoms in patients with SRED. This recommendation is based on the most recent and highest quality study available, which demonstrated the efficacy of topiramate in reducing SRED symptoms in a randomized controlled trial 1.
Key Considerations
- SRED is a parasomnia characterized by episodes of eating during sleep with partial or complete amnesia afterward, and it can be associated with other sleep disorders, such as sleepwalking, restless legs syndrome, and obstructive sleep apnea syndrome.
- Treatment of SRED typically involves addressing underlying sleep disorders and may include medications like topiramate or clonazepam.
- Securing the kitchen environment is essential to prevent injuries and accidents, and treating coexisting conditions like restless leg syndrome, sleep apnea, or stress is crucial, as these can trigger episodes.
- Cognitive behavioral therapy may help manage stress and improve sleep hygiene, and patients should undergo regular follow-up to assess the evolution of symptom severity and frequency, and to re-evaluate treatment efficacy and any side effects that may arise 2.
Medication Options
- Topiramate has been shown to be effective in reducing nocturnal eating episodes and improving symptoms in patients with SRED, with a significant reduction in symptoms and weight loss observed in clinical trials 1, 3, 4.
- Clonazepam may also be used as an alternative option, particularly in patients with SRED related to other parasomnias or sleep disturbances that cause sleep fragmentation 2.
- Dopamine agonists, such as pramipexole, may be used to treat SRED related to restless legs syndrome, and low-dose benzodiazepines, such as clonazepam, may be used to treat SRED related to sleepwalking 2.
Important Considerations
- Patients with SRED should be closely monitored for side effects, particularly those related to topiramate, such as paresthesias and cognitive dysfunction 1.
- Regular follow-up is essential to assess the evolution of symptom severity and frequency, and to re-evaluate treatment efficacy and any side effects that may arise 2.