Institute for Continuing Education

Sleep Disorder: Sleep Eating

Course Objectives

Upon successful completion of this module, you will be able to:

• Analyze the clinical diagnostic criteria for sleep-related eating disorder (SRED) according to the International Classification of Sleep Disorders (ICSD-3), differentiating it from night eating syndrome, nocturnal eating episodes, and other parasomnias with overlapping features.
• Evaluate the neurobiological mechanisms underlying SRED, including the role of impaired arousal systems, disrupted sleep architecture, and alterations in appetite regulation circuits involving the hypothalamus, orexin/hypocretin pathways, and dopaminergic systems.
• Synthesize the relationship between SRED and comorbid conditions including restless legs syndrome, periodic limb movement disorder, obstructive sleep apnea, psychiatric disorders, and medication effects, explaining how these associations influence clinical presentation and treatment planning.
• Compare and contrast the clinical features, polysomnographic findings, and management approaches for SRED versus other nocturnal eating behaviors and parasomnias, applying evidence-based assessment techniques including video-polysomnography and structured clinical interviews.
• Assess pharmacological and non-pharmacological treatment strategies for SRED, including dopaminergic agents, benzodiazepines, topiramate, selective serotonin reuptake inhibitors, cognitive-behavioral interventions, and management of precipitating factors, while evaluating treatment efficacy and safety profiles.
• Explain the role of polysomnographic monitoring in the diagnosis and management of SRED, including characteristic findings during nocturnal eating episodes, the importance of video documentation, and the differential diagnosis of complex motor behaviors during sleep.
• Apply safety assessment and harm reduction strategies for patients with SRED, identifying risks related to injury, ingestion of toxic substances, fire hazards, and nutritional consequences, while developing comprehensive patient education and environmental modification plans.

Course Information

Sleep eating is a sleep-related disorder, although some specialists consider it to be a combination of a sleep and an eating disorder. It is a relatively rare and little known condition that is gaining recognition in sleep medicine. Other names for sleep eating are sleep-related eating (disorder), nocturnal sleep-related eating disorder (NS-RED), and sleep-eating syndrome.


Sleep eating is characterized by sleepwalking and excessive nocturnal overeating (compulsive hyperphagia). Sleep eaters are comparable to sleepwalkers in many ways: they are at risk for self-injury during an episode, they may (or may not) experience excessive daytime sleepiness, and they are usually emotionally distressed, tired, angry, or anxious. Sleep eaters are also at risk for the same health complications as compulsive overeaters, with the added dangers of sleepwalking. Common concerns include excessive weight gain, daytime sleepiness, choking while eating, sleep disruption, and injury from cooking or preparing food such as from knives, utensils, or hot cooking surfaces. There is also the potential for starting a fire.


As with sleepwalkers, sleep eaters are unaware and unconscious of their behavior. If there is any memory of the episode, it is usually sketchy. A sleep eater will roam the house, particularly the kitchen, and may eat large quantities of food (as well as non-food items). In the morning, sleep eaters have no recollection of the episode. However, in many cases there are clues to their behavior. One woman woke up with a stomachache and chocolate smeared on her face and hands. Candy wrappers littered the kitchen floor. The next morning her husband informed her that she had been eating during the night. She was shocked and distressed because she had no recollection of the event.


As in the case described above, food consumed by sleep eaters tends to be either high sugar or high fat. Odd combinations of foods, such as potato chips dipped in peanut butter or butter smeared on hotdogs, as well as non-food items, have been reported. Oddly, one person was discovered cutting a bar of soap into slices and then eating it as if it were a slice of cheese!


Sleep eating is classified as a parasomnia. It is a rare version of sleepwalking, which is an arousal disorder. In 1968, Roger Broughton published a paper in Science (159: 1070-1078) that outlined the major features of arousal disorders. They are:

Abnormal behavior that occurs during an arousal from slow wave sleep;
The absence of awareness during the episode;
Automatic and repetitive motor activity;
Slow reaction time and reduced sensitivity to environment;
Difficulty in waking despite vigorous attempts;
No memory of the episode in the morning (retrograde amnesia); and
No or little dream recall associated with the event.