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02. Diagnosing Sleep-Related Eating Disorder (SRED)

Published on March 1, 2023 Certification expiration date: March 1, 2026

Carlos H. Schenck, M.D.

Professor & Senior Staff Psychiatrist at the Hennepin County Medical Center (HCMC) - University of Minnesota

Key Points

SRED is a female-predominant disorder.
SRED is a variant of sleepwalking or RLS.
SRED can be triggered by sedative-hypnotic medications.

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Slides and Transcript

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I will now discuss diagnosing sleep-related eating disorder. This is again the criteria from the American Academy of Sleep Medicine, the International Classification of Sleep Disorders third edition 2014.

Diagnosing Sleep-Related Eating Disorder (SRED) Slide 1 of 13

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The prevalence of sleep-related eating disorder in adults is at least 2%, if not up to 5%. This is a female predominant disorder with 60% to 83% of patients being female in various reported series. And this is basically a young adult to early, middle-aged adult phenomenon but it certainly can occur in adolescence and extend into the later years.

References:

American Academy of Sleep Medicine. (2014). International classification of sleep disorders (3rd ed.)

Diagnosing Sleep-Related Eating Disorder (SRED) Slide 2 of 13

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Sleep-related eating disorder is classified as a parasomnia. It involves the circadian misalignment in eating. Sleep and eating are instinctual behaviors that can become pathologically intertwined in sleep-related eating disorder and in fact they mutually reinforce each other.

References:

American Academy of Sleep Medicine. (2014). International classification of sleep disorders (3rd ed.)

Diagnosing Sleep-Related Eating Disorder (SRED) Slide 3 of 13

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And what’s very interesting is that this is not a hunger-driven disorder. Hunger is virtually never reported in these patients. And even though most of them have some degree of amnesia, they all deny ever feeling hungry and some of them, out of desperation, will have a second dinner before bedtime thinking that will suppress the urge to eat during sleep, but it doesn’t because this is not a hunger-driven behavior disorder.

References:

American Academy of Sleep Medicine. (2014). International classification of sleep disorders (3rd ed.).
“Parasomnias” (C. Schenck, personal communication, November 5, 2002)

Diagnosing Sleep-Related Eating Disorder (SRED) Slide 4 of 13

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Some patients have to engage in desperate measures. One of my patients was a single mother of three teenage children, and she was so desperate that she paid her children to sleep in sleeping bags in the kitchen so that, when she came at night to get food out of the refrigerator or the cupboard, they would tell their mother “you have to go to bed”. Well, she was so frustrated by the children following the orders and being paid to give the orders that my patient paid her children even more money so they can go back to bed and allow her access to food.

Diagnosing Sleep-Related Eating Disorder (SRED) Slide 5 of 13

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So even though there’s so much distress related to the eating and these consequences, the denial of access to food is even more frustrating and that’s a curious phenomenon as well about sleep-related eating disorder.

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Sleep-related eating disorder is at least in 50% of the published cases a nightly phenomenon. So at bedtime, they all feel like, yes, tonight, I will not eat. And there’s like this New Year’s resolution, positive feeling. And then in the morning when they realize that they have engaged in eating again, there’s tremendous dejection and depression because once again they have lost control over eating during the night.

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So, for diagnostic criteria, you have to have recurrent episodes of dysfunctional eating that occur after an arousal from sleep during the main sleep period, and there should be at least partial loss of conscious awareness during the eating episode with subsequent impaired recall.

References:

American Academy of Sleep Medicine. (2014). International classification of sleep disorders (3rd ed.).

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With the recurrent episodes of involuntary eating, these are the problems presented by patients when they seek medical attention: Number one by far is excessive weight gain and obesity. Up to 50% of patients meet BMI criteria for being overweight or obese. Also, destabilization or precipitation of diabetes mellitus type 1 or type 2. Third, hypertriglyceridemia and hypercholesterolemia.

References:

American Academy of Sleep Medicine. (2014). International classification of sleep disorders (3rd ed.).

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Fourth, dental problems including caries or tooth decay and chipped teeth. Some patients will go to the freezer and try to eat frozen pizza, for example. It’s so inappropriate, but they’re not fully awake. They don’t know what they’re doing that well. Fifth, allergic reaction from carelessly eating foods to which one is allergic. And six is secondary depression from loss of control.

References:

American Academy of Sleep Medicine. (2014). International classification of sleep disorders (3rd ed.).

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Slide 11 of 13

Now, sleep-related eating disorder emerges most commonly as a subtype of sleepwalking and restless legs syndrome, and also commonly emerges from sedative-hypnotic use, with zolpidem being number one, and I will discuss this further.

References:

American Academy of Sleep Medicine. (2014). International classification of sleep disorders (3rd ed.).

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Key points: Sleep-related eating disorder is a female predominant disorder in most reported cases. Second, sleep-related eating disorder is often a variant of sleepwalking or restless legs syndrome, and also can be triggered by sedative-hypnotic medications.

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Slide 13 of 13

Diagnosing Sleep-Related Eating Disorder (SRED) Slide 13 of 13

Next Section

03. Medication-Induced SRED, Sleepwalking, and Sleepdriving

Learning Objectives:

After completing this activity, the learner will be able to:

Recognize and analyze abnormal non-REM sleep behaviors.
Correlate sedative-hypnotics use patterns with the occurrence of parasomnias.
Confidently diagnose sleep-related eating disorder and sleepwalking.

Original Release Date: March 1, 2023

Review and Re-release Date: March 1, 2024

Expiration Date: March 1, 2026

Expert: Carlos Schenck, M.D.

Medical Editor: Horia Batranu, M.D.

Relevant Financial Disclosures:

Carlos H. Schenck, M.D. declares the following interests:

- Eisai, Inc.: One time lecture on REM sleep behavior disorder, without any product promotion.

All of the relevant financial relationships listed above have been mitigated by Medical Academy and the Psychopharmacology Institute.

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