Additional categories of sleep-related eating disorders and the current status of treatment

Sleep. 1993 Aug;16(5):457-66.

Abstract

Sleep-related eating disorders distinct from daytime eating disorders have recently been shown to be associated with sleepwalking (SW), periodic limb movement (PLM) disorder and triazolam abuse in a series of 19 adults. We now report eight other primary or combined etiologies identified by clinical evaluations and polysomnographic monitoring of 19 additional adults (mean age 40 years; 58% female): i) obstructive sleep apnea (OSA), with eating during apnea-induced confusional arousals (n = 3); ii) OSA-PLM disorder (n = 1); iii) familial SW and sleep-related eating (n = 2); iv) SW-PLM disorder (n = 1); v) SW-irregular sleep/wake pattern disorder (n = 1); vi) familial restless legs syndrome and sleep-related eating (n = 2); vii) anorexia nervosa with nocturnal bulimia (n = 2) and viii) amitriptyline treatment of migraines (n = 1). In our cumulative series of 38 patients (excluding six with simple obesity from daytime overeating), 44% were overweight (i.e. > 20% excess weight) from sleep-related eating. Nightly sleep-related binge eating (without hunger or purging) had occurred in 84% of patients. Onset of sleep-related eating was also closely linked with i) acute stress involving reality-based concerns about the safety of family members or about relationship problems (n = 6), ii) abstinence from alcohol and opiate/cocaine abuse (n = 2) and iii) cessation of cigarette smoking (n = 2). Current treatment data indicate a primary role of dopaminergic agents (carbidopa/L-dopa; bromocriptine), often combined with codeine and clonazepam, in controlling most cases involving SW and/or PLM disorder. Fluoxetine was effective in two of three patients. Nasal continuous positive airway pressure therapy controlled sleep-related eating in two OSA patients.

Publication types

  • Case Reports
  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Child, Preschool
  • Clinical Protocols
  • Clonazepam / administration & dosage
  • Clonazepam / therapeutic use
  • Combined Modality Therapy
  • Dopamine Agents / administration & dosage
  • Dopamine Agents / therapeutic use
  • Family
  • Feeding and Eating Disorders / diagnosis
  • Feeding and Eating Disorders / drug therapy
  • Feeding and Eating Disorders / etiology*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Obesity
  • Polysomnography
  • Positive-Pressure Respiration
  • Restless Legs Syndrome / complications
  • Restless Legs Syndrome / therapy
  • Sleep Apnea Syndromes / complications*
  • Sleep Apnea Syndromes / diagnosis
  • Somnambulism / complications*
  • Somnambulism / psychology
  • Somnambulism / therapy
  • Stress, Psychological / psychology

Substances

  • Dopamine Agents
  • Clonazepam