The Connection Between Eating Disorders and Sleep Problems

Ask any doctor – two of the most important factors in a person’s overall health are proper nutrition and getting enough sleep. The mind and body need fuel – that’s the nutrition part – and time to recharge, or they won’t be able to work properly. Accordingly, if a person isn’t getting enough of either, they are prone to suffering a litany of ill effects on their mental and physical health.

Lack of sleep has several negative effects on a person’s mindset and physical status. Some of these include (statistics courtesy of Johns Hopkins): 

• Significant increase in the chance of developing type 2 diabetes
• A 36 percent increase in the risk of colon and rectal cancer
• A similar increase in the risk of heart disease
• Higher blood pressure
• More frequent colds and cases of the flu
• Vastly increased rates of depression, anxiety, and other mental health illnesses
• Changes in personality such as irritability and inability to concentrate
• 33 percent increase in the risk of developing dementia
• Risk of accidents increase, especially while driving (it’s estimated that 6000 fatal car crashed per year are caused by “drowsy driving”

Sleep and eating are also deeply connected in a variety of ways. Also per Johns Hopkins, for people who get less than 5 hours of sleep per night, there is a 50 percent higher chance of becoming obese. Lack of sleep also promotes urges to eat food that provides quick energy boosts like sugary foods and carbohydrates, which also contribute to weight gain and diabetes.

How Do Restrictive and Purging-Type Eating Disorders Affect Sleep?

With restrictive eating disorders (most famously anorexia nervosa, but others as well) and purging-type disorders (bulimia nervosa), the body begins to shut down after extended periods of poor nutrition and lack of caloric intake. These cause many different negative symptoms, such as extreme weight loss, organ failures, seizures and strokes, and in many cases, death. Because of the lack of “fuel” that sufficient nutrition provides, many people with eating disorders report a constant state of fatigue.

Paradoxically, the same eating disorders that make people feel constantly tired also often prevent regular sleep patterns. Insomnia is one of the most commonly reported symptoms of both anorexia nervosa and bulimia nervosa. According to a 2011 study of sleep patterns in people with eating disorders, these reports involve many forms of insomnia, sometimes all at once; difficulty falling asleep, difficulty staying asleep, reduced amounts of REM sleep and an increase in day sleeping are all common in people with eating disorders.

In some situations, people with anorexia nervosa or bulimia nervosa might actively try to sleep less. The reasoning for this is troubling; it might be a way to clear more time for exercise. People with both disorders are usually troubled by a distorted body image which makes them feel “fat” or overweight even if they are dramatically underweight. Aside from self-starvation and various purging activities like self-induced vomiting or laxative abuse, many people with these disorders engage in compulsive, excessive exercise regimes. 

While exercise is normally a good thing, when it becomes compulsive, the person will push themselves past the point of pain or injury. They may also begin to skip social engagements like hanging out with friends or family gatherings to go running or otherwise exercising, which increases social isolation and feelings of depression or social anxiety. In this vein, people with eating disorders will often take “advantage” of their lack of sleep to exercise more. This exercise, in addition to already depleted caloric and nutritional resources, can have serious negative health effects.

Binge Eating Disorder, Sleep Difficulties, and Sleep Apnea

A relatively recent addition to the official ranks of eating disorders (it was only included in the DSM-V in 2013), binge eating disorder is actually more common than either anorexia nervosa or bulimia nervosa. Binge eating disorder goes in the face of the stereotype of an eating disorder because it doesn’t involve restricting calories or purging, and usually isn’t triggered by a fear of gaining weight. With BED, a person will regularly engage in “binge eating episodes” in which they eat a large amount of food in a short amount of time. This is usually done at night, and almost always in secret. 

Because there is no compensatory purging, people with binge eating disorder run the risk of becoming overweight. This is exacerbated by the kinds of food that are often eating during these episodes, which is often salty, fatty, and sugary foods high in carbohydrates – the basic description of “junk food.” As the Johns Hopkins info above described, these kinds of foods provide quick bursts of energy, which interferes with regular sleep patterns. Additionally, the late-night nature of the binge eating episodes also disturbs the circadian rhythms most people need to establish those sleep patterns.

An increase in BMI also brings an increased risk of sleep apnea. This syndrome is very common and very dangerous. Sleep apnea can cause many adverse symptoms such as hypersomnia (excessive tiredness and fatigue), reduced REM sleep, depression, and sometimes death by suffocation. 

The risk factors for sleep apnea dovetail with those for binge eating disorder in two main ways – sleep apnea is more common in people who are overweight and is almost twice as frequent in men. Binge eating disorder, in contradiction to the stereotype that eating disorders only affect young women, is almost as common in men as it is in women. This makes men with BED doubly at risk for sleep apnea and the adverse consequences it brings.

Sleep-Related Eating Disorder

Although every kind of eating disorder can trigger sleep-related issues, there is also an eating disorder that is directly related to sleep disturbances. It’s known as Sleep-Related Eating Disorder, and it’s a form of OSFED (Other Specified Feeding and Eating Disorder) that affects people mostly beginning in their late teens and early adulthood. 

In cases of Sleep-Related Eating Disorder, the individual will eat in their sleep on a regular basis. The disorder is closely related to sleepwalking, and the person is not aware consciously of what they are doing or what they are eating. The risk factors for this disorder include other sleep disorders like such as sleep apnea, sleepwalking, narcolepsy, and restless legs syndrome, as well as waking eating disorders like anorexia nervosa, bulimia nervosa, and ARFID. It is not clear whether eating in their sleep is an unconscious response to restricted eating in the latter cases.

Sleep-Related Eating Disorder carries with it several health risks. Because the person is not aware of what they are eating, there is a risk that they’ll eat non-edible objects or toxic materials that can cause choking or poisoning. If the person has food allergies, there is a chance of a negative allergic reaction, especially if they share food storage areas with roommates or family members who don’t also have that allergy. Less direct health risks include weight gain and subsequent obesity, which can be baffling for the individual, who doesn’t know that they are eating.

There are some medical treatments for Sleep-Related Eating Disorder that are similar to the ones used for somnambulism (sleepwalking disorders), such as Ambien and other sleep medications, although these can worsen the condition in some cases.

Treatment for Eating Disorders and Sleep Disorders

In the case that someone takes the courageous step to seek treatment for eating disorders, they should let the care team know if their sleeping patterns have been disturbed or are becoming disordered. A fully comprehensive care plan at an eating disorder treatment facility usually includes a full spectrum of therapy for the client’s entire spectrum of needs. This might include medical and psychiatric care, nutritional planning and visits with a dietician, and sleep therapy, as well as the eating disorder-focused talk therapy sessions. 

Among the types of evidence-based therapy employed during both residential and outpatient treatment programs is Cognitive Behavioral Therapy or CBT. This technique of retraining the thought processes in a person who has a mental health disorder is long-proven to help people identify their distorted thoughts and replace them with more objective ones. CBT-I (the “I” is for insomnia) is a useful variation of this therapeutic method, specifically tailored for people with a sleep disorder.

At many eating disorder treatment centers, medication is used as a last resort, which is why CBT-I is an extremely useful tool in retraining a client’s attitude toward sleep. If the client has been sleeping less so they can exercise more, for example, the therapist may work with them to identify that a) sleep is an essential part of good health, and b) that the person’s disordered exercise patterns and lack of sleep are actually hurting them more than helping. Over time and several sessions, the client can begin to replace their disordered thoughts and behaviors with healthier ones.

Eating disorders are dangerous, and they grow more intense over time if they are not treated. If you are suffering from an eating or sleep disorder, or know someone who is, please don’t hesitate. Reach out to your doctor or an eating disorder treatment center near you, like Monte Nido to find out if professional eating disorder treatment is for you.