Why I Wake Up Starving in the Middle of the Night!


This has been plaguing me and driving me crazy for months! I’m talking since the spring/summer of 2010! I may have an answer! Or if nothing more, a whack of things I can ramble on about regarding medicine.  I find that fun.

You know, I love it when I stumble across something so completely awesome, when I’m really researching something else.  Especially when it’s so awesome because it pertains to me.  Not to sound egotistical.  No, seriously.  I mean that.  If it isn’t enough that the human body is unbelievably fascinating, mine is unbelieavably disastrous!

Patient History: I am waking up, hungry as hell, for no apparent reason! This has never happened before in my entire life (excluding taking Zyprexa/Olanzapine; my Seroquel/Quetiapine has no effect upon my appetite.)  What is this all about? So, as any good…what would you wish to call me? Scientist? Researcher? Detective? WOMAN GOING OUT OF HER MIND??? I decided to see if there was some kind of pattern to all.

The foods I crave are always carbohydrates and definitely chocolate.  I do like chocolate but I wouldn’t say I’m a chocoholic.  Well, I guess I am now!

At first, I noted that if I starved myself (basically ate next to nothing and skipped a late meal/dinner), it wouldn’t happen.  However, if I ate dinner, or something later on before bed, it would happen.  This confused me greatly, as one would think if I didn’t have a late meal, I would wake up hungry!

Then, I thought checking the time might be a good idea.  It seemed intermittent, so when it happened, it was one hour after I fell asleep.  What did that mean? Now, as far as time and being intermittent, it’s all over and happening on pretty regular basis!

Time for Science Class Kids! And a bit of a confusing one, at that.  Nobody can call it one thing, give it a classification, describe its signs and symptoms in an agreeable manner (well the latter is just medicine in general.)  Regardless, I’m still feeling like I won’t survive another day without chocolate food in the middle of the night.

Patient Diagnosis: Night Eating Syndrome, Nighttime Eating Disorder (these are considered to fall under some Eating Disorder issue.)  According to Wiki that offered “Night Eating Syndrome,” it is being pushed for the DSM-V to be dropped on our heads in 2013.  What a fun day that will be!

There are some different signs and symptoms between the two, but these are the ones that drive it home for me.

- Little or no appetite for breakfast.

- Delays first meal for several hours after waking up–not hungry or upset about what was eaten the night before.

- Consume at least 25% of their calories after dinner. (Many sources would list this as after 9 or 10 pm; dessert is generally not included, if one is eaten.)

- Late-night binges almost always consist of consuming carbohydrates. Eats lots of carbohydrates (sugar and starch).

- Suffer from depression or anxiety, often in connection with their eating habits.

- May be moody at night – tense, anxious, nervous, depressed, etc.

- Have trouble sleeping in general.

- Wakes frequently and then often eats.

- To be considered a bona fide disorder, this pattern should continue for two months or more.

There are other things out there as potential “why’s,” in terms of Eating Disorders, but I still think something is being neglected.  What about the sleep??? Could this be a parasomnia?

“Night Eating Syndrome,” (NES) is not to be confused with “Nocturnal Sleep-Related Eating Disorder,” (NSRED.)  That’s when you’re walking around asleep, not knowing that you’re frying up some bacon and eggs, or whatever you’d like to eat.  Yet, some feel the latter is a combination of a parasomnia and an Eating Disorder! Further, there can be many levels of awareness with NES! I know I’ve woken up in the morning, only to see more food scattered all over the bed than I remembered eating!

Here are a few guys from the Wiki page about NSRED who are a bit fond of debating the similarities and differences.

  1. ^ Auger, R. Robert. “Sleep-Related Eating Disorders.” Psychiatry Volume 3. Issue 11. ISSN: 550-5952NOV 2006 64-70. 13 Sep 2008 http://www.psychiatrymmc.com/displayArticle.cfm?articleID=article249>.
  2. ^ a b c d e f g h i j Schenck, Carlos H., and Mark W. Mahowald. “Review of Nocturnal Sleep-Related Eating Disorders.” International Journal of Eating Disorders 15.4 (1994): 343-56.
  3. ^ a b c d Winkelman, J. W. “Clinical and Polysomnographic Features of Sleep-Related Eating Disorder.” The Journal of clinical psychiatry 59.1 (1998): 14-9.

Let us dispense with that, however.  I’m particularly fond of this piece of research on NES.  It makes lots of sense to me! The piece doesn’t specifically go into Circadian Rhythms, but it’s basically implied.  I also laughed.   Because I’ve had so many seizures, I’m convinced my hypothalamus has been completely destroyed!

NEW YORK (Reuters Health) – Night eating syndrome, characterized by a lack of appetite during the day and insomnia and increased appetite at night, may be caused by an abnormal response to stress, new study findings show.

“Night eaters have a different pattern of hormonal release to stress than normal eaters,” lead study author Dr. Grethe S. Birketvedt of the University of Tromso in Norway told Reuters Health.To investigate, Birketvedt and her colleagues studied stress hormone secretion patterns in five female night eaters and a comparison group of five women without the syndrome. The night eaters all consumed more than half of their daily food intake after 8 PM, and woke at least once during the night to eat.

The researchers injected the women with 100 micrograms of corticotropin-releasing hormone, which is released in response to stress and triggers the secretion of other stress hormones.

In general, the night eaters exhibited a gradual and slight increase in their stress hormones after the injection, followed by a gradual decrease, while their peers in the comparison group exhibited a rapid and significantly greater increase in their stress hormones, followed by a gradual decrease, the investigators report in the February edition of the American Journal of Physiology-Endocrinology and Metabolism. Thus the night eaters’ hormone secretion in response to induced stress was significantly weaker than their peers’.

The study group was “worn out,” Birketvedt explained. For example, their levels of the stress hormone cortisol at the beginning of the study were higher than those seen in the comparison group. “If (you are) stressed 24 hours a day, there will be no reaction when stress is induced,” Birketvedt said.

In general, these findings indicate that “the relationship between the adrenal gland (which releases cortisol), the hypothalamus, where the appetite center is and the pituitary, where a lot of hormones are produced, is out of control,” Birketvedt said. “No wonder they (night eaters) eat late at night and wake up during the night.”

The researcher added, “With these findings we can find a treatment that turns the biological clock back to normal.”

In the meantime, individuals with night eating syndrome “should try to think of what they eat before they go to bed,” Birketvedt stated. She advised them to eat carbohydrate-rich foods before bed, stay away from sleeping pills or antidepressants, and take melatonin about 30 minutes before sleeping in order to lower their risk of night eating.

SOURCE: American Journal of Physiology-Endocrinology and Metabolism 2002;282:E366-E369.

I hope I didn’t bore you to sleep with all of this.  Let me know if I did and you suddenly woke up hungry, though!

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  1. Shit. That’s me.

  2. Hi katm. *laughing*

    I know this isn’t a funny issue but when I saw your comment I just started laughing.

    Well, at least we know what we can try and do about it? I just woke up and had a bowl of cereal. Now, I’m going to head back, grab some yoghurt and some grapes? I don’t know.

    So far, I think my plan is to try and stuff something into me immediately after I take my meds. I always “eat fast” to get it over with, anyway. I only “linger” over my food if I feel like I’m going to explode (which doesn’t take much.)

    I don’t know about the rest of the day. However, first thing in the morning is enough of a step for now.

    PS – I woke up hungry again last night, too. I grabbed a chocolate Ensure (I’m out of chocolate lest Nutella!!!) a couple of granola bars and a bag or tortilla chips.

    You see, people? This is obviously insane? And quite clearly a problem if it’s ongoing and/or every night?

  3. Don’t worry about laughing. I was laughing as I wrote my comment. I like the part about avoiding antidepressants.

    What sucks is my sense of taste appears to have almost disappeared. Nothing tastes good. *wanders off to look up side effects of her ADs*

  4. Hi katm. Yes, I know it was all in good humour. We know each other well enough by now, right?

    The AP Zyprexa was completely obnoxious with me. However, it did give me the best sleep of my life.

    I didn’t gain that much weight compared to some people out there, but the worst was the uncontrollable appetite. It just wouldn’t stop!

    I did hate the weight gain. I did! I finally stopped it when I needed an entirely new wardrobe. The damn med was only to be temporary anyway, but pushed on me SO hard, for SO long by Dr. Asshole. I finally relented, as I was freaking out so much at the time.

    ADs can definitely cause problems in the food dept., too. Taste perversion can be a side effect for some meds, and not just ADs. That one usually falls under the “rare,” category. Although not always, perhaps. It depends.

    What are you on, if you don’t mind me asking. You can email me and let me know, if you don’t want to get into it here.

  5. Two TCAs, nortryptaline and anitrytaline (or however the hell you speel them). Why 2, I don’t understand. I think they’re for sleep and the depression as well. Lexapro. Valium. It’s playing the med go round again.

    And I can definitely say an IV in the palm side of the base of your wrist is probably one of the most painful places to have it placed. The IV Compazine did help with the nausea though.

    Problem is I have no appetite and nothing tastes right. I don’t eat. I get nauseous. I get nauseous and I want to even less. Repeat stupid cycle.

  6. Hi katm. Two? Maybe to add as an adjunct? I’ve never been on on the Tricyclics before, and I’m too tired and arsed right now to bother looking into the specifics of the pharmacology. It could depend upon what’s the sitch with with your bean. One med for depression, and one for sleep is a popular reason. Makes sense.

    I was taking Welbutrin and Effexor at the same time, as it “seemed,” I wasn’t getting enough out of them. Gee, that’s because I’m Bipolar and can’t take ADs! And on that note, med-go-round does not equal fun.

    What the…? I just had to look at my hand when I read that, in case I was wrong. PALM side at the BASE of your WRIST???

    Enter Dr. PA (or any sane person.)

    What happened to the good, ol’ simple vein on the top of your hand? Certainly less painful and definitely bigger, so easier to access!

    So nausea is a problem. And taste perversion. Well, you could check out if taste perversion is one side effect of a med? I know it was for me when I started Topamax. It was only temporary, though. Severe suckage if it was permanent.

    More “permanent,” nausea. That’s a pain. I know when I would have my gastro crap (bad pun) come back to haunt me, that would be part of the package. It can still come back in some ways when I am nervous, anxious and under stress (gee, does that sound like my entire life?)

    All joking aside, I was feeling nauseous last night and I knew it was because of stress. Maybe because I wasn’t eating either, but there was a stressful trigger to it all, as well.

    I guess all we can do is keep trying? I hadn’t eaten in days, but finally did last night. Now, I’m stressed like crazy about this flat business, so I probably will end up not eating for…?

  7. Very interesting read. I ate 2 large plates of left over thanksgiving stuffing, turkey, gravy, potatoes, carrots, and cranberry stuff right before bed and woke up starving! Ahhh the first 3 on the check list for NES don’t apply to me. The rest are pretty spot on

  8. Hi Anxiety patient. I’m glad you found this interesting. I did find that when you get it under control, the extra weight does seem to come off fairly quickly.

    I’m still having issues with it, but it’s because I’m sick (mostly.) I won’t get into any ED stuff here.

  9. Samira

    Hey somebody told me that this type of problem eating in the night is called Bulimia! Because we are afraid of gain weight in the day, and we dont hae such a full control of the brain over the night , and we lose control ….

  10. Hi Samira. Nice to meet you and welcome to my blog.

    NES (Night Eating Syndrome) or NED (Night Eating Disorder) seems to be relatively new in “The Literature.” A bomb dropped on my head when I found it after dealing with it for over a year!

    I find your comment re: bulimia interesting and also very enlightening as at least people are perhaps talking about it?

    If you want Dr. PAs commentary (note: Dr. PA is really not a doctor) here it is. It’s not so much limited to bulimia per se. In fact, you could toss in anorexia/anorectic behaviour as well. It’s the same regarding not wanting to eat for fear of gaining weight. That would be me (i.e. not bulimia.)

    I listed a bunch of things above that can contribute to the problem. Some psych problems, insomnia etc. Also, it’s going to be considered for the new DSM. So, obviously someone thinks it’s bonafide enough to be considered some type of disorder.

    In a way, this might make sense. If we’re starving ourselves, afraid of gaining weight and the typical, “I can’t control my life but I can control my eating!” metabolically things can get messed up. Let’s face it. Our bodies need food.

    This may not be the case for everyone (i.e. not everyone will develop NES/NED) but some of us might be more susceptible. And it’s really screwed up, because it can pack on the pounds FAST! Don’t ask me why. I would only venture to say, is that we’ve screwed up our metabolism (or it has become screwed up) in a severe way. That might fit with EDs

    Then, the vicious cycle starts. Now I’ve gained the weight, I HATE THIS so it’s time to get back to the ED business. Nope. The only way to get rid of the pounds is to try and eat regularly (even if it’s a bit) at regular times.

    Say you can manage breakfast. Then, try a small snack later. Then lunch? If you can’t handle that, just something! Try and continue in that fashion, and for dinner? Eat something before 7:00pm.

    Because what IS happening metabolically is your body is sucking up the majority of all your caloric intake way too late. It should be taking everything in far earlier as that’s when it needs it!

    It’s like, everything is backwards. That could be an example of the insomnia. You’re backwards. You need sleep at night but you’re not getting it. Ditto with the food. You’re getting it at the wrong time–and consistently.

    Anyway, sorry for rambling. If it’s any comfort, I’m back at dealing with it AGAIN! If you can believe it, I ate far too late in the night and I “gained” 5lbs. in a day! But if I get things straight, it won’t take very long to lose it at all.

    Take care,
    PA

  11. aa412

    OMG. .I have been dealing with This problem for years! I wake up every night and binge eat. And have had sleeping problems for years! I consider myself to be depressed ‘ anxious and I’m very unhappy in my current relationship. I have had my blood sugar and thyroid checked and they are normal. I don’t sleep much at all during the night. If I do go to sleep, I usually wake up an hour to 2 afterwards and an starving. I am always craving carbs and binge on them when I wake-up. I am very tired and ill in the mornings. I drag at work. Can’t keep my eyes open sitting at my desk. It’s a viscous cycle everyday.

  12. So, I already knew I was abnormally stressed. I have somatinization disorder. Basiclly, stress likes to beat up/shut down my organs. Odd my dr.s never thought of this in 7 yrs of treating insomnia/binge eating! My question is: what if you can’t avoid ADs? Do I really NOT want to eat a bowl of pasta, a bagel, cheese sticks, some cheeze nips, and so olives for good measure every two hours at night? Thanks for the info, thought I was crazy-er!

  13. Hi aa412. Welcome to my blog and I know it’s been over a month since I’ve gotten to this. I hope you still come back to read my response. The same goes for you LifeLivedWell although it hasn’t been a month for you!

    So, aa412. Thanks for your comment. I find it extremely valuable to hear your background health information. Regarding this “Syndrome” or “Disorder” it does not surprise me that your blood sugar levels (and even your thyroid?) tests would show up within normal ranges.

    The only way to get it to stop is you need to eat at regular intervals during the day. What you’ve said may lend credence to a little theory of mine.

    The problem is that it ties into our Circadian Rhythms. That is why it affects people who have insomnia. Now, add in any mood factors and your insomnia gets worse. It’s like, in the food intake dept., everything is turned upside down!

    Our bodies are incredibly sensitive to Circadian Rhythms in so many ways. As an Aspie, I can go all strange and way into Aspie Land, simply from changing the clocks back and forth twice a year!

    And as an aside, they are pitching this for the DSM-V. Oh, I can’t wait for the day when that comes out! The joy, the bliss. If only I could have been any kind of consultant. Or, re-wrote the whole goddamn thing in secret!

    Anyway… Dr. PA who is not really a doctor might suggest slowly, very slowly, trying to eat something/s during the day. Just in itty-bitty portions. You could also try Ensure (or other) that are proper meal replacements. I drink them all the time when I don’t feel like eating. They’re loaded with nutrients and the calorie count isn’t bad either.

    Because ULTIMATELY want you want to do is re-calibrate the CARB intake at night. Carbs are sugars, right? Simple or complex. That’s the biggest problem with the massive weight gain that can happen.

    What do you think?

    Hi LifeLivedWell. I can give you a very simple answer as to why your doctors never told you. They had no clue it existed!!!

    I found out about it and told my doctors when they weighed me in, it was wrong. Like a false positive. Because of this problem, it wasn’t my baseline. It took them a bit to grasp the concept but they did.

    I’ve gotten things under control now (well, some nights…) but I am pretty much back to baseline now. I was 100lbs. Now I’m 105lbs. Loss of weight due to being ill, but I don’t mind due to anorectic loveliness.

    I’m a little confused about your question regarding ADs. You can’t avoid them, as in you have to take them? Hands down and that’s it? And then do they cause a problem with an increase in appetite?

    I totally agree with stress and you can also toss that into the “equation” above, don’t you think? Absolutely.

    I’m not sure, but maybe what I recommended above might help you as well? I could compare the slow but steady food intake to a titration of a new medication. That might work. Something you need to get your body back on track and out of its current state of upside down lunacy.

  14. Karen C

    Great Blog, I was wondering if your strategies to stop this horrid cycle which I’ve been enduring for years has helped you? Blessings

  15. Hi Karen C. Nice to meet you and welcome to my blog. Also, thank you very much for your compliment. It means a lot to me.

    Although, you could be referring to my “past” blog? I haven’t been around here for so long, and when I have? My posts have been crap! *laughs*

    On that note (not being around so much) I do hope you come back to read my response. I respond to everyone who comments.

    To answer your question, YES! Granted, it can be a little bit of a challenge to eat properly due to my “anorectic tendencies.” However, as long as I keep getting something into me during the day on some kind of regular basis, any kind or regular basis, it’s all good.

    I also try to adhere to a suitable “cut-off time” at night. For me, the latest is 2000hrs. That’s my absolute limit. Okay, I don’t always make it! *winks*

    IF the “NES”/”NED” manages to creep back into my life, I jump straight back to the same routine to beat it (all the above) immediately. You shouldn’t waste any time!

    My scale has proven so as well. When I nip it in the bud, the pounds fall off in days.

    I hope that helps. Definitely come back if you have more questions or would like to talk further.

    Take care,
    PA

  16. I’ve really been having a problem with this lately. I sometimes wake up to east even 3 or 4 times at night and there’s no way I can go back to sleep if I don’t because I feel like I’m STARVING! I’ve also had my thyroid and blood work done and everything looks good except for having low cholesterol. Actually the only time I can usually sleep the whole night is when I take a sleeping pill. I’m not worried about weight gain. I do have anxiety disorder though and have suffered with full blown panic disorder in the past. I wonder if it could be that my body is just a bit haywire after all that even though emotionally I’m doing 90% better. ?? I also have food intolerances but try to avoid as much as I can the things I shouldn’t eat. So many factors it’s hard to know what the real problem is.

  17. Oh, and I don’t necessarily crave carbs either; eating a piece of steak would be fine by me…it’s just getting rid of the hunger.

  18. AND I still wake up hungry in the morning n have a good appetite through the day. Sorry I keep thinking of more stuff to write after I post my comments lol

  19. Hi foodndrea. Nice to meet you and welcome. Welcome to this post, and a welcome from me to go into the past to an older post. I love going back in time to see what I’ve written.

    First, not to worry about adding additional comments after a first or second. It actually helps me because then I can say more in return.

    The thyroid and bloods are/were a really good step. Cholesterol too but that is tough. It can be indicative of so much. However, if you were speaking to your physician within the context of this issue: NES/NED (Night Eating Syndrome/Night Eating Disorder) it could take on some relevance.

    Despite Dr. PA not being a real Dr., with the two former and the Cholesterol not falling through the basement? You’re health sounds okay overall? You might want to think of speaking about it if you feel this is really problematic. I’m serious. Better to be safe than sorry.

    I think I did mention they are actually pitching this for next DSM…(oh, joy, oh bliss…) Their reasons are actually psych. Insomnia, Anxiety, ED, Depression… Dr. PA, shit thee not!

    So, you’re sleeping alright. Some Anxiety/Panic. No ED problems, there. However, you sound like your emotional state is good, if not improved highly, since this business has been going on. Hmmm.

    I’ve never found anything in “The Literature” about food intolerances. Interesting that you brought that up. It makes me think, but everyone across the board says it’s the same thing and none of them have been in that situation (unless they haven’t mentioned it.) I have no food intolerances.

    It doesn’t necessarily have to be carbs that you crave either. It can be anything. I put a goddamn meat sandwich on my shelf by my bed one night when I knew I needed it! *laughing* It’s just that mostly people dive into the simples–straight for the sugar!!!

    I also find it interesting that you still wake up hungry straight away in the morning, after having the nighttime gorge! *laughs again*

    Appetite increase all over? Dr. PA in a flurry!!!

    Your Endocrine System rules so much of what your body does. It’s like your brain gives it an unlimited supply of AK-47′s full of hormones to blow your body apart!

    I don’t know. What do you think? How do feel based upon what I’ve had to say here?

    Take care,
    PA

  20. I suffer from anxiety and depression and occasional insomnia. I also have borderline binge eating disorder. Recently however I have been waking up regularly throughout the night and have been so hungry to the point where I struggle to fall back to sleep. I seem to be wide awake and needing a ton of food.

    All the symptoms seem to match with me, and Id like to mention this to my doctor. How could I bring it up do you think?

  21. Hi lylonmalanic. Welcome to my blog. And welcome to me being so tardy because I was almost going to take it down! *laughing*

    NES (Night Eating Disorder) can be a real sticky widget. They were pushing it for the new DSM but I don’t know where that stands. But they WERE pushing as a Psych Deal.

    It’s sort of “newish” (unless they have been hiding things from us…) *raises eyebrows* because it took me FOREVER to find out what it was!

    Alright. First things first. Does your doctor know of your current ED issues? If so, that might be a (big?) point in your favour.

    Ah, Cardinal Rule too. How does your doctor feel about you bringing any type of information to him/her? Whether it’s anecdotal or from the Internet?A lot of doctors don’t like that.

    If you have that type of relationship where you can do that? SUPER BONUS!!!

    When I discuss this with people, I always state don’t show them anecdotal. Bring in things from Medical Websites, Peer Reviewed Papers. They hold a lot of weight and are not garbage.

    So, If your doctor doesn’t know your ED issues, tell them. Even I don’t fit the diagnostic criteria for being Anorexic but I bloody well am! Or close enough? That’s why I say I have, “Anorectic Tendencies.”

    First step, then. Make sure your doctor knows your ED stuff.

    The NES (if I recall) was also going to be a “cross platform” diagnosis for EDs too. As far as I’m concerned, to hell with it! It is! It’s everything! Loads of Psych plus ED!

    I don’t know the relationship you have with your doctor, but if you feel comfortable, you already have the ED stuff on the table, you could simply state your feelings? I’m assuming that you find it distressing?

    Any decent doctor should address a patient’s concern that they find it upset’s them. It doesn’t matter what it is.

    Treatment? How to make it stop? I will not make any assumptions about your ED issues. I will not discourage you. Nothing of the sort. It is “simple” as there is only one way.

    Eat regular meals during the day and establish a point (say after dinner, early evening) when you won’t eat. As soon as you do that, just a few days of eating all of your food during the day, the extra weight is gone!

    At least for me! If it’s a really large amount. Then it takes a bit longer.

    I hope you come back and read this. If you do and have any more questions, let me know!

    Take care,
    PA

  1. 1 Oh Yes. That List Thing. Me Not Coming Back Online. « Patient Anonymous: Just Another Head Case

    [...] Not so.  It took me a bit, but it has everything to do with what I wrote here, regarding Night Eating Syndrome.  It can cause A LOT of weight gain, and sometimes very [...]




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