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

March 18, 2011 in Eating Disorders, Facts About Patient Anonymous, Health, Medicine, Meds, Neat Neuro Stuff, Patient Advocacy, Seizures, The Tummy Blues

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!