Eating Disorders and Insomnia: Exploring a Complex Relationship
Understand how eating disorders and sleep disturbances are deeply intertwined, affecting mental and physical well-being.
Insomnia and eating disorders are both serious health challenges on their own, but growing research reveals a strong, two-way relationship between disordered eating and sleep disturbances. For many, these conditions intertwine—worsening each other, influencing recovery, and deeply impacting everyday life. This article explores the connection, contributing factors, and what you can do if you find yourself struggling with both.
How Are Eating Disorders and Insomnia Connected?
Recent studies show that eating disorders (EDs) and insomnia frequently co-occur, each potentially driving or worsening the other. People with disordered eating often experience:
- Difficulty falling asleep
- Frequent nighttime awakenings
- Early morning waking and inability to return to sleep
- Feeling unrested during the day
This relationship is bidirectional: insomnia may increase the risk of developing or worsening eating disorder symptoms, while eating disorders themselves can disrupt sleep patterns through both physical and psychological mechanisms.
What Is Insomnia?
Insomnia is a sleep disorder marked by trouble falling asleep, staying asleep, or waking up earlier than planned and being unable to return to sleep. Key characteristics include:
- Difficulty initiating sleep
- Difficulty maintaining sleep
- Unrefreshing or poor-quality sleep
- Daytime impairments such as fatigue, irritability, mood changes, or trouble concentrating
Insomnia can be short-term (acute) or long-term (chronic, lasting three months or more).
Understanding Eating Disorders
Eating disorders are mental health conditions characterized by severe disruptions in eating patterns, behaviors, and related thoughts or emotions. Common types include:
- Anorexia nervosa: Extreme restriction of food, intense fear of gaining weight, and body image distortion.
- Bulimia nervosa: Binge eating episodes followed by compensatory behaviors such as vomiting or excessive exercise.
- Binge eating disorder (BED): Recurring episodes of consuming large amounts of food, often rapidly and to the point of discomfort, without subsequent purging.
- Other specified feeding or eating disorder (OSFED): Symptoms do not meet full criteria for the above, but still cause significant distress or impairment.
The Bidirectional Relationship Between Eating Disorders and Insomnia
The connection between sleep disturbance and eating disorders is complex and bidirectional:
- Insomnia can worsen eating disorder symptoms. Lack of sleep increases negative mood, stress, and emotional regulation difficulties, which may heighten disordered eating thoughts and behaviors.
- Eating disorder behaviors can disrupt sleep. For example, extreme food restriction can fuel nighttime hunger, while binge eating or night eating brings digestive issues or arousal that delay sleep.
Individuals with eating disorders are more likely to report sleep problems than those without. Poor sleep may also hinder recovery from eating disorders and increase relapse risk after treatment.
What Causes Insomnia in People With Eating Disorders?
Several factors contribute to insomnia among those with eating disorders:
What others are reading
- Food restriction may cause nighttime hunger, making it hard to fall or stay asleep.
- Binge eating—especially at night—can delay sleep onset, cause digestive upset, and increase nighttime awakenings.
- Poor nutrition may disturb neurochemical balance and affect the production of melatonin and serotonin, which regulate sleep.
- Fear or anxiety about food and eating may lead to rumination and mental arousal at bedtime.
- Using sleep or naps to escape eating can disrupt the body’s normal sleep-wake cycle.
- Excessive exercise, especially in the evening, may delay sleep onset and disturb sleep quality.
- Daytime dysfunction, including fatigue and mood changes, can reinforce both poor sleep and eating disorder patterns.
Chronotype and Eating Disorders
Recent research suggests individuals with anorexia nervosa may be more likely to have a “morning chronotype” (a preference for earlier sleep-wake times), and that this pattern may increase the risk of developing anorexia. Conversely, night-eating behaviors are associated with a late chronotype.
Types of Eating Disorders Linked to Sleep Problems
Some eating disorders have particularly strong links to disordered sleep:
- Night Eating Syndrome (NES): Marked by excessive food intake in the evening or after waking at night. Those with NES are conscious during eating episodes. NES often leads to insomnia and disrupted sleep cycles.
- Sleep-Related Eating Disorder (SRED): Classified as a parasomnia, SRED involves involuntary eating episodes while asleep—with no memory of the behavior. This can be dangerous, as people may unknowingly consume inedible or harmful substances.
- Binge Eating Disorder (BED): While not specific to nighttime, many with BED experience night-time binge eating—contributing to insomnia and a disrupted circadian rhythm.
Symptoms: What Does Eating Disorder-Associated Insomnia Look Like?
- Taking a long time to fall asleep
- Waking up often during the night
- Waking up too early and being unable to go back to sleep
- Feeling tired, unrefreshed, or irritable during the day
- Difficulty concentrating or remembering
- Daytime naps or sleep avoidance as coping mechanisms for eating disorder triggers
- Binge eating at night, leading to poor sleep quality
- Nighttime anxiety, worry, or rumination about food, body image, or other stressors
Who Is at Risk?
Certain individuals are at higher risk for experiencing insomnia with an eating disorder:
- Youth and young adults, especially those with pressure regarding appearance or athletic performance
- People with other mental health conditions, such as anxiety or depression, which commonly coexist with both insomnia and eating disorders
- Individuals experiencing high stress or emotional upheaval
- Those with a family history of eating disorders, insomnia, or both
- People with irregular eating patterns, chronic dieting, or frequent nighttime food intake
Potential Health Effects of Combined Insomnia and Eating Disorders
Having both an eating disorder and insomnia can significantly increase risks to both physical and mental health. Key consequences can include:
- Impaired cognitive function, memory, and concentration
- Decreased immune function and increased vulnerability to illness
- Greater risk of depression, anxiety, and mood swings
- Disrupted hormone balance (e.g., ghrelin, leptin, cortisol), leading to further appetite and sleep problems
- Increased risk of substance use disorders or relapse in recovery
- Diminished success or slower progress in eating disorder recovery due to sleep difficulties
Table: Common Effects of Combined Insomnia and Eating Disorders
| Effect | Example |
|---|---|
| Mental health | Increased anxiety, depression, and stress response |
| Cognitive effects | Poor concentration, impaired memory, decision-making difficulty |
| Physical health | Weakened immunity, hormonal imbalance, fatigue |
| Recovery impact | Slower ED recovery, higher risk of relapse |
Treatment Options for Eating Disorders and Insomnia
Effective treatment should address both the eating disorder and any coexisting insomnia. A multidisciplinary approach often yields the best outcomes:
- Psychoeducation: Understanding the link between sleep and eating behaviors can motivate change.
- Cognitive Behavioral Therapy (CBT): CBT for insomnia (CBT-I) helps address thoughts and habits that disrupt sleep. Specialized CBT for eating disorders (CBT-E) tackles food-related beliefs and behaviors.
- Nutritional rehabilitation: Addressing malnutrition and stabilizing eating patterns improves both energy regulation and sleep cycles.
- Medication: In some cases, supervised use of sleep aids or medications addressing anxiety, depression, or eating disorder symptoms may be useful. These are most effective as part of a broader treatment strategy.
- Chronotherapy and routine stabilization: Encouraging regular sleep and meal patterns helps regulate the body’s circadian rhythm.
- Addressing comorbid conditions: Treating co-occurring anxiety, depression, or trauma can relieve both insomnia and eating disorder symptoms.
Tips for Managing Sleep With an Eating Disorder
- Keep a regular sleep schedule—even on weekends.
- Eat regular, balanced meals, especially not skipping dinner.
- Avoid caffeine, nicotine, and heavy exercise before bedtime.
- Try relaxation techniques or mindfulness practices before sleep.
- Limit screen time in the evening to promote melatonin production.
- Seek professional help if insomnia or eating disorder symptoms persist or worsen.
When to Seek Help
If you are experiencing ongoing sleep disturbances, significant changes in eating habits, or emotional distress related to either issue, reach out to a healthcare provider or mental health specialist. Early intervention can prevent worsening symptoms and provide relief for both conditions. Treatment is available—and recovery from both eating disorders and insomnia is possible.
Frequently Asked Questions (FAQs)
Can insomnia make eating disorder symptoms worse?
Yes, research shows that sleep disturbance can heighten emotions, stress, and negative thoughts, which may worsen disordered eating behaviors and increase risk of relapse.
Why do people with eating disorders often have trouble sleeping?
Nighttime hunger, anxiety about food, irregular meal or sleep schedules, and binge eating episodes can all disrupt normal sleep. Both physical and psychological factors play a role.
What is night eating syndrome (NES)?
NES is an eating disorder characterized by excessive eating in the evening or after waking at night. People are awake and aware while eating, and NES often leads to insomnia.
Is sleep-related eating disorder (SRED) the same as NES?
No. In SRED, people eat in their sleep and have little or no memory of it the next day. NES involves conscious nighttime eating.
Are there specific treatments for sleep problems in people with eating disorders?
Yes. Cognitive-behavioral therapy approaches targeting both eating and sleep behaviors, nutritional support, and treatment of underlying mood issues are strongly recommended.
Key Takeaways
- Insomnia and eating disorders often occur together, each worsening the other.
- Causes are multifactorial—biological, psychological, and behavioral.
- Poor sleep can hinder recovery from eating disorders and increase relapse risk.
- Treatment addressing both sleep and eating issues yields the best outcomes.
- Professional support and early intervention are crucial for healing.
References
- https://www.medicalnewstoday.com/articles/anorexia-and-insomnia
- https://pmc.ncbi.nlm.nih.gov/articles/PMC9434493/
- https://www.healthline.com/health/eating-disorders/sleep-related-eating-disorder
- https://www.nimh.nih.gov/health/publications/eating-disorders
- https://www.sleepfoundation.org/nutrition
- https://withinhealth.com/learn/articles/unpacking-anorexia-and-insomnia
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