Archive for August, 2011
Treatments of Night Eating Syndrome
Posted by: | CommentsWhen working with night eaters, one of the first things we asked our patients was to tell us what prescription medications and over-the-counter remedies they had tried to control their Night Eating Syndrome. Then, we made a list of all the things they’d tried, and went over it very carefully. Even though quite an array of medications had been taken, the striking finding was that almost nothing worked. A few medications helped some of the people some of the time, but nothing worked consistently. There was one exception, the medication combination called fen-phen.
Fen-Phen
You probably recall the publicity about the wonder drug combination of two medications, fenfluramine and phentermine, for the treatment of obesity in the early 1990s. This treatment had great success in helping people lose weight. Those of our patients who had tried this combination reported that their night eating disappeared while they were taking these medications. Unfortunately, it turned out that the long-term use of these drugs caused heart valve problems, and fen-phen was taken off the market.
The experience with fen-phen was important in helping us understand what may control night eating. This combination produced a very large increase in the neurotransmitter serotonin in the areas of the brain that deal with appetite. This knowledge helped direct attention to medications that might help in the treatment of Night Eating Syndrome, particularly those medications that affect serotonin.
Over-the-Counter Medications
Over-the-counter remedies have been widely used by night eaters, but they have shown very little benefit. Two of the most common treatments are the hormone melatonin and an herbal medication made from the kava kava root. Some patients reported that these two agents helped them fall asleep, but they didn’t stay asleep. In fact, they told us that they still woke up during the night and ate.
All of these reports were anecdotal, and we don’t know how many night eaters have tried these remedies. If you are going to try any over-the-counter medications or herbal preparations for any condition, be sure to consult your physician first. This is important, especially if you are taking other medications.
Selective Serotonin Reuptake Inhibitors
Unfortunately, medication, alone or in combination, has had little success either with weight loss or with Night Eating Syndrome. The effect of fen-phen was to increase the levels of the neurotransmitter serotonin in the brain areas controlling appetite. It seemed logical then that selective serotonin reuptake inhibitors (SSRIs) would have similar results. Under their personal physicians’ care, several patients tried various SSRIs. You may be familiar with some of their names, such as fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil). These medications were originally designed for the treatment of depression.
Recently, however, they have been approved for other problems, such as anxiety disorders and eating disorders. Their efficacy in conditions other than depression and the experience with fen-phen suggested that we try the SSRI sertraline (Zoloft).
Health Care Providers and Night Eating Syndrome
Posted by: | CommentsHopefully you can explain more effectively to your physician how you are affected by night eating syndrome. For example, lack of sleep may be your main concern, and you may suspect that you have a sleep disorder in addition to night eating syndrome. In that case, tell your doctor about the symptoms you have noticed. Also report what your sleeping partner (if you have one) has observed about your sleeping habits. This may include loud snoring, gasping for air, jerking of your legs or arms, or violent night terrors. Being able to report these problems will allow your doctor to make appropriate diagnoses and perhaps to give you a referral to a sleep specialist.
If you do not have symptoms of other sleep disorders, but you are overweight or obese, talk to your physician about the impact your night eating syndrome is having on your weight. This will give him or her more insight into why it has been so difficult to lose some of the weight that is adversely affecting your health. If you haven’t told your physician about your night eating, he or she may think that you haven’t tried to follow the weight loss recommendations that were given to you at past visits. Be sure to be clear about the efforts you’ve already put forth.
Night Eating Syndrome – You Might Run across Other Night Eaters
Posted by: | CommentsThe more you reach out and tell your friends and family about your night eating syndrome, the more likely you are to find others who have night eating syndrome, or who know someone else who has it. This may provide a golden opportunity for you to team up with another night eater. Working together to help each other stay on track and sharing and exchanging helpful strategies for reducing night eating will be positively reinforcing and may give you more hope for change.
NES seems to be genetically driven in some cases. This means you may even discover a family member who has night eating syndrome and who has been suffering alone. Some of our patients recall running into their mother or father at the refrigerator in the middle of the night. Others say that they remember from their childhood seeing (or hearing) a parent or a grandparent up and about and eating at night. Because NES was discussed even less in the past than it is today, any relatives who have the problem may be relieved to have someone like you to talk to about it.
Some people have no reservations about talking to family and friends about their struggles. Others, however, do not feel as comfortable. Some families are very strict about keeping their problems secret. If that has been the case in your family, you may feel that no one in your family wants to help you. But, there is help from outside the family; also you may be able to find help on the Internet.
An Internet listserv called “Nightgrazers” has a large membership. Members share their struggles and successes on a daily basis. Many have found comfort in this personal, yet anonymous, connection. They are dedicated to finding a way to change their eating patterns, as well as to accept that they suffer from a syndrome – one with which it is very hard to cope. There are members from across the Unites States and Canada, as well as from Great Britain, and other points abroad. To join, send an e-mail introducing yourself to the following address: Night grazerssubscribe@yahoogroups.co.uk. The group moderator will get you started. You can write to them as little or as much as you are comfortable with, but the people who choose to participate more seem to get the most out of the experience.
Night Eating Syndrome – What Others Can Say in the Middle of the Night
Posted by: | CommentsIt’s all well and good to talk to your support person and receive emotional support during the day. But daytime is not the problem, is it? No. It’s during the night when you need the most support to help you change. What can you do about that? One good idea would be to talk to your friend during the day to figure out what will be most helpful in the middle of the night. What can someone say to you? If you get agitated when you are up in the middle of the night, then you may want to tell your friend to be patient with you while you are adjusting to becoming more receptive about receiving help. The more you talk about your night eating with your friend during the day, the more aware you will be during the night that this person is trying to help you.
About a hundred years ago, a man named Emile Coue had an enormous impact on the mental health movement in America and abroad. His major tool was a mantra. A mantra is a word or phrase that you find comforting and reinforcing. For many years, numbers of Americans were fervent advocates of Coue and his mantra, which was “Day by day in every way I am getting better and better.” Today Coue is looked upon as an interesting historical figure, and his movement has vanished. But at the time, his mantra was a major fixture in American society. If you think that this mantra would help you, feel free to adopt it and tell your support person about it. Otherwise, find a short phrase that you can make your own. A mantra may be able to help you control your night eating.
For example, you can repeat your chosen phrase to yourself, one such as, “I am not hungry. I will go back to sleep.” Work on those words that would provide you with the most comfort and help when the going gets tough. You can repeat your mantra as you do your breathing exercises, and the two can reinforce each other. You can also tell your chosen mantra to your housemate. When you are up at night looking for food and not using your mantra, your housemate can repeat your mantra out loud to help coax you back to bed. The more you believe in what you are saying, the more effective the words will be, and the more you will be able to identify with them when you are reminded of them in the middle of the night
Your support person could also talk to you about something that is meaningful to you. Perhaps you have a social function coming up and you are trying to lose a few pounds. You could ask your housemate to remind you of this event when you are trying to get up out of bed to eat, or when you are snacking before you go to bed. Again, if your friend tells you this in a way that is too invasive or overbearing, you may suggest a better way of saying it, or not saying it at all.
Night Eating Syndrome – Getting Help from Your Friends
Posted by: | CommentsIf you have, this means that you may have tried to eat more regular meals during the day, and to keep track of your thoughts and emotions when you are eating at night. You may also have tried some of the stress-reduction exercises, such as diaphragmatic breathing and progressive muscle relaxation. Although you can perform most of these exercises and activities as an individual, remember you have others out there to help you. Don’t forget that social support from family, friends, and others will also help you to overcome your night eating.
Reaching Out to Others
The first step in getting support from others is reaching out to them, letting them know you want help. If you have the tendency to keep your night eating a secret, this could have come about for many reasons. You may be embarrassed by it, or you may think that others might not understand. You may have told someone about your problem in the past, only to receive unhelpful comments in response. Have you heard, or even imagined, people saying things like, “Well, just don’t get up and eat,” or “You must have no willpower.” Listening to feedback like this when you are trying to get support can be discouraging and frustrating.
Opening up an honest dialogue with a friend, significant other, or family member can help you and them get past such superficial comments that are meant to help, even if they are misguided. Sitting down with someone and talking about your struggle with night eating takes courage. If you know someone who you think would be supportive of your efforts to end your night eating, then summoning the courage to hold this conversation will be worth your while. How do you go about opening an honest dialogue?
First, pick a time to talk to a supportive person (or people) when there will be few interruptions. Second, pick a place to talk that will be comfortable for you. You may feel comfortable talking to someone at a crowded mall or restaurant, while someone else may feel more comfortable in a quiet room at home. Setting up the right time and place will help ensure that the person you choose to trust will be able to devote full attention to you. It will also ensure that you will have enough time to explain the full impact of your night eating and how he or she could be helpful with your goal of overcoming this condition. (Note: For the purpose of the remainder of this discussion we will assume your friend is a girl or woman. We understand that your friend may be male, but we are choosing to make the text easier to read.)
Structured Mealtimes and Snacks Stimulus Control
Posted by: | CommentsWhat are the steps to help you go about limiting yourself to less frequent and healthier snacks? One simple step is to use stimulus control, or, in plain English, don’t keep the forbidden foods in your home. Stimulus control means limiting your exposure to the foods you like to eat. This strategy is helpful for all types of night eaters, but probably most specifically for the evening and nighttime overeaters and the cravings night eaters. However food is not the only thing that acts as a trigger signaling you to eat. Other stimuli, or situations, could provoke you to begin to graze.
Where do you eat your evening and nighttime snacks? Do you eat them in the kitchen, or do you have a favorite chair in your family room where you sit and snack? Do you have food readily available in that place? The goal of stimulus control is to have one designated place where you eat your meals and snacks. Usually, this would be at your dinner table or in your kitchen.
Exercise: Your Designated Eating Place
- A designated eating place might be your dining table or the table in your kitchen. Wherever that place may be, designate it as your eating place and try never to eat anywhere else in your home.
- If you are sitting in your favorite chair in front of the television and you would like a snack, remember to eat it in your designated eating area. If you are truly hungry, then getting up from your chair won’t seem like too much effort.
- If you want to eat because you are bored or for some other reason, then getting up to go to your designated eating place will seem to take more effort.
- The extra effort will also give you a chance to evaluate just how hungry you really are.
Although an important step in controlling your stimuli successfully is not to consume food at your former grazing spots, there is one exception to this rule. First, we are assuming that you haven’t selected your bed as your designated area, and, if you have, we strongly encourage you to rethink your choice. As you decrease the amount you eat when you wake at night, we do encourage you to keep a small snack by your bedside to (1) limit your choices for your nighttime snack and (2) keep you from getting up and out of bed to snack. This doesn’t mean that we want you to keep an unlimited number of snacks in your room. In fact, we want you to keep only your small, chosen snack there when you go to bed. Don’t choose a snack that smells particularly attractive or it will be so irresistible you will eat it before you go to sleep.
How to Raise Awareness about Automatic Thoughts When You Wake at Night
Posted by: | CommentsRecognizing your automatic thoughts during the late evening and nighttime hours before you go to sleep will be difficult, but catching those thoughts and writing them down in your journal when you wake to eat at night may be even more challenging. How difficult it will be depends on how aware or conscious you are when you awaken.
When do you first realize that you are awake? We have learned from our patients that there is a wide range of responses to this question. Some people say that they are wide awake while still in bed and they immediately become preoccupied with worries from the preceding day. If you are awake and aware from this early point, then you should be able to record many of the thoughts you are having.
On the other hand, some people say they are not aware that they have gotten out of bed until they are standing in front of the refrigerator or kitchen pantry. If this is the case, then your chances to record your thoughts will be more limited, but not impossible. Remember, the more you train yourself to research your own behaviors, the more aware of your behaviors you will become. If you have trouble writing neatly at night and want to keep scrap paper in the kitchen (or wherever you eat at night), that can work, too. But be sure and transfer whatever you write on the scrap paper into your journal the next day so your thoughts are written in an organized way. This way you will be able to review all of your notes easily.
The more you train yourself to really take notice of your behaviors and the thoughts associated with them, the earlier in your chain of behaviors you will become aware of them. Give yourself some time to get used to this process. If at first you are able to capture only the thoughts you have after you eat, then start there. You will still gain great insights from doing just this step. When you are able, focus your attention on the thoughts that come before your night eating. As time goes by, seeing your thoughts written down on paper will help you to see the big picture, instead of seeing your night eating as just an isolated behavior unrelated to the other stressors and issues in your life.
Examining and Evaluating Your Thoughts
When you have some pages of notes of your thoughts, it’s time to examine their logic. Let’s examine a thought like, “I need to get up and eat something right now. I can’t stand this craving any longer.” How true is it that you need to eat something at that moment? What would happen if you didn’t eat? Would your hunger pangs become intolerable? Would you be unable to fall back to sleep? The only way to learn the true answers to these questions is to test them out. Have you lain in bed before without acting on the urge to eat at night? If so, how long were you able to fight your craving? Five minutes? Two hours? All night?
We are asking you to experiment with your usual chain of behaviors. For instance, if you normally wake up and immediately get out of bed, make yourself wait at least five minutes. At the end of those five minutes, reassess your craving. If it has lessened, see if you can wait another five minutes. Keep reassessing your cravings. Only then will you know if they are so intolerable that you absolutely must get up to eat something.
If your cravings overwhelm you, plan to change another part of your chain by trying to limit the quantity of what you eat. It will help to have something premeasured waiting for you that you prepared before you went to bed. You will know that everything else is off-limits. This may be difficult, but as you continue to keep records of your thoughts, you will see how overindulging affects you, perhaps by increasing your feelings of guilt, depression, or anxiety.
You will also see that successfully eating smaller amounts at night can increase your feelings of self-efficacy and accomplishment. The more you expose yourself to the negative consequences of your night eating episodes, the more rewarding eating a smaller portion will become.
As limiting your snacking becomes easier, we suggest that you try having some water or a low-calorie drink instead of food. This may take some time, but in the long run, you will wean yourself from unhealthy eating and replace it with low-calorie substitutes. Not only will substituting something healthier than your favorite, high-calorie nighttime food help you to feel better about yourself, it also won’t add as many pounds. Moreover, if you have problems with indigestion, acid reflux, or any other digestive problems, these discomforts are likely to diminish as you decrease your night eating.
How to Raise Awareness about Automatic Thoughts in the Evening
Posted by: | CommentsNow that you have written down the series of behaviors that you perform each night in your night eating routine, let’s examine the thoughts that accompany your behaviors. It is very important to write down your thoughts, so keeping your journal close at hand is essential. You should already be keeping track of your food intake, so now we are going to add a space next to or below where you write your food in your journal. This space will capture your thoughts.
Exercise: Capturing Your Thoughts
- Turn your journal horizontally.
- Along top of the page, write the following six column heads:
(1) Time
(2) Thoughts before Eating
(3) Food/Beverage Consumed
(4) Amount /Quantity
(5) Calories
(6) Thoughts after Eating
Columns 2 and 6 should be given the widest amount of space on the page because you will be doing the most writing in them. You may also choose to keep a blank page next to your food diary to expand on these thoughts.
- To begin changing your nighttime eating, set an off-limits time for eating. Pick a time after which you do not want to eat. After this time, try not to go into the kitchen or wherever else you keep your food. For some, this time may be as early as 8:00 P.M.; for others, it will be later. This will depend on when you and your family eat your evening meal and on other activities that may go on in your household, such as making lunches for the next day or cleaning up the kitchen.
- Every time that you eat after your off-limits time, record your thoughts in your journal – both before and after you eat. Yes, we know this can be a lot of work. But in a sense, that is the exactly the point. The more work you have to do to eat, the less appealing and rewarding eating will become for you.
- If you find that you are not physically hungry when you are reaching for your nighttime snack, try to think about the reasons why you want to eat. Are you bored? Is your favorite food too readily available in the kitchen? Was there a trigger, such as just seeing an appetizing commercial on TV?
- After you assess your reasons for eating, think of something else you might do for fifteen minutes to distract yourself from eating, perhaps you can read a magazine, talk to someone on the phone, or do the dishes.
- Reassess how strong your cravings are after those fifteen minutes have passed.
- If your cravings still seem unbearable, try to refocus your attention onto another task, or have a drink of water or a low-calorie drink. If this still isn’t satisfying, have a small serving of a snack. However, taking only a small portion and resisting the urge to eat more is very difficult for most people.
- You may want to enlist someone else to help you stop at your pre-set quantity if you do choose to have a taste of your snack.
Types of Night Eating Syndrome – The Compelled Evening and Nighttime Overeater
Posted by: | CommentsYou have learned the three classic signs of Night Eating Syndrome are (1) not being hungry in the morning, (2) eating a very large part of your daily calories in the evening, and (3) getting up throughout the night to eat. In our work with Night Eating Syndrome patients, however, we discovered that about 15 percent of NES patients have the first two signs but they don’t get up to eat in the middle of the night. Why are these patients still considered night eaters? The reason we consider this subgroup as having NES is due to their daily, or circadian, pattern of eating. That is, much of what they eat is consumed in the evening and nighttime. Many times patients from this subgroup stay up quite late, and after eating their evening meal they continue eating well into the night before they feel ready to fall asleep. They report feeling a compulsion to eat during the evening and nighttime hours. This compulsion can be so strong that they do not believe they will be able to fall asleep without eating the foods that they are craving. Each night eater has preferred foods. Some crave snack foods while others continue to eat leftovers from their evening meal.
If you are a compelled evening and nighttime eater, a characteristic rationalization you might use before eating in the evening or late night might go something like this: “That ice cream I had an hour ago was really good. I really want some more. I need some more. I know that if I don’t eat it, there is no chance I’ll fall asleep later on when I go to bed. Also, I hardly ate anything earlier today, so it’s okay if I have more ice cream now.” This chain of thought allows you to give yourself permission to go ahead and eat an extra bowl (or two!) of ice cream at a time when you really do not want to be eating.
After you’ve eaten the ice cream, you may have thoughts like these: “1 can’t believe I couldn’t control myself again. I’ve been eating all night. I didn’t really need another bowl. I am a bad person.” Thoughts like these are often called automatic thoughts. They occur without much deliberation over their content, and you probably aren’t even aware that you’re having them. Yet, emotionally, they affect how you feel about yourself and your actions.
When we asked our patients to write down what they were thinking, many responded that they didn’t think much at all about their nighttime eating; they just selected their food and ate it in an automatic fashion. Note that they didn’t eat in an unconscious fashion. Unconscious eating would be categorized as nocturnal sleep-related eating disorder (NS-RED). However, when they were asked to stop and actually monitor their thoughts, they were able to remember many different statements they had been telling themselves, many of which were personally demeaning.
Several very different factors may influence your evening and nighttime overeating. The particular hormoNES may be working within your body to influence your nighttime pattern of eating, but there are also environmental cues that help to maintain this pattern. What do you typically do during the evening? Do you watch TV? Do you spend time with your friends or family? Do you exercise? Do you get engaged in activities outside your home, such as a club or class?
If most of your evenings are spent at home with little to do but watch TV or engage in other solitary activities, your chances of eating at night increase. First, when you watch TV, you are bombarded by commercials for fast-food restaurants, enticing snacks, and many other appealing food advertisements. These ads stimulate your appetite at a time when you, as a night eater, are already cued to eat. Second, if you are bored and not very absorbed mentally in an activity, then you are also more likely to eat. Finally, if you live alone, you may lack social support and group activities that could help you cut down on your nighttime eating. With no one else around, you may feel less inhibited about your food choices and portion sizes. Each of these issues may play into your own struggle with NES, and you are sure to have additional, unique situations that cue your eating.
Exercise: Describe Your Personal Cues to Eat at Night
If you identify with the compelled evening and nighttime overeater type, take out your journal now and try to describe some of your personal cues or vulnerable situations for eating in the evening or at night.
Help Yourself – Serving Up New Thought Patterns
Posted by: | CommentsNow that you know more about the different aspects of Night Eating Syndrome, we turn our attention to helping you to help yourself. We will focus on several different strategies, including behavioral tasks that you can try to carry out, cognitive approaches that aim at changing the negative thoughts that influence your emotions, and relaxation and stress-reduction techniques. First we will help you figure out what are the central thoughts and beliefs that may be influencing your Night Eating Syndrome.
In the diaries our patients keep, they record their thoughts before and after they eat at night so that they and we can gain more insight into their personal experiences with their late-night compulsions to eat. You will examine the thoughts you have before and after you eat, so that you can come to understand how your environment and your inner thoughts interact to maintain your night eating.
We must make one important point here. But even though these physical and genetic aspects may be influencing your behavior, this does not mean that you can’t change your behavior. What it means is that it will take some extra work on your part to resist the established patterns that you have been living with and then to change them.
Four Types of Night Eating
From our patients’ accounts, we have discovered that there are at least four different categories of NES:
1. the compelled evening and nighttime overeater
2. the anxious/agitated night eater
3. the cravings night eater
4. the all-or-nothing belief about sleep night eater