Tag: insomnia

Why Do I Eat at Night? Night Eating Syndrome Explained

On By Dr. Scott RennieIn Weight Loss & Metabolic HealthLeave a comment

Night Eating Syndrome (NES) is one of those conditions that many patients, and even some clinicians, overlook. NES is a recognizable eating disorder where the timing of food intake shifts into the evening and nighttime hours, distinct from occasional snacking after dinner. Patients often feel embarrassed and dismiss it as a bad habit. It has real consequences for weight, sleep, and overall health.

The diagnosis of NES is based on established criteria. To meet the definition, at least 25 percent of daily food intake occurs after the evening meal or there are at least two episodes of nocturnal eating per week. These episodes are not explained by social or cultural norms. People with NES are aware of what they are eating at night, unlike sleep-related eating disorders where the behavior may happen without recall. The condition also needs to cause significant distress or impairment in functioning (Allison & Tarves, 2011).

In practice, this can look two different ways. Some patients skip breakfast, eat a small lunch, and end up consuming half their calories after dinner. Others wake almost every night around 1 or 2 a.m., head to the kitchen, and eat before they can fall back asleep. Over time, the pattern disrupts sleep and drives weight gain.

NES also overlaps with mood and sleep disorders. Patients often report insomnia, depression, or evening stress. Eating becomes a way to cope with anxiety or to induce sleep. That’s why treatment has to be more than calorie restriction. Cognitive behavioral therapy focused on both eating and sleep habits has shown promise, and selective serotonin reuptake inhibitors (SSRIs) have been helpful in some patients (Allison & Tarves, 2011). I prefer CBT-I, but in practice medications often end up being what gets prescribed. I don’t treat night eating syndrome myself. I screen for it before prescribing weight loss medications, then refer out.

The tie between NES and obesity is important. McCuen-Wurst and colleagues (2018) have shown that NES is associated with higher rates of metabolic problems such as type 2 diabetes and hypertension. Timing matters. Eating late into the night throws off circadian rhythms and glucose metabolism, so the impact is greater than just extra calories.

On a video visit, NES surfaces only if you ask about it directly. Within the past six months, one patient told me, “I can’t sleep unless I eat something at midnight.” That single line was the diagnosis: Night Eating Syndrome. We had her follow up with behavioral health.

Treatment is best when it’s individualized. Weight loss alone won’t fix NES if the underlying behaviors and triggers aren’t addressed. Collaboration between primary care, psychiatry, nutrition, and sleep medicine can make a real difference. For colleagues, the key is asking when patients eat as closely as how much. For patients, understanding that this is a recognized condition with treatment options can take away some of the shame and open the door to better care.

Scott Rennie, D.O.
Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.

References:

Allison KC, Tarves EP. Treatment of night eating syndrome. Psychiatr Clin North Am. 2011;34(4):785-796. doi:10.1016/j.psc.2011.08.002

McCuen-Wurst C, Ruggieri M, Allison KC. Disordered eating and obesity: associations between binge-eating disorder, night-eating syndrome, and weight-related comorbidities. Ann N Y Acad Sci. 2018 Jan;1411(1):96-105. doi: 10.1111/nyas.13467. Epub 2017 Oct 16. PMID: 29044551; PMCID: PMC5788730

How to Sleep Better: Practical Steps for Patients

On By Dr. Scott RennieIn Other Diseases and ConditionsLeave a comment

Sleep gets a fraction of the attention we give diet and exercise, and it should not. Research from Dr. Ari Shechter at Columbia University has shown that poor sleep feeds obesity, diabetes, hypertension, and heart disease. It costs people their daily functioning, and underneath that it is quietly setting long-term disease risk. It is not a secondary problem.

When I ask patients about sleep, I keep it practical. When did this start, and is it new or has it always been like this? What is the bedroom like, too warm or too bright or too loud? Do they snore, gasp, or stop breathing, which points toward apnea? Any crawling or tingling in the legs, which points toward restless legs? I ask about weekdays versus weekends, because an irregular schedule can look exactly like insomnia. And I ask about caffeine, alcohol, nicotine, and medications, which patients rarely volunteer.

Formal tools give the conversation structure. The Epworth Sleepiness Scale is quick for daytime sleepiness. The Pittsburgh Sleep Quality Index is broader. STOP-Bang and the Berlin questionnaire flag possible apnea. The Insomnia Severity Index tracks both severity and how much it is costing someone functionally.

For objective data, in-lab polysomnography remains the standard for apnea, limb movement disorders, narcolepsy, and REM sleep behavior disorder. Wrist actigraphy at home gives a more practical picture of sleep and wake patterns over time, which is often what I actually need.

Adults should target 7 to 9 hours, and children and teenagers need more. Hours alone do not settle it. Timing, efficiency, and how someone feels the next day all matter. Patients tell me constantly that they are in bed for eight hours and wake up unrested. That is the point where efficiency and awakenings become the more useful thing to look at.

The consequences of chronic short sleep are well documented. It shifts ghrelin and leptin in the direction of more hunger and weight gain (Spiegel et al., 2004). It degrades glucose control and raises diabetes risk (Tasali et al., 2022). Hypertension, coronary disease, and stroke all track with insufficient sleep, and long-standing sleep problems are associated with cognitive decline and dementia risk (Vorster et al., 2024).

Causes are usually layered. Behavior contributes: irregular schedules, screens late, heavy meals and alcohol close to bed. So do physiologic and psychological factors: apnea, restless legs, anxiety, chronic pain.

Practical work starts with sleep hygiene. A consistent schedule resets circadian rhythm. Bedrooms should be cool, dark, and quiet. Bright light late interferes with sleep onset. Evening caffeine and alcohol come down. A wind-down routine, reading or stretching or a warm shower, makes the transition easier.

Daytime habits matter more than patients expect. Morning light anchors circadian rhythm. Even ten minutes of aerobic activity improves sleep depth. And for anyone waking in the night, what they do next shapes the rest of it: awake more than twenty minutes, get up and do something quiet in dim light rather than lie there getting frustrated.

The behavioral approach I use most is stimulus control. The principle is simple, which is rebuilding the association between the bed and sleep. Go to bed only when sleepy. Use the bed for sleep. Leave it if sleep is not coming. I have watched patients with years of insomnia retrain themselves this way. One had been scrolling his phone in bed for hours every night; once he started leaving the room when sleep would not come and only returning when he felt drowsy, his sleep onset shortened within a few weeks and the nightly frustration went with it.

Sleep is a medical necessity, and it belongs in routine care alongside everything else we screen for. Taking it seriously improves rest, and it also improves cardiometabolic health, mental health, and how people feel about their days.

Scott Rennie, D.O.

References

Shechter A. Improving Sleep in Your Patients. Columbia Cornell Obesity Medicine Course, 2024.

Spiegel K et al. Ann Intern Med. 2004.

Tasali E et al. JAMA Intern Med. 2022.

Markwald RR et al. PNAS. 2013.

Vorster A et al. Clin Transl Neurosci. 2024.

Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.

Managing Insomnia and Sleep Problems: A Physician’s Perspective

On By Dr. Scott RennieIn Other Diseases and ConditionsLeave a comment

Insomnia is one of the most common problems I deal with. A few bad nights bleed into everything: work, mood, patience, appetite. Patients usually open the visit asking about pills or supplements, and I understand why. Sleep feels like something that should have a switch. Most of the time the answer is duller than a prescription and works better, which is a hard sell at nine at night when someone has been staring at the ceiling for a week.

How Much Sleep Do We Need

Seven to nine hours suits most adults. Under six on a regular basis carries real risk, and routinely running past nine is its own signal that something else is going on. The exact number moves from person to person, and I put more weight on how someone functions at four in the afternoon than on the number they report.

What Sleep Actually Does

Sleep is repair time. It consolidates memory, sharpens focus, and steadies the emotional baseline, which is why a rested person absorbs a bad day and a chronically tired one doesn’t. It supports immune function, cardiovascular health, and metabolic balance. The long-run associations with longevity and lower rates of chronic disease are consistent enough that I treat sleep as a vital sign rather than a lifestyle detail.

The Cost of Short Nights

Chronic sleep loss shows up in obvious ways and quiet ones. Fatigue, irritability, work that slips. Those are the complaints people bring. What they usually do not connect to sleep are the things that accumulate over years: hypertension, diabetes, heart disease, obesity. Immunity weakens, which is why the poor sleepers in a household tend to be the ones who catch everything going around. Anxiety and depression travel with chronic insomnia in both directions, each making the other worse. Cognitive decline is the long-horizon concern, and it is the one patients ask about most once they hear it.

Medications for Insomnia

Short-term use can help. None of these drugs are free of risk, and I’d rather say so plainly than bury it at the end of a list.

Zolpidem (Ambien) helps with both falling asleep and staying asleep, though daytime drowsiness and the odd nighttime behaviors are well documented. Zaleplon (Sonata) is shorter acting and suits the patient whose whole problem is sleep onset. Eszopiclone (Lunesta) covers onset and maintenance, and the metallic taste is a common enough complaint that I mention it before someone calls about it. Temazepam (Restoril) is a benzodiazepine, still prescribed, and carries the most dependence risk of the group.

Shortest effective course, every time. These work best as a bridge while the behavioral changes take hold, not as the plan itself.

Supplements

Melatonin is the one everybody has already tried. It earns its place in circadian problems, delayed sleep phase and jet lag especially, and sometimes in mild insomnia. One to five milligrams is the usual range, and timing matters more than dose, which is the part most people get wrong. Magnesium is worth considering in patients who are actually deficient. Leafy greens and nuts are good sources. Supplements are gentler than prescription hypnotics, and they won’t touch the underlying driver of chronic insomnia.

Sleep Hygiene

In my opinion, the most effective and lasting treatment is better sleep hygiene. Patients who hold a consistent schedule, same bedtime and same wake time seven days a week, often notice a difference within a few weeks. Cool, dark, quiet. Screens and blue light in the last hour before bed work against the transition.

Routine matters more than people expect. Reading, stretching, meditation, anything repeated nightly trains the body to wind down on cue. Caffeine, nicotine, and alcohol all interfere and are best kept well away from evening. Daylight exercise helps; a hard workout an hour before bed usually doesn’t.

One small change that pays out more than it should: turn the clock away from the bed. Patients who wake at three and check the time start doing arithmetic about how much sleep is left, and the arithmetic keeps them up longer than the original waking would have.

Keeping a Sleep Diary

When insomnia persists, a diary earns its keep. Bedtimes, wake times, awakenings, caffeine, stress, exercise. Two weeks of honest entries usually surfaces a pattern nobody had noticed, and reviewing it together tends to point at a small, specific change rather than a large vague one.

When to Seek Help

If the problem holds after the schedule and the environment have genuinely been addressed, it needs a proper evaluation. Sleep apnea, restless leg syndrome, anxiety, and depression all hide behind a complaint of insomnia. Treating the thing underneath is what fixes the sleep.

Scott Rennie, D.O.

Sources

National Institutes of Health Office of Dietary Supplements. Magnesium Fact Sheet for Health Professionals. https://ods.od.nih.gov/factsheets/Magnesium

National Sleep Foundation. How Much Sleep Do We Really Need? https://www.thensf.org

Centers for Disease Control and Prevention. Sleep and Sleep Disorders. https://www.cdc.gov/sleep

American Academy of Sleep Medicine. Clinical Practice Guideline for the Pharmacologic Treatment of Chronic Insomnia in Adults. J Clin Sleep Med. 2017;13(2):307-349.

Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.

Bedside table with lit lamp, vintage alarm clock, book, glasses, and coffee cup next to bed

Sleep Tips to Help You Adjust After the Time Change

On By Dr. Scott RennieIn Other Diseases and ConditionsLeave a comment
shutterstock_165363764It’s that time of the year again for most of us in the United States to change our clocks back one hour to standard time (except Alaska and Arizona).  For most of us means gaining an extra hour of sleep on Sunday morning. The problem is that even this one hour time change can affect our “internal clock.”  The good news is however, that this time shift in the autumn is better tolerated for most, than the change in the spring.  If you find that you have trouble with your sleep however,  here are some hints. 1.  Don’t try to force yourself to go to sleep as this can cause frustration.  If you go to bed and find that you cannot fall asleep within a reasonable amount of time – say 15-30 minutes, get up out of bed and do something else until you start to fall sleepy.  Then go back to the bedroom and try sleeping again. 2.  Don’t read or use your computer in the bed.  If you do these other non-sleep related activities in bed, your brain actually begins to associate the bed with activities other than sleep. 3.  Decrease the amount of light you are exposed to an hour or so before bedtime.  Melatonin, a hormone released in the brain is affected by light exposure.  As the amount of light entering your eyes decreases, the level of melatonin in the brain increases and stimulates sleepiness. 4.  Don’t sleep in or take naps.  Get up at your normal time, even if you don’t have any obligations that you need to attend to.  Establishing a sleep pattern in important, and if you sleep in or take a nap, you may find it harder to sleep later on. 5.  Adjust the temperature of the room.  Usually decreasing the temperature  slightly at the night is helpful, because the natural circadian rhythm during sleep decreases our temperature slightly. 6.  Participate in some relaxing activity before bed rather than exercising, reading an adrenaline raising story, or watching a horror film.  It may seem obvious, but even watching the nightly news before going to bed can make getting to sleep more challenging. 7.  Decrease the noise in your environment.  Wear ear plugs if you cannot change to a location that is quiet. 8.  Don’t go to bed on an empty stomach, or when your stomach is over-full.  Too much fluid intake may also cause unwanted trips to the toilet.  Pay special attention to caffeine, nicotine and alcohol intake which can all negatively impact sleep.  Alcohol may make you feel sleepy at first, but as it wears off it may disrupt sleep later in the night.   I hope that you have found this information useful.  Wishing you the best of health,

Scott Rennie, D.O.
Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.