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Treatment of Night Eating Syndrome

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Night eating syndrome (NES) is a highly disruptive eating disorder affecting as many as 1 in every 100 people. (1) Because night eating syndrome is so complex and often occurs with other mental and physical health conditions, there are different treatment approaches and levels available.

Treatment of Night Eating Syndrome

Levels of Care for Night Eating Syndrome

People who struggle with night eating syndrome tend to also struggle with insomnia and can consume up to 25% or more of their daily food intake during the night. (2) 

People with NES often have other eating disorders, like bulimia and binge eating, and mood disorders, such as anxiety and depression, as well. (1) 

Like other eating and mental health disorders, night eating syndrome can have life-threatening complications and requires treatment. The treatment approach depends on the severity and complexity of the case, available options, and other factors.

Inpatient

The most intensive level of care for night eating syndrome, like other eating disorders, is inpatient treatment.

Typically, this type of treatment is reserved for people in immediate need of help. They may be medically unstable or suicidal and require medical care and around the clock supervision. 

Patients are typically hospitalized, where they can be monitored and offered medical help 24/7. Treatments can include:

  • Intravenous fluids
  • Tube feeding
  • Monitoring of vital signs

Patients can stay in inpatient care for a few days up to two weeks, leaving once they have been physically stabilized and cleared by physicians. 

Residential

A “step down” from inpatient care is residential treatment. Many people struggling with NES and other types of eating disorders start with residential treatment.

Residential care still involves 24/7 supervision, but in a specialized residential treatment facility for eating disorders. Patients live at the facility and are monitored day and night, though the atmosphere is more “homey” than hospital-like. 

That’s, in part, because residential treatment stays can be lengthy, with patients staying anywhere from several weeks to a year. This type of treatment is also typically recommended for patients who: (3)

  • Have unstable or dangerous family or home situations
  • Live alone without adequate support for recovery
  • Live too far from the treatment center to make the required regular visits

During their stay, patients may participate in a number of different treatments as part of their individualized care program, including: (3)

  • Supervised meals and snacks
  • Group therapy sessions focused on:
  • Coping skill development
  • Interpersonal relationships
  • Nutrition and sleep education
  • Individual therapy

For patients with night eating syndrome, emphasis may also be placed on developing healthier sleeping patterns through regular exercise or muscle relaxation techniques. And attention will also be devoted to any concurrent eating disorders, such as bulimia or binge eating disorder.

Partial Hospitalization Program (PHP)

Once a patient has made sufficient progress in a residential treatment facility, they can move on to a partial hospitalization program (PHP).

For people struggling with night eating syndrome, this transitional level of care is a particularly big step. It requires patients to be at a facility all day but allows them to go home at night, which is the most problematic time of day for people with NES.

As such, NES patients may be given additional therapeutic techniques or tools to help them through this phase. (2) Otherwise, patients in a PHP program can anticipate receiving help through: (3)

  • At least two supervised meals a day
  • Ongoing group therapy, with a focus on:
  • Coping skill development
  • Psychoeducation
  • Nutrition counseling
  • Sleep counseling
  • Individual therapy
  • Medication management

Most partial hospitalization programs call for patients to come into the facility five or six days per week, for between four to six weeks. (3)

Intensive Outpatient (IOP)

After completing a partial hospitalization program, patients enter an intensive outpatient program (IOP). At this level of care, the patient is able to manage their housing, transportation, and work or school responsibilities, as well as life stressors without significant fear of relapse.

During IOP, people with NES will continue to receive help through: (3)

  • Individual and group therapy sessions
  • Medication management
  • Sleep and nutrition education
  • Typically one supervised meal per day

Intensive outpatient programs are less demanding, with patients typically coming into a treatment center three to five hours per day, for around four to six weeks. This schedule allows them to not only incorporate new coping techniques into their home life but also start taking proactive steps toward further progress, such as by going to school or work.

Outpatient

The final level of care for people struggling with night eating syndrome is outpatient care.

At this point, patients have typically demonstrated sufficient control over all eating disorder symptoms, without letting the rigors of a busier schedule trigger a relapse.

Still, patients at this level of care may still feel they want some help. With outpatient care, that usually happens through recurring sessions with a therapist and regular meetings with physicians to discuss medication levels.

Overall, people who have reached the outpatient stage have shown great progress toward recovery, and are committed to continued healing.

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Signs and Symptoms of Night Eating Syndrome
Night eating syndrome (NES) is a condition where a person primarily eats at night. The eating disorder is...

Psychotherapy for Night Eating Syndrome

Nearly every level of care for people with night eating syndrome will include some type of psychotherapy. There are many different types of psychotherapy a person may undergo when seeking treatment for night eating syndrome.

Acceptance and Commitment Therapy (ACT)

At its core, acceptance and commitment therapy (ACT) teaches patients not to fight, change, or actively ignore their thoughts, but rather to simply accept them for what they are, then let them go. The technique is thought to help promote relaxation, mental peace, and clarity, and ease symptoms of anxiety and depression, which impact many people struggling with NES. (4,2)

ACT builds its therapeutic framework around six major principles, including: (5)

  • Acceptance: permitting inner-thoughts to just be, rather than attempting to fight, change or ignore them
  • Cognitive defusion: the concept that one’s inner-thoughts are separate from one’s self
  • Self as context: the concept that one’s thoughts are separate from one’s actions
  • Being present: mindfulness of external situations
  • Values: aspects of one’s life worth keeping, building on, or growing through preemptive action
  • Commitment: the dedication to maintaining changed and positive behaviors

Cognitive Behavioral Therapy (CBT)

As one of the most widely studied treatments for eating disorders, cognitive behavioral therapy (CBT) has become the leading evidence-based treatment for bulimia and is used to help combat many other types of eating disorders, including night eating syndrome. (6)

CBT works in almost the opposite way of ACT, focusing on helping people change disruptive thought and behavioral patterns that help lead to or sustain negative behaviors, such as night eating syndrome.

Typically following a pre-set schedule, cognitive behavioral therapy sessions focus on three main goals to accomplish this outcome:

  • Identifying troublesome thoughts/behaviors
  • Challenging these thoughts and behaviors
  • Replacing these thoughts and behaviors with healthier coping mechanisms

Most cognitive behavioral therapy programs also teach techniques that help a patient self-monitor after therapy is over and offer ideas for how to get back on track, should any relapses occur.

Though CBT programs are usually shorter in length, this type of therapy can be more intensive, with a number of “take home” assignments to reinforce these new lessons, including:

  • Journaling
  • Role-playing
  • Relaxation techniques
  • Strategic distractions

Cognitive Remediation Therapy (CRT)

Often used as a secondary type of therapy, cognitive remediation therapy (CRT) helps build stronger thinking skills, strategizing capabilities and other cognitive functions. Because of this, it’s frequently a companion to CBT, ACT, and other types of therapy to help patients reinforce the new skills and thought patterns they’re learning.

CRT can also help create more cognitive flexibility. Often cited as a contributing factor to eating disorders like anorexia nervosa and bulimia, a lack of cognitive flexibility can lead to rigid thinking patterns that help maintain the disorder. (7)

Cognitive remediation therapy forces the brain to consider more possibilities, using types of games, puzzles, or problem solving techniques to drive the lessons home.

Dialectical Behavior Therapy (DBT)

Dialectical behavior therapy (DBT) is an effective psychotherapy option for people who need help regulating their emotions or curbing self-destructive behavior. Generally, the goals of this practice include learning how to:

  • Live in the moment
  • Develop healthy stress management strategies
  • Improve relationships with others
  • Better regulate emotions

To reach these goals, DBT teaches patients:

  • Mindfulness method.
  • How to become more assertive in interpersonal relationships
  • Ways to recognize and cope with negative emotions
  • Techniques for handling a crisis

The goal is for these new skills to help a patient ease stress, build confidence, and move through the world with greater awareness and control. 

Exposure Therapy

Traditionally used to help people conquer their fears, exposure therapy works to bring patients face to face with situations or objects that have triggered unhelpful thought or behavioral patterns for them in the past.

Exposure doesn’t have to take place in real life. This therapy can also involve exposure through:

  • Visualization
  • Virtual reality or other technologies
  • Physical sensations

When used effectively, the concept can help a patient build a tolerance toward situations that used to deeply and negatively impact them. Other advantages of exposure therapy include: (8)

  • Unlearning negative associations with a feared object
  • Building confidence and self-esteem
  • Help with anxiety management

When it comes to recovering from night eating syndrome, exposure to certain situations connected to disordered eating or sleeping patterns may be beneficial.

Group Therapy

As its name implies, group therapy is a form of talk-therapy that takes place among a group of people, facilitated by one or more therapists.

This type of treatment can have a number of valuable outcomes, including:

  • Building a viable support group and sense of belonging
  • Adding perspective to a patient’s point of view
  • Encouraging patients to stay committed to their recovery
  • Offering advice and sharing coping strategies

Many times, group therapy patients may have shared backgrounds, or be struggling with similar disorders, but sometimes the group is more diverse. Groups can also be open to anyone, or closed to specific members who go through the program at the same time.

For people struggling with NES, support groups focused on sleeping or eating disorders may be helpful places to seek further treatment.

Family Therapy

Family-based therapy is a form of group therapy, this method involves members of the patient’s family concurrently attending therapy sessions. Members can all attend the same sessions at the same time or see a therapist separately.

The specific aim of this type of therapy is examining a person’s disorder or unhelpful thought or behavioral patterns through the lens of family roles or dynamics. Family therapy can also help with: (9)

  • Improving communication and interpersonal relationships
  • Identifying family strengths and weaknesses
  • Learning group strategies for overcoming unhelpful behavior

Family therapy is also especially useful for a person who lives with their family. And this can be doubly helpful for someone struggling with night eating syndrome, as a majority of the disordered behavior takes place at night, in the home.

Interpersonal Therapy (IPT)

Interpersonal therapy also operates on the framework of relationship dynamics but expands that view beyond the family unit.

This type of psychotherapy examines a person’s broader role in society, with a specific focus on how the conditions or expectations of that role change during times of transition. Situations that may be especially suited for interpersonal therapy include:

  • Divorce
  • Death of a loved one
  • Retirement
  • Becoming a parent

Of course, the technique is useful beyond this scope. At its core, interpersonal therapy strives to change someone’s relationship patterns, rather than targeting the disordered symptoms that may be caused by them. Helping someone change their relationships, or their feelings about their role in the world, the thought follows, will help encourage acceptance and, eventually, recovery.

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Nutrition Counseling and Meal Support

Nutrition counseling and meal support can be a particularly important aspect of treatment for night eating syndrome, since the condition is centered around a specific disordered eating pattern. 

Most people struggling with NES will not eat in the mornings, but will wake up once or several times during the night to eat. There’s also a correlation between people struggling with night eating syndrome and people who diet, because they don’t get enough food to nourish their bodies during the day. (2)

In these cases, nutrition counseling and meal support can help through the power of education and support.

For patients continually experimenting with diets, nutrition counseling can educate them about the damage diets do to the body and mind, why diets don’t work in the long term, and why they often lead to weight gain, as well as offer new strategies to improve their relationships with food and their bodies. 

Meal support can also help correct eating patterns, encouraging patients to eat more in the morning and throughout the day before they go to sleep. (10)

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Experiential Treatments for Night Eating Syndrome

Experiential therapies allow a person to express themselves through means other than talking and using words. Most of these methods are hands-on, which empowers the person to embody their feelings rather than analyze them.

The idea is to get people out of their minds and into their bodies, channeling—and, eventually, releasing—negative or pent-up energy through the act of creation. This can be accomplished through any number of mediums or activities, including:

  • Fine arts, such as drawing, painting, and sculpting
  • Dance
  • Music – playing, writing, or listening
  • Acting (also known as psychodrama)
  • Yoga
  • Walking or hiking

These types of therapies have been found to have many benefits, including:

  • Tapping into the left brain, which is more in tune with emotions and the senses 
  • Easing the burden of finding the right words
  • Accessing deep feelings patients may not have been previously aware of
  • Giving patients additional avenues of self-expression

For people struggling with night eating syndrome, experiential treatments—especially the more physically active ones—may have the added benefit of helping maintain a more regular sleep cycle. (11) As consistent energy outputs, these therapeutic techniques can offer valuable outlets and a stabilizing routine for people who may otherwise stay up all night or have difficulty falling asleep.

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Art Therapy

Treating Night Eating Syndrome at Within Health

Night eating syndrome may seem difficult to overcome, but help is available, and recovery is possible. The approaches above have all been found useful for treating eating disorders, including night eating syndrome.

The professionals at Within Health have specialized expertise in eating disorders and tailor personalized treatment programs for each individual’s needs. Our team offers virtual care programs for eating disorders, where we can help you from your home. If you suspect you or someone you love may need help with night eating syndrome, contact Within Health to learn more about effective treatment options.

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Frequently asked questions

Resources

  1. Night Eating Syndrome. (2021, September 16). Cleveland Clinic. Retrieved from https://my.clevelandclinic.org/health/diseases/21731-night-eating-syndrome-nes 
  2. Treatment of Night Eating Syndrome. (2011, September). Psychiatric Clinics of North America. Retrieved from https://my.clevelandclinic.org/health/diseases/21731-night-eating-syndrome-nes Levels of care in eating disorder treatment. (n.d.) National Eating Disorders Association. Retrieved from https://www.nationaleatingdisorders.org/sites/default/files/NEDA%20Webinar%20Levels%20of%20Treatment.pdf
  3. Twohig, M.P., Levin, M.E. (2017, December). Acceptance and Commitment Therapy as a Treatment for Anxiety and Depression: A Review. . Psychiatric Clinics of North America. Volume 40, Issue 4, 751-770. https://doi.org/10.1016/j.psc.2017.08.009
  4. Glashofer, D.R. (2021, September 26). What Is Acceptance and Commitment Therapy (ACT)? (2021, September). VeryWell Mind. Retrieved from https://www.verywellmind.com/acceptance-commitment-therapy-gad-1393175 
  5. Murphy, R., Straebler, S., Cooper, Z., & Fairburn, C. G. (2010). Cognitive behavioral therapy for eating disorders. The Psychiatric Clinics of North America, 33(3), 611–627. https://doi.org/10.1016/j.psc.2010.04.004 
  6. Cognitive remediation therapy for adolescents with ... (n.d.). Retrieved April 4, 2022, from https://www.researchgate.net/profile/Camilla-Lindvall-Dahlgren/publication/316190592_Cognitive_Remediation_Therapy_for_Adolescents_with_Anorexia_Nervosa-Treatment_Satisfaction_and_the_Perception_of_Change/links/58f5ead9a6fdcc11e56a05a2/Cognitive-Remediation-Therapy-for-Adolescents-with-Anorexia-Nervosa-Treatment-Satisfaction-and-the-Perception-of-Change.pdf 
  7. Exposure Therapy. (2021, June). Healthline. Retrieved from https://www.healthline.com/health/exposure-therapy#definition 
  8. Family Therapy. (2022). Mayo Clinic. Retrieved from https://www.mayoclinic.org/tests-procedures/family-therapy/about/pac-20385237 
  9. Leman, C. (2010, June). Night Eating Syndrome. (2010, January). Today’s Dietician. Vol. 12, No. 1, P. 8. Retrieved from https://www.todaysdietitian.com/newarchives/011110p8.shtml
  10. Exercise for Better Sleep. (2022). John’s Hopkins University. Retrieved from https://www.hopkinsmedicine.org/health/wellness-and-prevention/exercising-for-better-sleep 

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