Treatment of Sleep-Related Eating Disorder

Abstract

Sleep-related eating disorder (SRED) is classified as an NREM-related parasomnia characterized by recurrent episodes of dysfunctional eating that occur after an arousal from the main sleep period with partial or complete amnesia for the event, resulting in weight gain from eating high calorie foods and causing various injuries due to consumption of inedible or toxic items. SRED can be idiopathic or commonly associated with other primary sleep disorders such as sleepwalking, restless legs syndrome (RLS), obstructive sleep apnea syndrome (OSAS), other clinical conditions, or use of sedative-hypnotic medications. First-line treatment of idiopathic SRED includes selective serotonin reuptake inhibitors (SSRIs) at mean dosages of 20 to 30 mg/day. Topiramate at 100-300 mg/day and clonazepam at 0.5-2.0 mg/day can be valid alternative options. SRED related to other parasomnias or sleep disturbances that cause sleep fragmentation benefit most from treatment of the associated sleep disorder. In particular, RLS-related SRED is best treated with dopamine agonists such as pramipexole, while sleepwalking-related SRED benefits from low-dose benzodiazepines such as clonazepam. Different kinds of drug associations have been proposed in a limited number of cases, especially in the past. We strongly recommend that all patients suffering from SRED should undergo consistent and regular follow-up about 2-3 times per year or otherwise according to the physician's judgment, in order to assess the evolution of symptom severity and frequency and re-evaluate treatment efficacy and any side effects that may arise.

Sleep-Related Eating Disorder (SRED): Paradoxical Effect of Clonazepam

“…Sleep-related eating disorder (SRED) is characterized by the partial arousals from sleep to ingest food, and occurs usually within the first 3 hours of falling asleep. 3 This disorder is a form of non-rapid eye movement (NREM) parasomnia 4 similar to sleep terror. The patient does not have full memory of the events in the morning after waking.…”

Two Cases of Sleep-Related Eating Disorder Responding Promptly to Low-Dose Sertraline Therapy

“…However, this therapeutic approach is cumbersome, especially in light of the subsequent recognition of topiramate monotherapy efficacy in idiopathic SRED or SRED associated with SW, with the total number of reported cases currently being 45. 20,21,25 Similarly, SSRI monotherapy of SRED, as reported in 10 cases (n = 6, fluoxetine; n = 3, paroxetine; n = 1, fluvoxamine) 4,12-14 represents another noncumbersome treatment approach. Nearly 40 cases have been reported of dopaminergic therapy of SRED, involving levodopa, pramipexole, and bromocriptine, either as monotherapy or combined therapy with other agents.…”

“…Nearly 40 cases have been reported of dopaminergic therapy of SRED, involving levodopa, pramipexole, and bromocriptine, either as monotherapy or combined therapy with other agents. 4,19,25 Therefore, given what was just cited and discussed, a therapeutic approach for managing idiopathic SRED/SW-SRED cases, would first involve topiramate or SSRI monotherapy, or dopaminergic therapy, either alone or in combination with codeine and/or clonazepam. In cases where RLS is present, treatment with dopaminergic agents (at times with combined therapy) is the preferred treatment.…”

Sleep-Related Eating Disorder and Nocturnal Eating Syndrome

“…In contrast, patients with concomitant sleep disorders such as OSA, and secondary SERD caused by drugs, can be improved with continuous positive airway pressure treatment. If medication use like sleeping pills or antipsychotics is associated, stopping these triggering agents usually improves SRED [24].…”