Sleep on It: The Overlooked Link Between Sleep and Eating Disorders

· by · in anorexia nervosa, ARFID, atypical anorexia nervosa, Awareness, BED, body dissatisfaction, body image, bulimia nervosa, Commentary, disordered eating, healthcare, Lab News, medicine, mental health, nutrition, primary care, recovery, risk factors, sleep, Treatment, Uncategorized. ·

by Haley Graver, UNC CEED Summer Research Fellow and PhD student in clinical psychology at Drexel University

How Are Eating Disorders and Sleep Connected?

Have you ever noticed that your eating habits affect how well you sleep? Or that a bad night’s sleep makes you want to eat more? This isn’t just your imagination. Research increasingly shows that eating and sleeping are connected—and for people with eating disorders, that connection may be even more noticeable.

Studies have found that people with a range of eating disorders often experience sleep problems. Night eating syndrome (NES) is one example of how eating and sleep can overlap. People with this disorder frequently wake during the night to eat, eat 25% or more of their calories in the evening or nighttime, and often feel like they cannot fall back to sleep unless they are full. But sleep problems aren’t limited to NES. In fact, people with anorexia nervosa (AN), bulimia nervosa (BN), and binge-eating disorder (BED) may all be more prone to sleep difficulties1. One study found that women who reported very poor sleep were over five times more likely to be diagnosed with BED than those who slept very well.2 That’s a striking difference!

Some of the most common sleep problems seen in people with eating disorders include frequent nighttime awakenings, early morning waking, sleep apnea (brief pauses in breathing during sleep), and low sleep efficiency (the percentage of time actually spent asleep while in bed)1. All of these can lead to not feeling rested upon awakening and being tired during the day. Other findings include reduced deep sleep (called slow-wave sleep) and REM sleep, which is important for dreaming and emotional processing.

Cause or Effect? It Might Be Both!

One key question researchers continue to explore is whether poor sleep contributes to eating disorder symptoms, or whether the eating disorder is what disrupts sleep. The answer might be both.

One theory focuses on how starvation and malnutrition affect sleep. For example, when the body isn’t getting enough food, a brain chemical called orexin can become dysregulated. Orexin helps control both appetite and wakefulness. When someone is hungry, orexin levels may rise, making them feel more alert. In women with AN, higher levels of orexin-A have been linked to poorer sleep quality.3 This theory suggests that disordered eating (malnutrition) may be contributing to poorer sleep.

But not all people with eating disorders are malnourished, so other explanations may also be at play. Another theory suggests that sleep deprivation affects the hormones that regulate hunger and fullness. For example, one study showed that men who only had 4 hours of sleep time had higher ghrelin levels (a hormone that increases hunger) and lower leptin levels (a hormone that signals fullness) than men who had 10 hours of sleep time.4 This hormonal imbalance—higher ghrelin and lower leptin—may increase the risk of binge eating.4,5 In this case, poor sleep may actually contribute to disordered eating, rather than the other way around. 

There also seems to be a behavioral component—some people use eating disorder behaviors to help themselves fall asleep. For instance, some report binging or purging before bed as a way to calm down before sleeping.1 This adds yet another layer to the relationship between sleep and eating disorders: for some, disordered eating may be a response to sleep problems, while for others it may be the cause – or even both. Overall, the relationship between sleep and eating disorders is complex, and researchers are still working to understand exactly how and why they are linked. 

What Can You Do About It?

Currently, there’s no eating disorder-specific treatment for sleep problems. However, the leading treatment for insomnia—Cognitive Behavioral Therapy for Insomnia (CBT-I)6—has shown strong results for improving sleep. Here are a few CBT-I-based tips that may help:

  • Wake up at the same time every day – even on weekends, even if you slept poorly.
  • Skip naps – it’s tempting, but they make it harder to fall asleep later, fueling a vicious cycle.
  • Use your bed only for sleep (and intimacy) – avoid scrolling, studying, or eating in bed.
  • If you can’t fall asleep after 20 minutes – get up and do something calming, like reading in low light, until you feel drowsy.
  • Limit screens in the evening – try to avoid phones, computers, and TVs for 1-2 hours before bed.
  • Cut back on habits that hurt sleep – like smoking, vaping, caffeine, and alcohol.
  • Create a sleep-friendly space – keep your room cool, dark, quiet, and free of visible clocks.

Improving sleep won’t cure an eating disorder, but it may reduce stress, ease some symptoms, and support overall recovery.7 If you or your loved ones struggle with both sleep and eating, it’s worth bringing up with your treatment team. Both deserve care and attention!

References

1.         Allison KC, Spaeth A, Hopkins CM. Sleep and Eating Disorders. Curr Psychiatry Rep. 2016 Aug 23;18(10):92.

2.         Trace SE, Thornton LM, Root TL, Mazzeo SE, Lichtenstein P, Pedersen NL, et al. Effects of reducing the frequency and duration criteria for binge eating on lifetime prevalence of bulimia nervosa and binge eating disorder: Implications for DSM-5. Int J Eat Disord. 2012;45(4):531–6.

3.         Sauchelli S, Jiménez-Murcia S, Sánchez I, Riesco N, Custal N, Fernández-García JC, et al. Orexin and sleep quality in anorexia nervosa: Clinical relevance and influence on treatment outcome. Psychoneuroendocrinol. 2016 Mar 1;65:102–8.

4.         Spiegel K, Tasali E, Penev P, Cauter EV. Brief Communication: Sleep curtailment in healthy young men is associated with decreased leptin levels, elevated ghrelin levels, and increased hunger and appetite. Ann Intern Med. 2004 Dec 7;141(11):846–50.

5.         Aspen V, Weisman H, Vannucci A, Nafiz N, Gredysa D, Kass AE, et al. Psychiatric co-morbidity in women presenting across the continuum of disordered eating. Eat Behav. 2014 Dec 1;15(4):686–93.

6.         Baglioni C, Espie CA, Riemann D. Cognitive-Behavioural Therapy for Insomnia (CBT-I) Across the Life Span: Guidelines and Clinical Protocols for Health Professionals. John Wiley & Sons; 2022. 286 p.

7.         Lombardo C, Battagliese G, Venezia C, Salvemini V. Persistence of poor sleep predicts the severity of the clinical condition after 6   months of standard treatment in patients with eating disorders. Eat Behav. 2015 Aug 1;18:16–9.