Eating behaviours and attitudes in narcolepsy and their association with sleepiness and mood

A number of studies have found maladaptive eating behaviours and attitudes in individuals with narcolepsy, however, few studies have comprehensively investigated possible reasons (other than hypocretin deficiency) for these findings. The aim was to investigate the eating behaviours and attitudes of individuals with narcolepsy. The sample consisted of 73 individuals with narcolepsy and 74 controls. Measures used were the Bulimia Test, Depression Anxiety Stress Scale and Epworth Sleepiness Scale, a one day Food and Drink Intake Diary, a newly developed Meal and Snack Timing Questionnaire and an adapted Meal Choice Questionnaire and Snack and Drink Choice Questionnaire. Results showed that individuals with narcolepsy consumed significantly more snacks and drinks than controls. Controls were more concerned about the impact of snack and drink choice on their weight. Individuals with narcolepsy were more likely to binge eat than controls. Individuals with narcolepsy rated the importance of timing food intake with convenience of sleepiness more highly than controls. Individuals with narcolepsy had significantly higher levels of depression, anxiety and stress than controls. Individuals with narcolepsy with moderate to severe levels of anxiety and stress scored significantly higher on the binge factor than those with normal to mild levels of anxiety and stress. A hypothesis is developed suggesting that two opposing frameworks may be operating in narcolepsy, one of a purposeful eating behaviour and another of uncontrolled eating behaviour. The pattern of timing meals and snacks according to the convenience of sleepiness implies that individuals with narcolepsy are engaging in a purposeful behaviour to control their symptom of daytime sleepiness. Binge eating may be an uncontrolled compensatory factor as a consequence of this purposeful timing of food and sleepiness. Further, this study suggests that this extent to which binge eating is engaged by individuals with narcolepsy may be driven by anxiety and stress.