Sleep and Quality of Life in Eating Disorders

Anorexia nervosa (AN) and bulimia nervosa (BN) are well-recognized eating disorders clinically. Night eating syndrome (NES) and binge eating disorder (BED) are also of considerable importance and are increasingly recognized in the clinic, because of the distress they cause and their links with obesity. Each of these four eating disorders has the capacity to disturb sleep and in that respect additionally impair quality of life and the ability to function for sufferers supplementary to the characteristic eating disorder symptoms, per se. Sleep disturbance in the form of subjective impairments in sleep quality, initial- and mid-phase insomnia, changes in Rapid Eye Movement (REM) duration and density, and reduced sleep efficiency appear to be most marked in AN and NES. The NES produces the most clinically overt disturbance in sleep with frequent awakenings to ingest food and marked reductions in sleep efficiency being cardinal diagnostic features. It can be distinguished from the parasomnia, sleep-related eating disorder (SRED) by the presence of awareness during and the lack of amnesia for nocturnal eating episodes. Treatment of eating disorders is associated with improvements in quality of life measures. Sleep dysfunction is also ameliorated by successful treatment of the associated eating disorder. Although improvements in functioning and quality of life must no doubt to a large degree ensue from controlling of distressing eating disorder symptoms such as restricting, purging, and bingeing, it is also plausible that improvements in sleep quality and duration also contribute. Further research is needed to assess further links between sleep disturbance in eating disorders and quality of life.