Eating Disorders and Sleep: Understanding the Connection

Eating disorders can wreak havoc on a seemingly endless list of things, from physical well-being and mental health to relationships, family dynamics, and more. But one area that is often overlooked when it comes to the repercussions of these illnesses is sleep. Research has shown that eating disorders and sleep disorders frequently coexist, and behaviors like food restriction, bingeing, and purging can negatively affect sleep quality. Fortunately, with the right support and specialized treatment, it’s possible to effectively address both sleep concerns and disordered eating. Read on to learn how and why eating disorders and sleep affect one another, and what to do if you or a loved one are struggling.

The link between eating disorders and sleep

The connection between eating disorders and sleep is complex and multifaceted, and in many ways, still being explored. While research has demonstrated worse sleep in people with eating disorders compared to those without, the exact mechanisms behind the sleep problems eating disorders cause remain unknown. That said, experts do know that the relationship seems to go both ways: disordered eating can affect sleep quality and quantity and, in the other direction, sleep plays a critical role in regulating psychological, hormonal, and metabolic balance, and even has an influence on the food choices people make.

According to Equip Therapy Lead Jennifer Simmons, eating disorders affect nearly every physical, mental, and emotional system in the body, and sleep is an area that is often disrupted but rarely discussed. “Whether someone is restricting food, binge eating, or purging, their sleep can be impacted in significant and distressing ways,” Simmons says. “Taking a look at the link between disordered eating and sleep is crucial to understanding both.”

It’s also important to note that there is a specific type of sleep disorder called sleep-related eating disorder (SRED) which causes individuals to prepare and eat food (or even toxic or non-food substances) while sleeping and leaves them with no memory of their actions when they wake up. While experts aren’t sure of the exact causes of SRED, underlying medical or mental conditions, medications, and routine changes may all contribute.

Why disordered eating affects sleep (and vice versa)

There are a number of ways disordered eating can negatively impact sleep—and that poor sleep can, in turn, influence eating behaviors.

Feeling hungry

One of the most straightforward ways eating disorders can affect sleep is the fact that it’s hard to rest when your body and brain are in need of nutrients. While a lack of nutrition can result in fatigue during the day, it can, somewhat ironically, lead to insomnia at night. The mechanism of action here may have to do with a neuropeptide in the brain called orexin, which is involved in both appetite and wakefulness. High levels of orexin have been associated not only with hunger, but also with increased wakefulness, as well as mood and cognition issues.

“When someone restricts food, their body is in a starvation state,” Simmons says. “This can cause restlessness and difficulty settling in at night. Think about what a baby does when they’re hungry: they’re fussy, uncomfortable, and have a hard time relaxing. This is the same thing our bodies go through at every age.” Being hungry can also cause obsessive thoughts about food, making it difficult to turn off your mind and sleep.

Poor temperature regulation

Body temperature can also be a serious impediment to sleep. Many people with eating disorders are at a low weight or undernourished, which can impair temperature regulation and make it difficult to feel physically comfortable and fall asleep. “You might need two blankets on you when you go to bed, and then kick them all off just to be freezing cold again,” Simmons says.

Side effects of disordered behaviors

Disordered behaviors like bingeing or purging can have a profound effect on the body’s ability to fall asleep due to physical side effects like acid reflux, bloating, and digestive discomfort, as well as emotional fallout. “Shame and guilt can often arise after these disordered eating behaviors and lead to emotional turmoil, making it more difficult to relax and fall asleep,” Simmons says. “The gut-brain axis is a growing area of research that suggests what we eat or don’t eat directly impacts mood, cognition, and sleep quality.”

Malnutrition

Simmons also points out that malnutrition itself can be a prime cause of dysregulated sleep because of its potential to cause daytime fatigue and sleep cycle disruptions, including reduced rapid eye movement (REM) sleep. REM sleep is characterized by intense dreams and is associated with mood regulation, mental concentration, and the consolidation and processing of new information—meaning that when you miss out on this phase, it can have a significant effect on your mental health and cognitive function.

Co-occurring conditions

It’s also important to remember that eating disorders often co-occur with other mood-related disorders such as anxiety, depression, and obsessive-compulsive disorder (OCD), which can all impact sleep. “Anxiety can make going to sleep or staying asleep more difficult if dysregulated thoughts are present,” Simmons says. “Depression can make someone sleep too much or not enough, which can throw off their circadian rhythm, and OCD can cause difficulty relaxing if patterns or routines are not followed.”

How poor sleep fuels disordered behaviors

Just as eating disorders impact sleep, sleep quality can also have an effect on eating behaviors. On a biological level, sleep deprivation interferes with a variety of hormones that help to regulate appetite, including leptin (which promotes satiety), ghrelin (which increases hunger), and orexin (which is involved in appetite and wakefulness). “With a lack of sleep, these are all dysregulated, which could cause issues with hunger cues,” Simmons says. “Cortisol, the stress hormone, can also rise, and melatonin, the sleep-wake hormone, can be suppressed, which confuses the body’s natural circadian rhythm.”

She adds that poor sleep can increase cravings, weaken impulse control, and potentially lead to more disordered eating behaviors. “When someone has not gotten enough rest, recovery can feel even more difficult,” she says. “How do you fight the eating disorder if you don’t have any energy to do so?”

How to address sleep issues caused by eating disorders

Many people who navigate recovery find that, as they heal the symptoms of their eating disorder, many of their sleep issues also improve or completely resolve. But working proactively to address both the eating disorder and sleep hygiene (i.e. the practices and habits that support good sleep) is the most effective way to see improvement in both arenas.

“Having sleep issues can be tiring—no pun intended,” Simmons says. “It is important to address sleep and eating disorder recovery holistically. This means paying attention to both basic sleep hygiene and eating disorder-focused skills to help wind down for a restful sleep.”

Here are some of Simmons’ recommendations for addressing sleep issues caused by an eating disorder:

Commit to a regular eating pattern

A predictable daily meal and snack schedule will not only go a long way toward setting the foundation for eating disorder recovery, but also support healthy sleep. “By eating at regular times, our sleep hormones become more regulated, which will help the body rest peacefully when it comes to bedtime,” Simmons says.

Stick to a consistent sleep schedule

Choose both a wake-up time and bedtime that you can stick to every day—including weekends. “When you are deciding what time to go to sleep, be sure to give yourself enough time to wind down doing relaxing activities like taking a hot shower or bath, dimming your lights, reading, journaling, meditation, and gentle stretching, or yoga,” Simmons advises.

Eliminate distractions

Not only can the blue light from digital devices interfere with your ability to sleep, but the mental stimulation of doomscrolling, comparing yourself to others on social media, or watching endless videos can undermine your ability to unwind. “Try to avoid screens, social media, intense conversations, or anything that might stimulate you before bed,” Simmons says.

Be mindful of energy-boosters

If movement is part of your recovery journey, be sure not to engage in physical activity too late in the day, as this can make it more difficult to fall asleep. Simmons also advises limiting or skipping caffeine during the day, or at least avoiding it too close to bedtime. “Caffeine stays in the system for quite some time so if you are drinking caffeine late in the afternoon this could be one of the culprits keeping you awake.”

Create a calming sleep environment

Make sure your bedroom is dimly lit and set at a comfortable temperature before you slip under the covers. “And only get into bed when you are ready to go to sleep,” Simmons says. “If you’re tossing and turning in bed and unable to sleep, the best thing you can do is to get up and go into another space for a short time. Think of this as a sleep reset. This time is a chance to try to relax, which means you can read, listen to some calm music—and then, after a few minutes, try going back to bed.”

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The Equip takeaway on eating disorders and sleep

Interrupted or poor sleep isn’t just an inconvenience; it can seriously affect your overall health and hinder eating disorder recovery. “If you are struggling with sleep during eating disorder treatment, tell your treatment team and let them help you with some skills and tips,” Simmons says. “Getting enough rest is one of the best things you can do for your eating disorder recovery.”

And if you are consistently tossing and turning or finding sleep to be stressful, know that there are solutions to help you feel rested, restored, and better prepared to prioritize recovery. “Don’t lose hope if sleep is rough right now!” Simmons says. “Many people notice that as you make progress in your eating disorder recovery, you may also notice your sleep improves gradually and naturally. Your body is designed to function well when it receives what it needs to function, with regular food intake being a great start. Celebrate the small wins as you start to implement changes. Maybe you enjoyed journaling before bed and noticed your thoughts weren’t as loud? Perhaps you did a meditation and felt relaxed and at peace when laying down? Keep working on adding those small changes—they do add up!”