Many sleep eaters realize what they have done, Mahowald said, after they wake up and find cereal boxes in their beds, frosting in their hair or debris strewn around their kitchen.
"It's quite disturbing for patients to think they have performed some complex behavior in their sleep and don't remember it," said Emsellem, former acting chairman of neurology at George Washington University School of Medicine, who has treated about two dozen sleep eaters. "It's also quite embarrassing, which is one reason patients don't even tell their doctors about it."
Neurologist John F. Cochran, who directs the sleep lab at Inova Alexandria Hospital, treats some patients who exhibit symptoms of nocturnal sleep-related eating disorder.
(Susan Biddle - The Washington Post)
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Carla Boynton, a 45-year-old Montessori teacher, struggled with the problem for nearly 25 years.
"One morning I woke up and looked in the mirror and thought my face was bleeding, and then I realized it was smeared with chocolate," recalled Boynton, who recently moved from Montgomery County to Delaware. "For years I thought I was just weak-willed. I had a lot of shame around it. I thought I was the only person who did this and I really, really wanted to stop."
After gaining 30 pounds over a year, Boynton said, she found that she'd started to use her toaster oven and a blender during these episodes. Worried she might start a fire, Boynton confided in a doctor, who referred her to Emsellem six months ago. Since she started taking clonazepam, a potent drug used to control seizures and anxiety, she said that the episodes have virtually stopped.
Another of Emsellem's patients, a 50-year-old former foreign service officer who continues to work for the State Department, reported that she felt intense feelings of shame.
"I cannot tell you the self-loathing I felt when I woke up every morning feeling sick to my stomach with an absolutely horrible taste in my mouth realizing I had done it again," she said the woman. (She refused to be identified for this article, citing concerns about how her colleagues at State might react.)
None of the people she told about her problem -- her psychiatrist, nutritionists, her internist -- was familiar with it, she added.
"Most of the people I see have had this problem for a minimum of 10 years and have been in therapy for years without success in changing this behavior," said psychiatrist John W. Winkelman, medical director of the Sleep Health Center at Brigham and Women's Hospital in Boston.
Patients sometimes resort to desperate selp-help measures, noted Winkelman, an associate professor at Harvard Medical School, who estimates that he has treated 100 sleep eaters. Some barricade themselves in their bedrooms, install alarms in their homes, lock food in the trunks of their cars or pay friends or relatives to guard their refrigerators.
