Eating Disorders and Sleep: Workarounds People Find

When an eating disorder is impairing sleep, partial solutions are easily found.

Reviewed by Jessica Schrader

Key points

• Everyday habits offer partial and temporary workarounds for the sleep problems common in eating disorders.
• These can exacerbate the sleep problems and create dependencies.
• The workarounds can also reduce motivation for deeper change.

As we explored in the first part of this post, many aspects of what it means to have an eating disorder—psychological, physical, and behavioural—interfere with good sleep. Bad sleep in turn often makes life with an eating disorder even worse, and/or makes recovery feel even more out of reach.

Evolution has made humans comfort-seeking, inventive, and also effort-averse. So if there’s a three-way choice between settling for doing nothing, undertaking a high-cost, high-gain solution, and finding a quick but dubious fix, the last of these options is often optimal. If you’re in a bad situation, it’s reasonable to work out just how much less bad you can make it with easy interventions before deciding whether to invest the effort in trying to change the situation entirely.

Of course, life is so complex and demanding that we don’t tend to experience our quick-fix efforts as clear-eyed experiments in testing out the tenability of the status quo, prior to making an equally lucid decision about whether to enact profound change. Instead, we often muddle along, drifting into habits that serve us poorly for reasons that often remain as opaque to us are as the sources of our hazy ideas for making things feel a bit better.

My own anorexic life was a good example of this kind of practical and existential muddle, this stumbling sort of life design. And the intersection of eating and sleep was an excellent micro-example. As I’ve described in other posts (e.g., this one on arbitrary rules), my anorexic way of eating was defined by deferral: Keep yourself going with hot drinks and put off the real eating until everything else in the day is done. The result was middle-of-the-night eating and a comprehensively messed-up circadian rhythm. But as my therapist pointed out soon after I embarked on my final, successful recovery attempt, the way I ate not only caused sleep problems, it was also a great solution to them—as great as any solution could be that existed within the anorexic status quo.

Specifically, after being hungry all day, I would eat a relatively large meal (with, as I worked out later, a higher energy content than most women on a diet would think acceptable) combining high-fibre elements (e.g., boiled cabbage, muesli), high-water elements (e.g., lettuce, skimmed milk), and high-sugar and high-fat elements (e.g., chocolate, cake). In a sequence stretching from the least exciting (white bread and veg) to the most (chocolate, etc.), I would sate myself on all the main dimensions, from the fake satiety of excess fluids through the fibrous to the fatty and sugary. My therapist lighted especially on the sugar that came in the final phase: She remarked that giving myself an enormous sugar high followed soon after by a crash was a great way to help myself fall reliably to sleep despite a long day of hunger. Everything on the internet insists that high-sugar meals before bed are an awful idea if you want to sleep well, but they’re probably less awful than serious hunger, especially in the context of chronic malnutrition. Many individuals suffering with anorexia have a great fear of going to bed hungry, and they do their best to avoid this whilst also avoiding eating more.

Another common resort for those with ED-generated sleeping difficulties is alcohol, which creates a more pronounced version of the effects that sugar has: It helps you fall asleep but reduces overall sleep quality later in the night, especially the amount of rapid eye movement (REM) sleep. Similarly, caffeine creates alertness in the context of sleep deprivation, but does short- and long-term damage to sleep quality and circadian rhythm. Compulsive exercise problems are a common companion to eating disorders, and exercising in the evening can (depending on duration and intensity) be a way to help create the kind of physical tiredness that’s conducive to falling asleep. But over-exercise can also temporarily or chronically increase adrenaline and chronically increase cortisol, both of which interfere with sleep, as well as exacerbating the body’s energy deficit and perpetuating a catabolic state where tissues are being broken down to substitute for inadequate energy intake (see also this post on exercise).

So, these are a few common examples of quick sleep fixes that reliably backfire: If you’re not eating and therefore not sleeping enough, you might resort to rigid meal timings, drugs, and/or exercise to paper over the problem, and all of these will probably worsen the problem. They may do so by directly impairing sleep in everything but the shortest term. In the case of chemical dependencies (including in exercise addiction), they will do so via habituation effects that mean you need more over time to achieve the same result. And all of them may do so simply by making the status quo seem bearable enough that there’s no need to take any action to find more than superficial solutions.

In my posts on cognitive dissonance, I explored the chasm between dissonance reduction (doing whatever is needed to reduce the discomfort of holding two incompatible beliefs, or of acting counter to your beliefs) and dissonance elimination. Dissonance reduction involves massaging reality; dissonance elimination means transforming it. Weird nighttime meals and alcohol and caffeine and all the rest are great ways of massaging reality more or less deliberately to feel just tolerable enough.