Sleep Disturbances in Eating Disorders
Summary
Sleep disturbances are a pervasive yet often under-recognised component of eating disorders. Patients with anorexia nervosa, bulimia nervosa and binge-eating disorder commonly report insomnia, fragmented sleep and non-restorative rest, alongside daytime fatigue and impaired concentration. These disturbances arise from a complex interplay of psychological, hormonal and neurobiological factors. Hyperarousal, heightened anxiety and depressive symptoms disrupt sleep continuity, while alterations in ghrelin, cortisol and melatonin secretion further perturb circadian regulation. In anorexia nervosa, extreme nutritional deficits may exacerbate sleep fragmentation and amplify nocturnal awakenings, whereas in bulimia nervosa recurrent binge-purge cycles can provoke nocturnal gastrointestinal discomfort and insomnia. Emerging evidence suggests that sleep problems not only compromise quality of life and cognitive function but also hinder response to standard treatments, including psychological therapies and nutritional rehabilitation. Conversely, targeted improvements in sleep quality appear to bolster mood regulation, attenuate anxiety and support behavioural change. On a global scale, appreciating sleep as both a symptom and a modifiable target in eating-disorder care promises more holistic intervention strategies. Integrating sleep hygiene, cognitive-behavioural approaches and, where appropriate, pharmacological support may strengthen existing treatment paradigms and reduce relapse rates in diverse healthcare settings.
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Sleep Disturbances in Eating Disorders publication trend
The graph below shows the total number of articles in sleep disturbances in eating disorders across all publications each year (not limited to Nature Index journals).
Technical terms
Sleep efficiency: The proportion of time spent asleep relative to total time in bed, typically expressed as a percentage.
Sleep fragmentation: Frequent brief awakenings or arousals during the sleep period that disrupt continuity and reduce restorative rest.
Circadian preference: An individual’s propensity for activity and alertness at certain times of day, commonly referred to as “morningness” or “eveningness”.
Actigraphy: A non-invasive method using a wrist-worn device to record movement and infer sleep–wake patterns over extended periods.
References
- Sleep quality in eating disorders: A systematic review and meta-analysis. Sleep Medicine Reviews (2024).
- Sleep Pathologies and Eating Disorders: A Crossroad for Neurology, Psychiatry and Nutrition. Nutrients (2023).
- Engagement in binge eating and fasting associated with poorer sleep quality in an online sample of adults. Journal of Eating Disorders (2024).
- Exploring the Relationship between Disordered Sleep and Mood in Male Anorexia Nervosa: An Actigraphy Study. Nutrients (2023).
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