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Sleep quality deteriorates over a binge-abstinence cycle in chronic smoked cocaine users

Laboratory of Neurophysiology Center for Sleep and Cognition and Department of Psychiatry, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
Psychopharmacology (Impact Factor: 3.99). 07/2005; 179(4):873-83. DOI: 10.1007/s00213-004-2088-z
Source: PubMed

ABSTRACT In cocaine dependent individuals, changes in subjective and objective sleep quality accompany their characteristic binge-abstinence cycle. Preliminary studies suggest that sleep quality may decline with prolonged abstinence. Reported here are results of the most extensive study to date on sleep abnormalities during cocaine binge and confirmed abstinence under controlled conditions.
The purpose of the current study was to use an experimental, inpatient model of the cocaine binge and abstinence cycle to examine the course and magnitude of sleep disturbances during cocaine use and abstinence.
Five inpatient non-treatment seeking cocaine users completed 3 baseline days of drug abstinence followed by 3 days of medically monitored "binge" cocaine use, and then 15 days of drug abstinence. Physiological sleep was recorded with polysomnography and the Nightcap ambulatory monitor, while subjective sleep was assessed by questionnaire.
Across 3 days of binge cocaine use and 15 subsequent days of confirmed drug abstinence, mean sleep duration, efficiency and latency changed in the direction of poorer sleep quality. In contrast, subjective reports of sleep quality remained unchanged across the same period.
Physiological sleep quality deteriorated from days when cocaine was used across the first 2 weeks of confirmed drug abstinence. In contrast, subjective reports of sleep quality remained unchanged across the same period. We postulate that this dissociation between objective and subjective sleep quality results from a cocaine-use related disruption of the sleep homeostat. Worsening sleep quality during cocaine abstinence may contribute to the risk of relapse and its treatment may offer novel therapeutic strategies for cocaine dependence.

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    • "Decreased SWS has been found early in abstinence and during sub-acute withdrawal from cocaine use (Angarita et al., 2014; Morgan et al., 2010; Schierenbeck et al., 2008) in addition to other polysomnographic changes present during the first weeks of abstinence from cocaine (Matuskey et al., 2011; Morgan et al., 2006, 2008, 2010). These changes include early REM rebound (Pace-Schott et al., 2005), prolongation of REM latency (Angarita et al., 2014), and decreases in REM, SWS, and total sleep time (TST) during the first 3 weeks of abstinence (Angarita et al., 2014; Morgan et al., 2006, 2008, 2010; Pace-Schott et al., 2005; Thompson et al., 1995). Lastly, subjective self-reports of sleep may impact clinical outcomes in chronic substance users. "
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    • "Moreover, this deficit is potentially clinically relevant, as it has been shown to predict relapse among alcohol dependent individuals (Allen et al., 1971; Brower, 2003). Also in line with previous studies (Johanson et al., 1999; Pace-Schott et al., 2005; Morgan et al., 2008; Walsh et al., 2009), we found that REM latency was shortened in the early abstinence period. Given that REM latency is associated with relapse in alcohol dependent patients (Gillin et al., 1994), this finding may prove clinically significant. "
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    ABSTRACT: Former sleep studies among non-treatment seeking chronic cocaine users had captured polysomnographic changes for as long as three weeks of abstinence. 20 cocaine dependent participants, randomized to placebo in an ongoing clinical trial, received 12 days of inpatient substance abuse treatment followed by 6 weeks of outpatient cognitive behavioral therapy. Polysomnographic recording was performed on consecutive nights during the 1st and 2nd inpatient and 3rd and 6th outpatient weeks. Number of days abstinent was determined from thrice weekly urine toxicology and self-report. Polysomnographic sleep was compared between study week 1 and 2, using paired t-tests. Trajectory of total sleep time (TST) was modeled both as a linear and a quadratic function of days abstinent. Despite reporting an improvement in overall sleep quality, polysomnographic sleep worsened from week 1 to 2. Among all participants, TST and stage 2 sleep time decreased, while REM sleep latency increased. Among participants who began the study with a positive urine test, there was also a decrease in REM and a trend for decreased slow wave sleep. TST compared to number of days abstinent (up to 54 days) was best fit with a quadratic model (p=0.002), suggesting the possibility of an improvement in total sleep time with extended abstinence. This is the first polysomnographic characterization of sleep in a large sample of cocaine users in treatment. Present findings confirm earlier results of poor and deteriorating sleep early in abstinence, and raise the possibility of improvement after an extended abstinence.
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    • "likelihood of relapse to cocaine use indicate that monitoring or improving sleep quality should be a primary clinical focus as abstinence progresses [3]. A second problem facing cocaine dependent individuals as abstinence progresses is a worsening of performance on tasks assessing impulsivity (Iowa Gambling Task), immediate and delayed memory, and sustained attention [5] [6]. "
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