Psychopharmacology

, Volume 179, Issue 4, pp 873–883 | Cite as

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

  • Edward F. Pace-Schott
  • Robert Stickgold
  • Amir Muzur
  • Pia E. Wigren
  • Amie S. Ward
  • Carl L. Hart
  • Denise Clarke
  • Alexandra Morgan
  • J. Allan Hobson
Original Investigation

Abstract

Rationale

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.

Objectives

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords

Cocaine Sleep quality Abstinence Drug use 

Notes

Acknowledgements

This research is dedicated to the memory of Dr. Marian W. Fischman, who died before the completion of this study. Dr. Fischman’s guidance on the design of this study was invaluable and she will be missed immensely. Our thanks to Dr. Matthew Walker for useful suggestions. We would like to thank the National Institute on Drug Abuse for supporting this research with DA11744. All experiments described in this report were in compliance with the laws of the State of New York and of the USA.

References

  1. Ajilore OA, Stickgold R, Rittenhouse C, Hobson JA (1995) Nightcap: laboratory and home-based evaluation of a portable sleep monitor. Psychophysiology 32:92–98Google Scholar
  2. Beck A, Steer RA, Brown GK (1996) Beck depression inventory®—II. The Psychological Corporation, San Antonio, Tex.Google Scholar
  3. Bonnet MH, Arand DL, McNulty TB (1993) 24-Hour metabolic rate in matched normals and insomniacs. Sleep Res 22:175Google Scholar
  4. Borbely AA (1982) A two process model of sleep regulation. Hum Neurobiol 1:195–204PubMedGoogle Scholar
  5. Brower KJ, Maddahian E, Blow FC, Beresford TP (1992) A comparison of self-reported symptoms and DSM-III-R criteria for cocaine withdrawal. Am J Drug Alcohol Abuse 14:347–356Google Scholar
  6. Budney AJ, Hughes JR, Moore BA, Novy PL (2001) Marijuana abstinence effects in marijuana smokers maintained in their home environment. Arch Gen Psychiatry 58:917–924CrossRefGoogle Scholar
  7. Budney AJ, Moore BA, Vandrey RG, Hughes JR (2003) The time course and significance of cannabis withdrawal. J Abnorm Psychol 112:393–402CrossRefGoogle Scholar
  8. Cantero JL, Atienza M, Hobson JA, Stickgold R (2002) Nightcap: a reliable home monitor for detecting normal sleep onset. Sleep 25:238–245Google Scholar
  9. Carroll KM, Rounsaville BJ (1993) History and significance of childhood attention deficit disorder in treatment-seeking cocaine abusers. Comp Psychiatry 34:75–82CrossRefGoogle Scholar
  10. Coffey SF, Dansky BS, Carrigan MH, Brady KT (2000) Acute and protracted cocaine abstinence in an outpatient population: a prospective study of mood, sleep and withdrawal symptoms. Drug Alcohol Depend 59:277–286CrossRefGoogle Scholar
  11. Cohen J (1988) Statistical power analysis for the behavioral sciences, 2nd edn. Erlbaum, Hillsdale, N.J.Google Scholar
  12. Cottler LB, Shillington AM, Compton WM, Mager D, Spitznagel E (1993) Subjective reports of withdrawal among cocaine users: recommendations for DSM-IV. Drug Alcohol Depend 33:97–104CrossRefGoogle Scholar
  13. Dackis CA, O’Brien CP (2002) Cocaine dependence: the challenge for pharmacotherapy. Curr Opin Psychiatry 15:261–267CrossRefGoogle Scholar
  14. Dudish-Poulsen S, Hatsukami DK (2000) Acute abstinence effects following smoked cocaine administration in humans. Exp Clin Psychopharmacol 8:472–482Google Scholar
  15. Falck RS, Wang J, Siegal HA, Carlson RG (2004) The prevalence of psychiatric disorder among a community sample of crack cocaine users: an exploratory study with practical implications. J Nerv Mental Disord 192:503–507CrossRefGoogle Scholar
  16. Foltin RW, Fischman MW (1997) A laboratory model of cocaine withdrawal in humans: intravenous cocaine. Exp Clin Psychopharmacol 5:404–411Google Scholar
  17. Foltin RW, Fischman MW, Nestadt G, Stromberger H, Cornell EE, Pearlson GD (1990) Demonstration of naturalistic methods for cocaine smoking by human volunteers. Drug Alcohol Depend 26:145–154CrossRefGoogle Scholar
  18. Gann H, van Calker D, Feige B, Cloot O, Bruck R, Berger M, Riemann D (2004) Polysomnographic comparison between patients with primary alcohol dependency during subacute withdrawal and patients with a major depression. Eur Arch Psychiatr Clin Neurosci 254:263–271Google Scholar
  19. Gawin FH, Kleber HD (1986) Abstinence symptomatology and psychiatric diagnosis in cocaine abusers: clinical observations. Arch Gen Psychiatry 43:107–113Google Scholar
  20. Gillin JC, Pulvirenti L, Withers N, Golshan S, Koob G (1994) The effects of lisuride on mood and sleep during acute withdrawal in stimulant abusers: a preliminary report. Biol Psychiatry 35:843–849CrossRefGoogle Scholar
  21. Golan N, Shahar E, Ravid S, Pillar G (2004) Sleep disorders and daytime sleepiness in children with attention-deficit/hyperactive disorder. Sleep 27:261–266Google Scholar
  22. Haney M, Ward AS, Comer SD, Foltin RW, Fischman MW (1999) Abstinence symptoms following smoked marijuana in humans. Psychopharmacology 141:395–404CrossRefGoogle Scholar
  23. Heine H, Magnussen H (2003) Literature-based values of control subjects in sleep medicine. Somnologie 7:28–34CrossRefGoogle Scholar
  24. Hudson JI, Pope HG, Sullivan LE, Waternaux CM, Keck PE, Broughton RJ (1992) Good sleep, bad sleep: a meta-analysis of polysomnographic measures in insomnia, depression, and narcolepsy. Biol Psychiatry 32(11):958–975CrossRefGoogle Scholar
  25. Jacobs GD, Pace-Schott EF, Stickgold R, Otto MW (2004) Cognitive–behavioral therapy and pharmacotherapy for insomnia. Arch Intern Med 164:1888–1896CrossRefGoogle Scholar
  26. Johanson CE, Roehrs T, Schuh K, Warbasse L (1999) The effects of cocaine on mood and sleep in cocaine dependent males. Exp Clin Psychopharmacol 7:338–346Google Scholar
  27. Koob GF, Le Moal M (2001) Drug addiction, dysregulation of reward, and allostasis. Neuropsychopharmacology 24:97–129Google Scholar
  28. Kowatch RA, Schnoll SS, Knisely JS, Green D, Elswick RK (1992) Electroencephalographic sleep and mood during cocaine withdrawal. J Addict Dis 11:21–45Google Scholar
  29. Kripke DF, Garfinkel L, Wingard DL, Klauber MR, Marler MR (2002) Mortality associated with sleep duration and insomnia. Arch Gen Psychiatry 59:131–136CrossRefGoogle Scholar
  30. Lukas SE, Dorsey CM, Mello NK, Mendelson JH (1996) Reversal of sleep disturbance in cocaine- and heroin-dependent men during chronic buprenorphine treatment. Exp Clin Psychopharmacol 4:413–420Google Scholar
  31. Mendelson WB, Garnett D, Gillin JC, Weingartner H (1984) The experience of insomnia and daytime and nighttime functioning. Psychiatry Res 12:235–250CrossRefGoogle Scholar
  32. Michaud M, Soucy JP, Chabli A. Lavigne G, Montplaisir J (2002) SPECT imaging of striatal pre- and postsynaptic dopaminergic status in restless legs syndrome with periodic leg movements in sleep. J Neurol 249:164–170Google Scholar
  33. Morin CM (1993) Insomnia, psychological assessment and management. Guilford Press, New YorkGoogle Scholar
  34. Pace-Schott E, Kaji J, Stickgold R, Hobson JA (1994) Nightcap measurement of sleep quality in self-described good and poor sleepers. Sleep 17:688–692Google Scholar
  35. Pace-Schott EF, Stickgold R, Muzur A, Wigren P, Ward AS, Hart C, Walker M, Edgar C, Fischman MW, Hobson JA (2003) Cognitive performance in chronic cocaine users over binge–abstinence is temporally associated with sleep quality declines. Sleep (Supplement) 26:A380Google Scholar
  36. Perlis ML, Kehr EL, Smith MT, Andrews PJ, Orff H, Giles DE (2001) Temporal and stagewise distribution of high frequency EEG activity in patients with primary and secondary insomnia and in good sleeper controls. J Sleep Res 10:93–104CrossRefGoogle Scholar
  37. Post RM, Gillin JC, Goodwin FK, Wyatt JR (1974) The effect of orally administered cocaine on sleep of depressed patients. Psychopharmacology 37:59–66CrossRefGoogle Scholar
  38. Rechtschaffen A, Kales A (1968) A manual standardized terminology, techniques and scoring system for sleep stages of human subjects. US Department of Health, Bethesda, Md.Google Scholar
  39. Reynolds C, Kupfer D (1987) Sleep research in affective illness: state of the art circa 1987. Sleep 10:199–215PubMedGoogle Scholar
  40. Rye DB, Jankovic J (2002) Emerging views of dopamine in modulating sleep/wake state from an unlikely source: PD. Neurology 58, 341–346Google Scholar
  41. Schneider-Helmert D (1987) Twenty-four-hour sleep–wake function and personality patterns in chronic insomniacs and healthy controls. Sleep 10:452–462Google Scholar
  42. Silvestri R, Pace-Schott EF, Gersh T, Stickgold R, Salzman C, Hobson JA (1998) Changes in sleep and dreaming during SSRI treatment and withdrawal in a home setting. J Clin Psychiatry 62:642–652Google Scholar
  43. Stepanski E, Zorick F, Roehrs T, Young D, Roth T (1988) Daytime alertness in patients with chronic insomnia compared with asymptomatic control subjects. Sleep 11:54–60Google Scholar
  44. Strecker RE, Morairty S, Thakkar MM, Porkka-Heiskanen T, Basheer R, Dauphin LJ, Rainnie DG, Portas CM, Greene RW, McCarley RW (2000) Adenosinergic modulation of basal forebrain and preoptic/anterior hypothalamic neuronal activity in the control of behavioral state. Behav Brain Res 115:183–204CrossRefGoogle Scholar
  45. Thakkar M, Winston S, McCarley RW (2003) A1 receptor and adenosinergic homeostatic regulation of sleep-wakefulness: effects of antisense to the A1 receptor in the cholinergic basal forebrain. J Neurosci 23:4278–4287Google Scholar
  46. Thompson PM, Gillin JC, Golshan S, Irwin M (1995) Polygraphic sleep measures differentiate alcoholics and stimulant abusers during short-term abstinence. Biol Psychiatry 38:831–836CrossRefGoogle Scholar
  47. Toda S, Alguacil LF, Kalivas PW (2003) Repeated cocaine administration changes the function and subcellular distribution of adenosine A1 receptor in the rat nucleus accumbens. J Neurochem 87:1478–1484Google Scholar
  48. Volkow ND, Fowler JS, Wang GJ, Hitzemann R, Logan J, Schlyer DJ, Dewey SL, Wolf AP (1993) Decreased dopamine D2 receptor availability is associated with reduced frontal metabolism in cocaine abusers. Synapse 14:169–177CrossRefGoogle Scholar
  49. Ward AS, Haney M, Fischman MW, Foltin RW (1997a) Binge cocaine self-administration by humans: smoked cocaine. Behav Pharmacol 8:736–744Google Scholar
  50. Ward AS, Haney M, Fischman MW, Foltin RW (1997b) Binge cocaine self-administration in humans: intravenous cocaine. Psychopharmacology 132:375–381CrossRefGoogle Scholar
  51. Watson R, Bakos L, Compton P, Gawin F (1992) Cocaine use and withdrawal: the effect on sleep and mood. Am J Drug Alcohol Abuse 18:21–28Google Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Edward F. Pace-Schott
    • 1
  • Robert Stickgold
    • 1
  • Amir Muzur
    • 1
  • Pia E. Wigren
    • 2
  • Amie S. Ward
    • 2
  • Carl L. Hart
    • 2
  • Denise Clarke
    • 1
  • Alexandra Morgan
    • 1
  • J. Allan Hobson
    • 1
  1. 1.Laboratory of Neurophysiology Center for Sleep and Cognition and Department of Psychiatry, Harvard Medical SchoolBeth Israel Deaconess Medical CenterBostonUSA
  2. 2.Substance Use Research Center, Department of PsychiatryColumbia University College of Physicians and SurgeonsNew YorkUSA

Personalised recommendations