Journal of Gambling Studies

, Volume 29, Issue 2, pp 241–253 | Cite as

Pathological Gambling, Problem Gambling and Sleep Complaints: An Analysis of the National Comorbidity Survey: Replication (NCS-R)

  • Iman Parhami
  • Aaron Siani
  • Richard J. Rosenthal
  • Timothy W. Fong
Original Paper


The purpose of this study is to investigate the relationship between sleep disturbances and gambling behavior. Data from the National Comorbidity Survey—Replication (NCS-R) was used to examine the relationship between three specific sleep complaints (difficulty initiating sleep [DIS], difficulty maintaining sleep [DMS], and early morning awakening [EMA]) and gambling behavior. Bivariate logistic regression models were used to control for potentially confounding psychiatric disorders and age. Almost half of respondents with problem gambling behavior (45.9%) and two thirds (67.7%) of respondents with pathological gambling behavior reported at least one sleep compliant. Compared to respondents with no gambling pathology, respondents with pathological gambling were significantly more likely to report at least one sleep complaint (Adjusted Odds Ratio [AOR] = 3.444, 95% CI = 1.538–7.713), to report all sleep complaints (AOR = 3.449, 95% CI = 1.503–7.914), and to report any individual complaint (DIS: OR = 2.300, 95% CI = 1.069–4.946; DMS: AOR = 4.604, 95% CI = 2.093–10.129; EMA: AOR = 3.968, 95% CI = 1.856–8.481). The relationship between problem gambling and sleep complaints were more modest (any sleep complaint: AOR = 1.794, 95% CI = 1.142–2.818; all three sleep complaints: AOR = 2.144, 95% CI = 1.169–3.931; DIS: AOR = 1.961, 95% CI = 1.204–3.194; DMS: AOR = 1.551, 95% CI = 0.951–2.529; EMA: AOR = 1.796, 95% CI = 1.099–2.935). Given the individual and societal ramifications linked with the presence of sleep problems, this study presents another health-related repercussion associated with gambling pathology rarely discussed in the literature.


Gambling Sleep National comorbidity survey replication Epidemiology 



This project was supported by the National Institute on Drug Abuse (Grant #: K23DA 19522-2) and a grant from the Annenberg Foundation. The authors would like to thank everyone involved with conducting the National Comorbidity Survey Replication and making the data publically available. Christopher Biely offered invaluable statistical advice.


  1. Ancoli-Israel, S. (2009). Sleep and its disorders in aging populations. Sleep Medicine, 10, S7–S11.PubMedCrossRefGoogle Scholar
  2. APA. (2000). Diagnostic and statistical manual of mental disorders DSM-IV-TR (Text Revision): American Psychiatric Association. DC: Washington.Google Scholar
  3. Arnedt, J. T., Conroy, D. A., Armitage, R., & Brower, K. J. (2011). Cognitive-behavioral therapy for insomnia in alcohol dependent patients: A randomized controlled pilot trial. Behaviour Research and Therapy, 49, 227–233.PubMedCrossRefGoogle Scholar
  4. Ayas, N. T., White, D. P., Manson, J. A. E., Stampfer, M. J., Speizer, F. E., Malhotra, A., et al. (2003). A prospective study of sleep duration and coronary heart disease in women. Archives of Internal Medicine, 163, 205–209.PubMedCrossRefGoogle Scholar
  5. Bakken, I. J., Gotestam, K. G., Grawe, R. W., Wenzel, H. G., & Øren, A. (2009). Gambling behavior and gambling problems in Norway 2007. Scandinavian Journal of Psychology, 50, 333–339.PubMedCrossRefGoogle Scholar
  6. Bolla, K. I., Lesage, S. R., Gamaldo, C. E., Neubauer, D. N., Funderburk, F. R., Cadet, J. L., et al. (2008). Sleep disturbance in heavy marijuana users. Sleep, 31, 901–908.PubMedGoogle Scholar
  7. Bonn-Miller, M. O., Babson, K. A., Vujanovic, A. A., & Feldner, M. T. (2010). Sleep problems and PTSD symptoms interact to predict Marijuana use coping motives: A preliminary investigation. Journal of Dual Diagnosis, 6, 111–122.CrossRefGoogle Scholar
  8. Bootzin, R. R., & Stevens, S. J. (2005). Adolescents, substance abuse, and the treatment of insomnia and daytime sleepiness. Clinical Psychology Review, 25, 629–644.PubMedCrossRefGoogle Scholar
  9. Breslau, N., Roth, T., Rosenthal, L., & Andreski, P. (1996). Sleep disturbance and psychiatric disorders: A longitudinal epidemiological study of young adults. Biological Psychiatry, 39, 411–418.PubMedCrossRefGoogle Scholar
  10. Brewer, J. A., Grant, J. E., & Potenza, M. N. (2008). The treatment of pathologic gambling. Addictive Disorders & Their Treatment, 7, 1–13.CrossRefGoogle Scholar
  11. Brower, K. J., Aldrich, M. S., Robinson, E. A. R., Zucker, R. A., & Greden, J. F. (2001). Insomnia, self-medication, and relapse to alcoholism. American Journal of Psychiatry, 158, 399–404.PubMedCrossRefGoogle Scholar
  12. Brower, K. J., & Perron, B. E. (2010). Sleep disturbance as a universal risk factor for relapse in addictions to psychoactive substances. Medical Hypotheses, 74, 928–933.PubMedCrossRefGoogle Scholar
  13. Buysse, D. J., Hall, M. L., Strollo, P. J., Kamarck, T. W., Owens, J., Lee, L., et al. (2008). Relationships between the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and clinical/polysomnographic measures in a community sample. Journal of Clinical Sleep Medicine, 4, 563–571.PubMedGoogle Scholar
  14. Crum, R. M., Storr, C. L., Chan, Y. F., & Ford, D. E. (2004). Sleep disturbance and risk for alcohol-related problems. American Journal of Psychiatry, 161, 1197–1203.PubMedCrossRefGoogle Scholar
  15. Daley, M., Morin, C., LeBlanc, M., Gregoire, J., Savard, J., & Baillargeon, L. (2009). Insomnia and its relationship to health-care utilization, work absenteeism, productivity and accidents. Sleep Medicine, 10, 427–438.PubMedCrossRefGoogle Scholar
  16. First, M., Spitzer, R., Gibbon, M., & Williams, J. (1995). Structured clinical interview for DSM-IV axis I disorders-patient edition (SCID-I/P, Version 2.0). New York: Biometric Research, New York State Psychiatric Institute.Google Scholar
  17. Goudriaan, A. E., Oosterlaan, J., de Beurs, E., & Van den Brink, W. (2004). Pathological gambling: A comprehensive review of biobehavioral findings. Neuroscience and Biobehavioral Reviews, 28, 123–141.PubMedCrossRefGoogle Scholar
  18. Griffiths, M. (2001). Gambling: an emerging area of concern for health psychologists. Journal of Health Psychology, 6, 477–479.PubMedCrossRefGoogle Scholar
  19. Hagger, M. S. (2010). Sleep, self regulation, self control and health. Stress and Health, 26, 181–185.CrossRefGoogle Scholar
  20. Harrison, Y., & Horne, J. A. (2000). The impact of sleep deprivation of decision making: A review. Journal of Experimental Psychology: Applied, 6, 236–249.PubMedCrossRefGoogle Scholar
  21. Hodgins, D. C., & El Guebaly, N. (2000). Natural and treatment assisted recovery from gambling problems: A comparison of resolved and active gamblers. Addiction, 95, 777–789.PubMedCrossRefGoogle Scholar
  22. Hossain, J. L., & Shapiro, C. M. (2002). The prevalence, cost implications, and management of sleep disorders: An overview. Sleep Breath, 6, 85–102.PubMedCrossRefGoogle Scholar
  23. Jaehne, A., Loessl, B., Barkai, Z., Riemann, D., & Hornyak, M. (2009). Effects of nicotine on sleep during consumption, withdrawal and replacement therapy. Sleep Medicine Review, 13, 363–377.CrossRefGoogle Scholar
  24. Johnson, E. O., & Breslau, N. (2001). Sleep problems and substance use in adolescence. Drug and Alcohol Dependence, 64, 1–7.PubMedCrossRefGoogle Scholar
  25. Kessler, R. C., Hwang, I., LaBrie, R., Petukhova, M., Sampson, N. A., Winters, K. C., et al. (2008). DSM-IV pathological gambling in the national comorbidity survey replication. Psychological Medicine, 38, 1351–1360.PubMedGoogle Scholar
  26. Kessler, R. C., & Merikangas, K. R. (2004). The national comorbidity survey replication (NCS-R): Background and aims. International Journal of Methods in Psychiatric Research, 13, 60–68.PubMedCrossRefGoogle Scholar
  27. Kessler, R. C., & Üstün, T. B. (2004). The world mental health (WMH) survey initiative version of the world health organization (WHO) composite international diagnostic interview (CIDI). International Journal of Methods in Psychiatric Research, 13, 93–121.PubMedCrossRefGoogle Scholar
  28. Killgore, W. D. S., Kahn-Greene, E. T., Lipizzi, E. L., Newman, R. A., Kamimori, G. H., & Balkin, T. J. (2008). Sleep deprivation reduces perceived emotional intelligence and constructive thinking skills. Sleep Medicine, 9, 517–526.PubMedCrossRefGoogle Scholar
  29. Kripke, D. F., Garfinkel, L., Wingard, D. L., Klauber, M. R., & Marler, M. R. (2002). Mortality associated with sleep duration and insomnia. Archives of General Psychiatry, 59, 131–136.PubMedCrossRefGoogle Scholar
  30. Kyle, S. D., Morgan, K., & Espie, C. A. (2010). Insomnia and health-related quality of life. Sleep Medicine Reviews, 14, 69–82.PubMedCrossRefGoogle Scholar
  31. Leger, D., & Bayon, V. (2010). Societal costs of insomnia. Sleep Medicine Reviews, 14, 379–389.PubMedCrossRefGoogle Scholar
  32. Lesieur, H. R., & Custer, R. L. (1984). Pathological gambling: Roots, phases, and treatment. The Annals of the American Academy of Political and Social Science, 474, 146–156.CrossRefGoogle Scholar
  33. Lesieur, H. R., & Rosenthal, R. J. (1991). Pathological gambling: A review of the literature (prepared for the American Psychiatric Association Task Force on DSM-IV Committee on Disorders of Impulse Control Not Elsewhere Classified). Journal of Gambling Studies, 7, 5–39.CrossRefGoogle Scholar
  34. Leung, K. S., & Cottler, L. B. (2009). Treatment of pathological gambling. Current Opinion in Psychiatry, 22, 69–74.PubMedCrossRefGoogle Scholar
  35. Lorains, F. K., Cowlishaw, S., & Thomas, S. A. (2011). Prevalence of comorbid disorders in problem and pathological gambling: Systematic review and meta analysis of population surveys. Addiction, 106, 490–498.PubMedCrossRefGoogle Scholar
  36. Lorenz, V. C., & Yaffee, R. A. (1986). Pathological gambling: Psychosomatic, emotional, and marital difficulties as reported by the gambler. Journal of Gambling Studies, 2, 20–49.Google Scholar
  37. Lumley, M., Roehrs, T., Asker, D., Zorick, F., & Roth, T. (1987). Ethanol and caffeine effects on daytime sleepiness/alertness. Sleep, 10, 306–312.PubMedGoogle Scholar
  38. McCann, U. D., & Ricaurte, G. A. (2007). Effects of (±) 3,4-methylenedioxymethamphetamine (MDMA) on sleep and circadian rhythms. ScientificWorldJournal, 7, 231–238.PubMedCrossRefGoogle Scholar
  39. Morasco, B. J., Pietrzak, R. H., Blanco, C., Grant, B. F., Hasin, D., & Petry, N. M. (2006a). Health problems and medical utilization associated with gambling disorders: Results from the national epidemiologic survey on alcohol and related conditions. Psychosomatic Medicine, 68, 976–984.PubMedCrossRefGoogle Scholar
  40. Morasco, B. J., vom Eigen, K. A., & Petry, N. M. (2006b). Severity of gambling is associated with physical and emotional health in urban primary care patients. General Hospital Psychiatry, 28, 94–100.PubMedCrossRefGoogle Scholar
  41. Neubauer, D. N. (2009). Current and new thinking in the management of comorbid insomnia. American Journal of Managed Care, 15, S24–S32.PubMedGoogle Scholar
  42. Ohayon, M. M. (2009). Difficulty in resuming or inability to resume sleep and the links to daytime impairment: Definition, prevalence and comorbidity. Journal of Psychiatric Research, 43, 934–940.PubMedCrossRefGoogle Scholar
  43. Parhami, I., Siani, A., Rosenthal, R. J., Lin, S., Collard, M., & Fong, T. W. (2012). Sleep and gambling severity in a community sample of gamblers. Journal of Addictive Diseases, 31, 67–79.PubMedCrossRefGoogle Scholar
  44. Peterson, M. J., & Benca, R. M. (2008). Sleep in mood disorders. Sleep Medicine Clinics, 3, 231–249.CrossRefGoogle Scholar
  45. Petry, N., Stinson, F., & Grant, B. (2005). Comorbidity of DSM-IV pathological gambling and other psychiatric disorders: Results from the national epidemiologic survey on alcohol and related conditions. Journal of Clinical Psychiatry, 66, 564–574.PubMedCrossRefGoogle Scholar
  46. Potenza, M. N., Fiellin, D. A., Heninger, G. R., Rounsaville, B. J., & Mazure, C. M. (2002). Gambling: An addictive behavior with health and primary care implications. Journal of General Internal Medicine, 17, 721–732.PubMedCrossRefGoogle Scholar
  47. Ramsawh, H. J., Stein, M. B., Belik, S. L., Jacobi, F., & Sareen, J. (2009). Relationship of anxiety disorders, sleep quality, and functional impairment in a community sample. Journal of Psychiatric Research, 43, 926–933.PubMedCrossRefGoogle Scholar
  48. Riemann, D. (2007). Insomnia and comorbid psychiatric disorders. Sleep Medicine, 8(Suppl 4), S15–20.PubMedCrossRefGoogle Scholar
  49. Roane, B. M., & Taylor, D. J. (2008). Adolescent insomnia as a risk factor for early adult depression and substance abuse. Sleep, 31, 1351.PubMedGoogle Scholar
  50. Rosekind, M. R., Gregory, K. B., Mallis, M. M., Brandt, S. L., Seal, B., & Lerner, D. (2010). The cost of poor sleep: Workplace productivity loss and associated costs. Journal of Occupational Environmental Medicine, 52, 91–98.CrossRefGoogle Scholar
  51. Rosenthal, R. J., & Lesieur, H. R. (1992). Self reported withdrawal symptoms and pathological gambling. American Journal on Addictions, 1, 150–154.Google Scholar
  52. Roth, T. (2007). Insomnia: Definition, prevalence, etiology, and consequences. Journal of Clinical Sleep Medicine, 3, S7–10.PubMedGoogle Scholar
  53. Roth, T., Jaeger, S., Jin, R., Kalsekar, A., Stang, P. E., & Kessler, R. C. (2006). Sleep problems, comorbid mental disorders, and role functioning in the national comorbidity survey replication. Biological Psychiatry, 60, 1364–1371.PubMedCrossRefGoogle Scholar
  54. Rybarczyk, B., Lund, H. G., Mack, L., & Stepanski, E. (2009). Comorbid Insomnia. Sleep Medicine Clinics, 4, 571–582.CrossRefGoogle Scholar
  55. Salminen, S., Oksanen, T., Vahtera, J., Sallinen, M., Härmä, M., Salo, P., et al. (2010). Sleep disturbances as a predictor of occupational injuries among public sector workers. Journal of Sleep Research, 19, 207–213.PubMedCrossRefGoogle Scholar
  56. Schierenbeck, T., Riemann, D., Berger, M., & Hornyak, M. (2008). Effect of illicit recreational drugs upon sleep: Cocaine, ecstasy and marijuana. Sleep Medicine Review, 12, 381–389.CrossRefGoogle Scholar
  57. Shaffer, H., & Hall, M. (2002). Updating and refining prevalence estimates of disordered gambling behaviour in the United States and Canada. Canadian Journal of Public Health. Revue Canadienne de Sante Publique, 92, 168–172.Google Scholar
  58. Shaffer, H. J., Stein, S. A., Gambino, B., & Thomas, N. (1989). Compulsive gambling: Theory, research, and practice. Lexington, MA: Lexington Books.Google Scholar
  59. Sharma, R., Engemann, S., Sahota, P., & Thakkar, M. M. (2010). Role of adenosine and wake-promoting basal forebrain in insomnia and associated sleep disruptions caused by ethanol dependence. Journal of Neurochemistry, 115, 782–794.PubMedCrossRefGoogle Scholar
  60. Smolensky, M. H., Di Milia, L., Ohayon, M. M., & Philip, P. (2011). Sleep disorders, medical conditions, and road accident risk. Accident Analysis and Prevention, 43, 533–548.PubMedCrossRefGoogle Scholar
  61. Sobanski, E., Schredl, M., Kettler, N., & Alm, B. (2008). Sleep in adults with attention deficit hyperactivity disorder (ADHD) before and during treatment with methylphenidate: A controlled polysomnographic study. Sleep, 31, 375–381.PubMedGoogle Scholar
  62. Spiegel, K., Leproult, R., & Van Cauter, E. (1999). Impact of sleep debt on metabolic and endocrine function. The Lancet, 354, 1435–1439.CrossRefGoogle Scholar
  63. Stein, M. D., & Friedmann, P. D. (2005). Disturbed sleep and its relationship to alcohol use. Substance Abuse, 26, 1–13.PubMedCrossRefGoogle Scholar
  64. Stepanski, E. J., & Rybarczyk, B. (2006). Emerging research on the treatment and etiology of secondary or comorbid insomnia. Sleep Medicine Reviews, 10, 7–18.PubMedCrossRefGoogle Scholar
  65. Tochikubo, O., Ikeda, A., Miyajima, E., & Ishii, M. (1996). Effects of insufficient sleep on blood pressure monitored by a new multibiomedical recorder. Hyptertension, 27, 1318–1324.CrossRefGoogle Scholar
  66. Tucker, A. M., Whitney, P., Belenky, G., Hinson, J. M., & Van Dongen, H. P. A. (2010). Effects of sleep deprivation on dissociated components of executive functioning. Sleep, 33, 47–57.PubMedGoogle Scholar
  67. Tynjala, J., Kannas, L., & Levalahti, E. (1997). Perceived tiredness among adolescents and its association with sleep habits and use of psychoactive substances. Journal of Sleep Research, 6, 189–198.PubMedCrossRefGoogle Scholar
  68. van Holst, R. J., van den Brink, W., Veltman, D. J., & Goudriaan, A. E. (2010a). Brain imaging studies in pathological gambling. Current Psychiatry Reports, 5, 418–425.CrossRefGoogle Scholar
  69. van Holst, R. J., van den Brink, W., Veltman, D. J., & Goudriaan, A. E. (2010b). Why gamblers fail to win: A review of cognitive and neuroimaging findings in pathological gambling. Neuroscience and Biobehavioral Reviews, 34, 87–107.PubMedCrossRefGoogle Scholar
  70. Van Reeth, O., Weibel, L., Spiegel, K., Leproult, R., Dugovic, C., & Maccari, S. (2000). Interactions between stress and sleep: From basic research to clinical situations. Sleep Medicine Reviews, 4, 201–219.CrossRefGoogle Scholar
  71. Venkatraman, V., Chuah, Y., Huettel, S. A., & Chee, M. (2007). Sleep deprivation elevates expectation of gains and attenuates response to losses following risky decisions. Sleep, 30, 603–609.PubMedGoogle Scholar
  72. Wade, A. G. (2010). The societal costs of insomnia. Neuropsychiatric Disease and Treatment, 7, 1–18.PubMedCrossRefGoogle Scholar
  73. Wareham, J. D., & Potenza, M. N. (2010). Pathological gambling and substance use disorders. American Journal of Drug and Alcohol Abuse, 36, 142–151.CrossRefGoogle Scholar
  74. Wasielewski, J. A., & Holloway, F. A. (2001). Alcohol’s interactions with circadian rhythms. A focus on body temperature. Alcohol Research and Health, 25, 94–100.PubMedGoogle Scholar
  75. Wojnar, M., Ilgen, M. A., Wojnar, J., McCammon, R. J., Valenstein, M., & Brower, K. J. (2009). Sleep problems and suicidality in the national comorbidity survey replication. Journal of Psychiatric Research, 43, 526–531.PubMedCrossRefGoogle Scholar
  76. Wong, M. M., Brower, K. J., Fitzgerald, H. E., & Zucker, R. A. (2004). Sleep problems in early childhood and early onset of alcohol and other drug use in adolescence. Alcoholism, Clinical and Experimental Research, 28, 578–587.PubMedCrossRefGoogle Scholar
  77. Wong, M. M., Brower, K. J., & Zucker, R. A. (2009). Childhood sleep problems, early onset of substance use and behavioral problems in adolescence. Sleep Medicine, 10, 787–796.PubMedCrossRefGoogle Scholar
  78. Wray, I., & Dickerson, M. G. (1981). Cessation of high frequency gambling and ‘withdrawal’symptoms. British Journal of Addiction, 76, 401–405.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Iman Parhami
    • 1
  • Aaron Siani
    • 1
  • Richard J. Rosenthal
    • 1
  • Timothy W. Fong
    • 1
  1. 1.UCLA Gambling Studies, Department of Psychiatry and Biobehavioral SciencesUniversity of CaliforniaLos AngelesUSA

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