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.
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References
Ajilore OA, Stickgold R, Rittenhouse C, Hobson JA (1995) Nightcap: laboratory and home-based evaluation of a portable sleep monitor. Psychophysiology 32:92–98
Beck A, Steer RA, Brown GK (1996) Beck depression inventory®—II. The Psychological Corporation, San Antonio, Tex.
Bonnet MH, Arand DL, McNulty TB (1993) 24-Hour metabolic rate in matched normals and insomniacs. Sleep Res 22:175
Borbely AA (1982) A two process model of sleep regulation. Hum Neurobiol 1:195–204
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 14:347–356
Budney AJ, Hughes JR, Moore BA, Novy PL (2001) Marijuana abstinence effects in marijuana smokers maintained in their home environment. Arch Gen Psychiatry 58:917–924
Budney AJ, Moore BA, Vandrey RG, Hughes JR (2003) The time course and significance of cannabis withdrawal. J Abnorm Psychol 112:393–402
Cantero JL, Atienza M, Hobson JA, Stickgold R (2002) Nightcap: a reliable home monitor for detecting normal sleep onset. Sleep 25:238–245
Carroll KM, Rounsaville BJ (1993) History and significance of childhood attention deficit disorder in treatment-seeking cocaine abusers. Comp Psychiatry 34:75–82
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 59:277–286
Cohen J (1988) Statistical power analysis for the behavioral sciences, 2nd edn. Erlbaum, Hillsdale, N.J.
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 33:97–104
Dackis CA, O’Brien CP (2002) Cocaine dependence: the challenge for pharmacotherapy. Curr Opin Psychiatry 15:261–267
Dudish-Poulsen S, Hatsukami DK (2000) Acute abstinence effects following smoked cocaine administration in humans. Exp Clin Psychopharmacol 8:472–482
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 192:503–507
Foltin RW, Fischman MW (1997) A laboratory model of cocaine withdrawal in humans: intravenous cocaine. Exp Clin Psychopharmacol 5:404–411
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 26:145–154
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 254:263–271
Gawin FH, Kleber HD (1986) Abstinence symptomatology and psychiatric diagnosis in cocaine abusers: clinical observations. Arch Gen Psychiatry 43:107–113
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 35:843–849
Golan N, Shahar E, Ravid S, Pillar G (2004) Sleep disorders and daytime sleepiness in children with attention-deficit/hyperactive disorder. Sleep 27:261–266
Haney M, Ward AS, Comer SD, Foltin RW, Fischman MW (1999) Abstinence symptoms following smoked marijuana in humans. Psychopharmacology 141:395–404
Heine H, Magnussen H (2003) Literature-based values of control subjects in sleep medicine. Somnologie 7:28–34
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):958–975
Jacobs GD, Pace-Schott EF, Stickgold R, Otto MW (2004) Cognitive–behavioral therapy and pharmacotherapy for insomnia. Arch Intern Med 164:1888–1896
Johanson CE, Roehrs T, Schuh K, Warbasse L (1999) The effects of cocaine on mood and sleep in cocaine dependent males. Exp Clin Psychopharmacol 7:338–346
Koob GF, Le Moal M (2001) Drug addiction, dysregulation of reward, and allostasis. Neuropsychopharmacology 24:97–129
Kowatch RA, Schnoll SS, Knisely JS, Green D, Elswick RK (1992) Electroencephalographic sleep and mood during cocaine withdrawal. J Addict Dis 11:21–45
Kripke DF, Garfinkel L, Wingard DL, Klauber MR, Marler MR (2002) Mortality associated with sleep duration and insomnia. Arch Gen Psychiatry 59:131–136
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 4:413–420
Mendelson WB, Garnett D, Gillin JC, Weingartner H (1984) The experience of insomnia and daytime and nighttime functioning. Psychiatry Res 12:235–250
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 249:164–170
Morin CM (1993) Insomnia, psychological assessment and management. Guilford Press, New York
Pace-Schott E, Kaji J, Stickgold R, Hobson JA (1994) Nightcap measurement of sleep quality in self-described good and poor sleepers. Sleep 17:688–692
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:A380
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 10:93–104
Post RM, Gillin JC, Goodwin FK, Wyatt JR (1974) The effect of orally administered cocaine on sleep of depressed patients. Psychopharmacology 37:59–66
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.
Reynolds C, Kupfer D (1987) Sleep research in affective illness: state of the art circa 1987. Sleep 10:199–215
Rye DB, Jankovic J (2002) Emerging views of dopamine in modulating sleep/wake state from an unlikely source: PD. Neurology 58, 341–346
Schneider-Helmert D (1987) Twenty-four-hour sleep–wake function and personality patterns in chronic insomniacs and healthy controls. Sleep 10:452–462
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 62:642–652
Stepanski E, Zorick F, Roehrs T, Young D, Roth T (1988) Daytime alertness in patients with chronic insomnia compared with asymptomatic control subjects. Sleep 11:54–60
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 115:183–204
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 23:4278–4287
Thompson PM, Gillin JC, Golshan S, Irwin M (1995) Polygraphic sleep measures differentiate alcoholics and stimulant abusers during short-term abstinence. Biol Psychiatry 38:831–836
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 87:1478–1484
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 14:169–177
Ward AS, Haney M, Fischman MW, Foltin RW (1997a) Binge cocaine self-administration by humans: smoked cocaine. Behav Pharmacol 8:736–744
Ward AS, Haney M, Fischman MW, Foltin RW (1997b) Binge cocaine self-administration in humans: intravenous cocaine. Psychopharmacology 132:375–381
Watson R, Bakos L, Compton P, Gawin F (1992) Cocaine use and withdrawal: the effect on sleep and mood. Am J Drug Alcohol Abuse 18:21–28
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.
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Financial disclosure for J.A.H.—Harvard University holds the patent on the Nightcap sleep monitor and its production is licensed to Respironics, Inc. The Laboratory of Neurophysiology receives a small royalty on its sales.
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Pace-Schott, E.F., Stickgold, R., Muzur, A. et al. Sleep quality deteriorates over a binge–abstinence cycle in chronic smoked cocaine users. Psychopharmacology 179, 873–883 (2005). https://doi.org/10.1007/s00213-004-2088-z
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DOI: https://doi.org/10.1007/s00213-004-2088-z