Sleep, sleep-dependent procedural learning and vigilance in chronic cocaine users: Evidence for occult insomnia

Morgan, Peter T.; Pace‐Schott, Edward F.; Sahul, Zakir; Coric, Vladimir; Stickgold, Robert; Malison, Robert T.

doi:10.1016/j.drugalcdep.2005.09.014

Cited by 96 publications

(178 citation statements)

References 65 publications

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“…Over the first several weeks of abstinence, polysomnographically (PSG) measured sleep in chronic cocaine users worsens, with shortening total sleep time, diminishing REM sleep (rapid eye movement sleep; a sleep phase characterized by rapid and random eye movements, muscle inhibition, and brain waves similar to those exhibited during wakefulness) time, increasing sleep latency, and chronically decreased slow-wave sleep time. 16,17,[19][20][21][22][23][24][25][26] However, such findings are in contrast with seminal studies characterizing cocaine withdrawal and abstinence, which found self-reported (SR) improvements in sleep quality and related SR measures over a similar time frame. 27,28 Studies that combined PSG and SR qualitative measures reconciled these findings by showing that chronic cocaine users are largely unaware of their worsening sleep, with SR measures of sleep quality at their best when PSG-measured sleep times and sleep latency are at their worst, 17 and not different from sleep quality measures reported by healthy sleepers.…”

Section: Introductioncontrasting

confidence: 52%

“…16,17,[19][20][21][22][23][24][25][26] However, such findings are in contrast with seminal studies characterizing cocaine withdrawal and abstinence, which found self-reported (SR) improvements in sleep quality and related SR measures over a similar time frame. 27,28 Studies that combined PSG and SR qualitative measures reconciled these findings by showing that chronic cocaine users are largely unaware of their worsening sleep, with SR measures of sleep quality at their best when PSG-measured sleep times and sleep latency are at their worst, 17 and not different from sleep quality measures reported by healthy sleepers. 24 This coincidence of improving SR sleep quality with poor and worsening sleep was termed "occult insomnia" 17 to reflect the relative lack of awareness of what appears to be severely disrupted sleep.…”

Section: Introductioncontrasting

confidence: 52%

“…Like chronic users of other substances including alcohol, opiates, and cannabis, [7][8][9][10][11][12][13][14][15] chronic cocaine users have severely disrupted sleep 16,17 that may persist for weeks, months, or even longer (for review, see Angarita et al 18 ). Over the first several weeks of abstinence, polysomnographically (PSG) measured sleep in chronic cocaine users worsens, with shortening total sleep time, diminishing REM sleep (rapid eye movement sleep; a sleep phase characterized by rapid and random eye movements, muscle inhibition, and brain waves similar to those exhibited during wakefulness) time, increasing sleep latency, and chronically decreased slow-wave sleep time.…”

Section: Introductionmentioning

confidence: 99%

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Sleep Perception and Misperception in Chronic Cocaine Users During Abstinence

Hodges

Pittman

Morgan

2016

Sleep

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Study Objectives: During abstinence, chronic cocaine users experience an objective worsening of sleep that is perceived as qualitatively improving. This phenomenon has been termed "occult insomnia." The objective of this study was to determine whether chronic cocaine users experience positive sleep state misperception during abstinence. Methods: Forty-three cocaine-dependent persons were admitted to an inpatient research facility for 12 days and 11 nights to participate in a treatment study of modafinil. Polysomnographic sleep recordings were performed on study nights 3, 4, 10, and 11, when participants were on average 1 and 2 weeks abstinent from cocaine. Participants also completed sleep diary questionnaires every evening before bed and every morning upon awakening. Polysomnographic and sleep diary measurements of total sleep time, sleep latency, time awake after sleep onset, and time in bed after final awakening were compared. Results: Chronic cocaine users accurately reported total sleep time after 1 week of abstinence but overreported total sleep time by an average of 40 min after 2 weeks of abstinence. Underestimating sleep latency and time spent awake after sleep onset were responsible for this difference. Conclusions: Positive sleep state misperception is revealed in chronic cocaine users after 2 weeks of abstinence and is consistent with the previously identified "occult insomnia" in this population.

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Section: Introductioncontrasting

confidence: 52%

Section: Introductioncontrasting

confidence: 52%

Section: Introductionmentioning

confidence: 99%

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Sleep Perception and Misperception in Chronic Cocaine Users During Abstinence

Hodges

Pittman

Morgan

2016

Sleep

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“…Despite the fact that the use of objective actigraphy data is more precise and accurate than subjective measures of sleep quality 39 during cannabis abstinence, actiwatch measures of sleep quality did not predict the severity of subjective cannabis withdrawal symptoms. This is somewhat surprising given that the objective data presented show evidence of fragmented and disturbed sleep during cannabis abstinence, in support of previous studies.…”

Section: Sleep Quality and The Severity Of Perceived Cannabis Withdrawalmentioning

confidence: 99%

The Effects of Lithium Carbonate Supplemented with Nitrazepam on Sleep Disturbance during Cannabis Abstinence

Bartlett

Johnston

Helliwell³

et al. 2015

Journal of Clinical Sleep Medicine

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Study Objectives: Sleep disturbance is a hallmark feature of cannabis withdrawal. In this study we explored the effects of lithium treatment supplemented with nitrazepam on objective and subjective measures of sleep quality during inpatient cannabis withdrawal. Methods: Treatment-seeking cannabis-dependent adults (n = 38) were admitted for 8 days to an inpatient withdrawal unit and randomized to either oral lithium (500 mg) or placebo, twice daily in a double-blind RCT. Restricted nitrazepam (10 mg) was available on demand (in response to poor sleep) on any 3 of the 7 nights. Dependent outcome measures for analysis included repeated daily objective actigraphy and subjective sleep measures throughout the 8 day detox, subjective cannabis withdrawal ratings, and detoxifi cation completion rates. S leep diffi culties and cannabis use appears to be a bi-directional relationship. Individuals often start using cannabis when they experience sleep diffi culties during stressful times, often for coping reasons 1 ; and this is a risk factor for cannabis lapse (within the fi rst 2 days out of 7) following a self-guided quit attempt.2,3 The most prevalent sleep disturbances with cannabis withdrawal include diffi culty getting to sleep, staying asleep, nightmares and strange dreams, and night sweats.4 During the withdrawal process, sleep diffi culties predict relapse to cannabis use. [5][6][7][8] There is some evidence that pharmacotherapy during cannabis abstinence attenuates withdrawal related sleep disturbances, 9 including improvements in polysomnographic measures of sleep effi ciency (but not latency) with the nonbenzodiazepine GABA(A) receptor agonist zolpidem.10 While there is a plethora of studies exploring self-reported sleep disturbances associated with cannabis withdrawal, there are very S C I E N T I F I C I N V E S T I G AT I O N Sfew that quantify sleep patterns using objective means, with the exception of the paper by Vandrey et al. 10 Poor sleep is often the last symptom to remit, and recent trials have started to specifi cally target sleep disturbances during withdrawal. Haney and colleagues conducted a small BRIEF SUMMARY Current Knowledge/Study Rationale: Sleep disturbance is the most consistent, prevalent, and severe symptom of cannabis withdrawal. However, there are currently no evidence-based medicines to assist with cannabis dependence or cannabis withdrawal. Study Impact: This formal RCT demonstrates that, contrary to positive open label clinical fi ndings, lithium carbonate does not improve cannabis withdrawal related sleep disturbances. However, the hypnotic benzodiazepine rescue medication nitrazepam signifi cantly improved multiple objective measures of sleep disturbance during cannabis withdrawal.

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“…Difficulty in initiating and maintaining sleep as well as lower sleep efficiency (SE) and significant sleep onset delay are common amongst cocaine users (6). Furthermore, in cocaine-dependent individuals, alterations in objective sleep quality accompany their characteristic bingeabstinence cycle (7).…”

Section: Introduction Introduction Introduction Introduction Introducmentioning

confidence: 99%

Effects of cocaine, methamphetamine and modafinil challenge on sleep rebound after paradoxical sleep deprivation in rats

Martins

Andersen

Shih

et al. 2008

Braz J Med Biol Res

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Sleep loss is both common and critically relevant to our society and might lead to the abuse of psychostimulants such as amphetamines, cocaine and modafinil. Since psychoactive substance abuse often occurs within a scenario of sleep deficit, the purpose of this investigation was to compare the sleep patterns of rats challenged with cocaine (7 mg/kg, ip), methamphetamine (7 mg/kg, ip), or modafinil (100 mg/kg, ip) subsequent to paradoxical sleep deprivation (PSD) for 96 h. Our results show that, immediately after 96 h of PSD, rats (10 per group) that were injected with a psychostimulant presented lower percentages of paradoxical sleep compared to those injected with saline (P < 0.01). Regarding slow wave sleep (SWS), rats injected with psychostimulants after PSD presented a late rebound (on the second night subsequent to the injection) in the percentage of this phase of sleep when compared to PSD rats injected with saline (P < 0.05). In addition, the current study has produced evidence of the characteristic effect of each drug on sleep architecture. Home cage control rats injected with modafinil and methamphetamine showed a reduction in SWS compared with the saline group. Methamphetamine affected sleep patterns most, since it significantly reduced paradoxical sleep, SWS and sleep efficiency before and after PSD compared to control (P < 0.05). Cocaine was the psychostimulant causing the least changes in sleep pattern in relation to those observed after saline injection. Therefore, our results suggest that abuse of these psychostimulants in a PSD paradigm aggravates their impact on sleep patterns.

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Sleep, sleep-dependent procedural learning and vigilance in chronic cocaine users: Evidence for occult insomnia

Cited by 96 publications

References 65 publications

Sleep Perception and Misperception in Chronic Cocaine Users During Abstinence

Sleep Perception and Misperception in Chronic Cocaine Users During Abstinence

The Effects of Lithium Carbonate Supplemented with Nitrazepam on Sleep Disturbance during Cannabis Abstinence

Effects of cocaine, methamphetamine and modafinil challenge on sleep rebound after paradoxical sleep deprivation in rats

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