A multistudy analysis of the effects of early cocaine abstinence on sleep

Abstract

Objective To describe the sleep patterns of early cocaine abstinence in chronic users by polysomnographic and subjective measures. Methods 28 cocaine-dependent participants (ages 24-55) underwent polysomnographic sleep (PSG) recording on the 1st, 2nd and 3rd weeks of abstinence on a research dedicated inpatient facility. Objective measures of total sleep time, total REM time, slow wave sleep, sleep efficiency and a subjective measure (sleep quality) along with demographic data were collected from three different long term research studies over a five year period. Data were reanalyzed to allow greater statistical power for comparisons. Results Progressive weeks of abstinence had main effects on all assessed PSG sleep measures showing decreased total sleep time, REM sleep, stage 1 and 2 sleep, and sleep efficiency; increases in sleep onset and REM latencies and a slight increase in slow-wave sleep time were also present. Total sleep time and slow wave sleep were negatively associated with years of cocaine use. Total sleep time was positively associated with the amount of current ethanol use. Sex differences were found with females having more total REM time and an increase at a near significance level in slow wave sleep. Subjective measures were reported as improving with increasing abstinence over the same time period. Conclusions Chronic cocaine users show a general deterioration in objective sleep measures over a three-week period despite an increase in subjective overall sleep quality providing further evidence for “occult insomnia” during early cocaine abstinence.

Modafinil and sleep architecture in an inpatient–outpatient treatment study of cocaine dependence

“…Although direct data supporting this hypothesis is limited (Trksak et al, 2013), the increase in nocturnal slow-wave activity caused by daytime administration of cocaine (Morgan et al, 2006) and the normalization of slow-wave sleep time by morning-dosed modafinil (Morgan et al, 2010), suggest that chronic cocaine users do not suffer from an impaired ability to generate slow-waves, but rather suffer from abnormalities in brain activation during wakefulness (but see also Trksak et al, 2013). These abnormalities, similar to the sleep abnormalities observed in chronic users, are presumably related to chronic use (Matuskey et al, 2011), but could also reflect pre-morbid traits. Our present data suggest that correcting these abnormalities with a morning-dosed stimulant may improve clinical outcomes during treatment.…”

“…The finding that improvement in slow-wave sleep time is a statistical mediator of clinical response was hypothesized based on the importance of sleep (and slow-wave sleep in particular) to a wide range of functions, the profound deficits in slow-wave sleep time observed previously in chronic cocaine users (Matuskey et al, 2011; Morgan et al, 2006, 2008) and the normalizing effect of modafinil on slow-wave sleep time in chronic cocaine users (Morgan et al, 2010). The present results do not, however, indicate that getting more of the slow, thalamo-cortical oscillations characteristic of slow-wave sleep promotes abstinence itself.…”

“…Previous work has identified dramatic alterations in sleep architecture associated with chronic use as examples of targetable neurophysiological abnormalities (Angarita et al, 2014a, 2014b; Morgan and Malison, 2008; Morgan et al, 2010, 2006; Pace-Schott et al, 2005). These alterations include profound and largely stable deficits in slow-wave sleep as well as alterations in REM sleep and total sleep time (Angarita et al, 2014b; Matuskey et al, 2011; Morgan et al, 2010, 2006, 2008). Deficits in slow-wave sleep are particularly troubling as slow-wave sleep time is typically preserved despite significant sleep restriction (Van Dongen et al, 2003).…”

Correlates of polysomnographic sleep changes in cocaine dependence: Self-administration and clinical outcomes

“…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).…”

Sleep Perception and Misperception in Chronic Cocaine Users During Abstinence

“…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.…”