Sleep Disorders in Substance Abusers

| December 29, 2009 | 0 Comments

Dear Editor:

I found the article written by Mahfoud et al in the September issue of Psychiatry 2009 on sleep disorders in substance abusers quite interesting [Sleep Disorders in Substance Abusers: How Common Are They? Psychiatry (Edgemont). 2009;6(9):38–42].

The relationship between substance abusers and change in sleep architecture is quite a fertile area for research, as the authors have noted. One also cannot understate the influence that psychiatric and physical conditions plays in the change in sleep patterns of substance abusers. There are difficulties in determining cause and effects between sleep disorders and substance abusers.

The authors commented mainly on the sleep architecture changes in alcohol-dependent subjects. Cocaine use also has been shown to suppress rapid eye movement (REM) sleep, decrease total sleep time, and increase time to first REM sleep, followed by a rebound specific to REM sleep.[1] This is similar to the effects of amphetamines on sleep.[2] In another study looking at the effects of Cannabis on sleep, it was mentioned that two constituents of Cannabis sativa, 9-tetrahydrocannabinol and cannabidiol, caused contrasting effects on sleep—the former causing slight residual sedation while the latter causing mild activating effect via the hypothalamus and dorsal raphe nucleus.[3]

Acute heroin withdrawal on the other hand causes more abrupt transitions from quiet awake or sleeping conditions into the awake state and impeded progression into slow wave or REM sleep states.[4]

There was an interesting study done by Lukas et al in 1996, which studied the reversal of the sleep architecture of cocaine- and heroin-dependent men following chronic administration of buprenorphine. The initial sleep changes as a result of cocaine and heroin use, which comprised delayed sleep latency, reduced total sleep time, increased wake time after sleep onset, reduced REM latency, and minimal stage 3 and 4 slow wave sleep, all improved after low-dose buprenorphine but not with high doses.[5] Buprenorphine’s effect on cocaine seems to be a surprising one, though some other studies have mentioned its benefits.

Further research studying whether insomnia was a modifiable risk factor in substance abuse treatment would be valuable. Exploring other neurobiological theories regarding sleep regulation, and how they are affected by the different substances would be beneficial.

1. Watson R, Bakos L, Compton P, Gawin F. Cocaine use and withdrawal: the effect on sleep and mood. Am J Drug Alcohol Abuse. 1992;18(1):21–28.
2. Rechtschaffen A, Maron L. The effect of amphetamine on the sleep cycle. Electroencephalogr Clin Neurophysiol. 1964;16:438–445.
3. Russo EB, Guy GW, Robson PJ. Cannabis, pain, and sleep: lessons from therapeutic clinical trials of Sativex, a cannabis-based medicine. Chem Biodivers. 2007;4(8):1729–1743.
4. Howe RC, Phillips JL, Hegge FW. Acute heroin abstinence in man: IV. Sleep –waking state contingencies. Drug Alcohol Depend. 1981;7(2):163–176.
5. Lukas SE, Dorsey CM, Mello NK, et al. Reversal of sleep disturbances in cocaine-and heroin-dependent men during chronic buprenorphine treatment. Exp Clin Psychopharmacol. 1996;4(4):1996;413–420.

With regards,
Adegboyega Oyemade, MD
Addiction Psychiatrist, Heritage Behavioral Health Center, Inc., Decatur, Illinois

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Category: Letters to the Editor, Neurology, Past Articles, Psychiatry, Sleep Disorders, Substance Use Disorders

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