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Sunday, December 19, 2010

Cigarette smoking and a good night’s sleep

According to a new study published online ahead of print in the journal Sleep Medicine, current cigarette smokers are more than twice as likely to report insufficient sleep as non-smokers.

As the study authors explain, “The mechanism through which active smoking affects sleep has been established. Nicotine, the active component of cigarette smoke, stimulates the release of sleep regulating neurotransmitters including dopamine and serotonin, resulting in sleep disturbance. Cigarette smoking is associated with disturbances in sleep architecture including lighter sleep, long latency in sleep initiation, decreased sleep efficiency and increased daytime sleepiness. Nicotine dependence and nightly withdrawal are associated with anxiety and stress disorders. Further, cigarette smoking impacts sleep by exacerbating respiratory symptoms or contributing to sleep disordered breathing.”

In other words, nicotine disrupts the chemical processes in the brain that help us fall asleep and stay asleep. Further, during sleep smokers do not ingest nicotine at the same rate as they do when awake and so sleep is further compounded by anxiety and stress associated with nightly nicotine withdrawal symptoms. It’s a bit of damned if you do, damned if you don’t cycle every single night.

In the Sleep Medicine study, a group of West Virginia University researchers examined questionnaire results provided by over 80,000 respondents participating in the 2008 Behavioral Risk Factor Surveillance System - a large behavioral health study based on random, nation-wide phone surveys conducted in 2008. (Sabanayagam C, et al. The association between active smoking, smokeless tobacco, second-hand smoke exposure and insufficient sleep. Sleep Med. 2010 Dec 6. [Epub ahead of print])

Their particular aim was to confirm previous study results connecting insufficient sleep/chronic insomnia and current cigarette smokers, and to verify whether similar sleep disturbances were present in people who use smokeless tobacco and non-smokers regularly exposed to cigarette smoke.

The research team discovered that approximately 18% of current cigarette smokers suffered from insufficient sleep (defined by the researchers as not getting enough rest or sleep everyday in the preceding 30 days). By comparison, only 9% of non-smokers reported insufficient sleep when completing the survey. This led the researchers to conclude that current smokers have 100% higher odds of experiencing insufficient sleep compared to non-smokers.

With regard to smokeless tobacco, the study investigators found 67% higher incidence of insufficient sleep among current smokeless tobacco users compared to never smokeless tobacco users. While this level was lower than the odds ratio for current cigarette smokers, it is still statistically significant.

Among non-smokers exposed to second hand cigarette smoke, the study results showed 41% higher odds of insufficient sleep compared to non-smokers not exposed to second hand cigarette smoke.

It appears from these results that regardless of consumption source (inhaling cigarette smoke, chewing tobacco, inhaling snuff, or inhaling second hand cigarette smoke), nicotine exposure is disruptive to a good night’s sleep. As the article authors concluded, “Consistent with previous studies, active smoking was associated with insufficient rest/sleep in the current study. Effect of smokeless tobacco on sleep has not been studied before. To our knowledge this is the first study showing an association between smokeless tobacco and insufficient rest/sleep.”

So short of permanent smoking cessation, what can people regularly exposed to cigarette smoke do to improve their odds of a good (or at least better) night’s sleep?

From our reading of sleep related research, we have several suggestions to offer:

1. Exercise – multiple studies have shown that adults of various ages and physical condition enjoy better sleep latency (the amount of time it takes for one to fall asleep), sleep duration and self-reported sleep quality from engaging in a regular exercise program. In fact, a separate study published this month online ahead of print in the journal Sleep Medicine showed that elderly study subjects who engaged in 30-40 minutes of sub-maximal aerobic exercise 3-4 times each week over a 16 week period reported a 1.25 hour increase in sleep duration, a 21% drop in the time it took them to fall asleep, and a significant jump in self-reported sleep quality.

2. Caffeine – avoid consuming products with caffeine after 2 p.m. each day. Much like nicotine, caffeine is a brain chemical stimulant that disrupts the body’s normal sleep cycle. If you can’t give up nicotine, then at least avoid compounding the problem by eliminating caffeine after 2 p.m. each day in order to give your body a chance to flush the caffeine consumed earlier in the day before bedtime.

3. Alcohol – thought alcohol is not a stimulant (it’s considered a depressant), consuming too much alcohol does disrupt the normal release of sleep inducing chemicals in the brain. Research suggests that consuming more than 2-3 alcoholic beverages within 4 hours of attempting to sleep does affect the body’s ability to fall asleep.

4. Television/Internet usage – though many people unwind at night by watching television or surfing the web, research has shown that cutting off television viewing/Internet surfing 1 hour or more before bedtime enhances the body’s ability to drift off to sleep.

5. Snack – studies have shown that consuming a light snack prior to bedtime enhances the body’s ability to fall asleep and stay asleep. Note, we said light snack, not full meal.

6. Sleep environment – scientists have found that odds of a good night’s sleep are enhanced by sleeping under warm bedding in a dark, cold room. Further, retiring to your bed only when ready to sleep (versus reading a book or watching TV in bed for a prolonged period before sleep) has been shown to improve the time it takes one to fall asleep.

7. Wake-time – an effective way of shocking your body to accept sleep more readily is to set your alarm clock to wake 30 minutes before your current waking time for at least a week. When you combine this technique with avoiding naps during the day during the same reset period, you effectively reset your body’s sleep clock (meaning at night your body is more receptive to sleep).

While there are surely other techniques for improving the time it takes one to fall asleep, stay asleep and wake up feeling well rested and full of energy, these techniques are the ones most often cited by sleep advocates such as the American Academy of Sleep Medicine.

1 comment:

Joye eGo said...

Among non-smokers exposed to second hand cigarette smoke, the study results showed 41% higher odds of insufficient sleep compared to non-smokers not exposed to second hand cigarette smoke.

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