title: Abstinence-related changes in sleep during treatment for cocaine dependence.
abstract: BACKGROUND
  Former sleep studies among non-treatment seeking chronic cocaine users had captured polysomnographic changes for as long as three weeks of abstinence.
  
  
  METHODS
  20 cocaine dependent participants, randomized to placebo in an ongoing clinical trial, received 12 days of inpatient substance abuse treatment followed by 6 weeks of outpatient cognitive behavioral therapy. Polysomnographic recording was performed on consecutive nights during the 1st and 2nd inpatient and 3rd and 6th outpatient weeks. Number of days abstinent was determined from thrice weekly urine toxicology and self-report. Polysomnographic sleep was compared between study week 1 and 2, using paired t-tests. Trajectory of total sleep time (TST) was modeled both as a linear and a quadratic function of days abstinent.
  
  
  RESULTS
  Despite reporting an improvement in overall sleep quality, polysomnographic sleep worsened from week 1 to 2. Among all participants, TST and stage 2 sleep time decreased, while REM sleep latency increased. Among participants who began the study with a positive urine test, there was also a decrease in REM and a trend for decreased slow wave sleep. TST compared to number of days abstinent (up to 54 days) was best fit with a quadratic model (p=0.002), suggesting the possibility of an improvement in total sleep time with extended abstinence.
  
  
  CONCLUSIONS
  This is the first polysomnographic characterization of sleep in a large sample of cocaine users in treatment. Present findings confirm earlier results of poor and deteriorating sleep early in abstinence, and raise the possibility of improvement after an extended abstinence.
authors: Psychiatry, Yale University School of Medicine, New Haven, CT, United States; Clinical Neuroscience Research Unit, Connecticut Mental Health Center, New Haven, CT, United States. Electronic address: Gustavo.angarita@yale.edu.
authors: G A
authors: GA
authors: Angarita
authors: Psychiatry, Yale University School of Medicine, New Haven, CT, United States; Clinical Neuroscience Research Unit, Connecticut Mental Health Center, New Haven, CT, United States.
authors: S V
authors: SV
authors: Canavan
authors: Psychiatry, Yale University School of Medicine, New Haven, CT, United States; Clinical Neuroscience Research Unit, Connecticut Mental Health Center, New Haven, CT, United States.
authors: E
authors: E
authors: Forselius
authors: Psychiatry, Yale University School of Medicine, New Haven, CT, United States; Clinical Neuroscience Research Unit, Connecticut Mental Health Center, New Haven, CT, United States.
authors: A
authors: A
authors: Bessette
authors: Psychiatry, Yale University School of Medicine, New Haven, CT, United States.
authors: B
authors: B
authors: Pittman
authors: Psychiatry, Yale University School of Medicine, New Haven, CT, United States; Clinical Neuroscience Research Unit, Connecticut Mental Health Center, New Haven, CT, United States.
authors: P T
authors: PT
authors: Morgan
mesh_terms: D000328:Adult; D019970:Cocaine-Related Disorders / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods / Q000639:trends*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017286:Polysomnography / Q000639:trends; D012890:Sleep / Q000502:physiology*; D013375:Substance Withdrawal Syndrome / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy*; D016896:Treatment Outcome
keywords: Abstinence; Clinical trial; Cocaine; Polysomnography; Sleep