Association between cigarette smoking and quality of sleep

in Sleep Research and Insights

HEALTH CAREGIVERS: EFFECT OF SHIFTWORK ON SLEEP, VIGILANCE, AND EFFICIENCY AT WORKPLACE

Fellow research review of: “Sleep quality in cigarette smokers and nonsmokers,”research conducted by Yanhui Liao, Liqin Xie, Xiaogang Chen, Brian C. Kelly, Chang Q, Chen Pan, Mei Yang, Wei Hao, Tieqiao Liu and Jinsong Tang.

ASSOCIATION BETWEEN CIGARETTE SMOKING AND QUALITY OF SLEEP

HIGHLIGHTS:

  • Sample method was used to recruit 27,300 participants in a survey in Hunan, China. About 26 282 individuals participated in the survey to reveal the relationship between quality of sleep in cigarette smokers and nonsmokers. One of the criteria for selecting participants is that they must be above 12 years of age. The survey took about a month to complete, running from September to October. The characteristics of smokers considered were the number of cigarettes each day, how long they have been smoking, the number of times they have tried to quit, and how much they crave smoking. The category of smokers comprises individuals who have smoked more than 100 sticks in their life. These people also must have had smoke in the last 28 days to meet the criteria for the category of cigarette smokers. The aim of the study was to determine if there was a significant difference in sleep quality between individuals who smoked and those who did not.

  • Cigarettes are among the most common recreational drugs in the world. Across every continent and nation of the world, smoking cigarette is prevalent. Typically, smoking starts in the teenage years. Some may quit in their middle ages due to health complications or a decision for lifestyle modification. Others smoke until they are well advanced in age. The major components of cigarettes are nicotine, tar, and carbon monoxide, among several thousand compounds. Nicotine is a potent chemical usually indicated for addiction to smoking. A few seconds after inhaling cigarette smoke, it causes the brain to release dopamine, which causes the body to feel good. The individual may get hooked to that feeling of goodness. It alters the brain chemicals, and this may affect sleep quality. These compounds in cigarettes can be toxic, thus altering the circadian rhythm. 

  • The human body needs rest and sleep. However, sleep is a natural phenomenon that you can not escape. If, for any reason, you are getting less sleep than normal, then the whole system suffers. myAir monitors the sleep and wellness of individuals based on their activities. This research is particularly useful for individuals who smoke cigarettes. These findings offer a scientific standard for the education and recommendation for lifestyle changes for clients. We aim to ensure individuals who use the app live a satisfactory life. Adequate sleep is key in living well and maintaining a balance between the circulating hormones in the body. Nicotine is a stimulant; hence it can make one more awake. Smoking more during bedtime may disturb sleep latency and sleep patterns. Such individuals may wake up at frequent intervals before dawn. Consequently, those trying to quit may experience withdrawal symptoms, the chief of which is the inability to fall into a deep sleep. The knowledge of the interaction between the components of cigarettes and sleep pattern helps us serve our clients better.

RESULTS

Out of the initial 27,300 sample population, only 26 282 individuals responded to the questionnaires. A greater percentage of the smoking population were males. The population of smokers experienced worse sleep quality (PSQI > 5) than nonsmokers. Cigarette smoking is associated with subjective sleep quality, sleep duration, sleep latency, sleep efficiency, and daytime dysfunction.  

After controlling factors like age, BMI, gender, marital status, employment, rural and urban residency, the analysis showed that poor sleep quality was inversely proportional with cigarettes per day and positively associated with years of smoking, quit attempts, and smoking craving. On the other hand, logistic regression revealed that the odds of sleep disturbances were higher with attempts to quit and smoking cravings. 

INTRODUCTION TO THE RESEARCH

In cold regions, likewise temperate regions, cigarette smoking is common. The population of smokers is on the rise Despite the announcement that “smokers are liable to die young.” Cigarettes contain toxic and carcinogenic-cancer-causing compounds. The tobacco plant is the main ingredient in producing cigarettes. The leaves of the tobacco plant are dried and processed industrially to produce cigarettes. Nicotine, the active substance in the tobacco plant, has significant effects on the brain. 

The effects of cigarette smoking depend on various factors like frequency, urge, and dependency. However, there is no moderation to smoking cigarettes. As little as one stick per day can predispose a person to several health hazards. Smoking cigarette is one of the avoidable ways in which an individual’s health deteriorates. 

myAir focuses on promoting wellness in clients. Therefore, a comprehensive understanding of cigarette smoking history helps us serve you better. We can custom chocolate bars to meet your nutritional requirements. There are times we can make suggestions for detoxification to reduce the toxic and carcinogenic compounds in our bodies. Moreso, when the app detects a disturbance in sleeping patterns, we can generate suggestions that help you live a healthy and fulfilling life. 

It is no news that some people require a stick or two to go through the day. It helps them deal with anxiety and provides a sense of calm. However, they do not understand the implication of smoking cigarettes on their sleep pattern. myAir wellness company has qualified personnel who can suggest something else for anxiety that improves sleep patterns. Nicotine in the cigars can upset the circadian rhythm, especially if a person is trying to quit and relapses. 

We understand the relationship between cigarette smoking and sleep pattern, thanks to the evidence generated by the study conducted. We are committed to using this information for the benefit of our clients. Adequate sleep is a priority in maintaining health.

HOW CIGARETTE SMOKING AFFECTS SLEEP QUALITY

Cigarette smoking has been linked to various physical and mental illnesses. It contains chemicals that are poisonous to humans leading to cancers and heart disease. It also contains nicotine, an addictive compound that causes a major disruption to sleep quality. Regular smoking can significantly impair the quality and pattern of sleep in an individual. Prolonged exposure to cigarette smokes worsens sleep quality. It causes a disruption in the biological clock. Most times, the effects of poor sleep quality progress to include anxiety that is only relieved by more smoking and other mood disorders.

Cigarette smoking can cause inflammation of the tissues of the nose and throat. This inflammatory response is due to the irritation caused by toxic and carcinogenic compounds in the smoke. Inflammation is often accompanied by swelling, and this may restrict airflow. There is also a possibility of a collapse of muscles located behind the throat. This is common during sleep and causes a temporary inability to breathe properly in smokers. This is one of the ways that smoking affects sleep quality.

Another way smoking affects sleep quality is that nicotine causes smokers to wake up more often during the night. Smokers usually take a longer time to fall asleep, and when they do, they remain in the light sleep stage for a longer period. Staying in the light sleep stage partly accounts for easy wakefulness during the night. Furthermore, more smokers usually experience restless sleep than nonsmokers do. In addition, sleep may be interrupted by a craving for smoke. Due to the high potency of nicotine, the body craves more when the circulating amount is low.

Cigarette smokers have a shorter sleep frequency and require a longer time to fall into a deep sleep. Cigarette smoking can predispose individuals to insomnia. The factors that cause insomnia may span across physical, chemical, mental, or medical conditions. However, continuous intake of nicotine alters the chemical composition of the brain. Consequently, smokers have trouble falling asleep because nicotine stimulates their alertness center. Unfortunately, the withdrawal symptoms set in by the morning. This makes smokers restless and irritated than nonsmokers in the morning. 

EFFECTS OF CIGARETTE SMOKING ON CIRCADIAN RHYTHM

The Circadian rhythm is a 24-hour cycle that is the body’s internal clock system. It is important for maintaining balance in the body. It influences many processes, such as the release of hormones. The circadian rhythm is consistent but can be thrown off balance by several factors. For example, traveling to a location with a different time zone, say 18hours apart. The body’s internal clock takes time to reset and adjust to the day and night of the new location. There are various examples of circadian rhythms in the human body. One important of such is the sleep-wake circadian cycle. This cycle regulates how much sleep we get at night and when we wake up. In non-smokers, habits form the background for the development of this internal clock. The usual sleeping and waking pattern define the sleep-wake rhythm of an individual. 

As earlier stated, cigarettes contain nicotine, which can stimulate wakefulness. Most smokers always smoke one or two before bedtime to help them relax and fall asleep. They may feel the relaxing effect of the cigarette. However, it interacts with the brain by inhibiting the ability to fall asleep. Many smokers are addicted because of this nicotinic interaction with the brain. Certain neurotransmitters are released in the evening to relax the body and promote sleep. At dawn, stress hormone levels rise, which contribute to wakefulness. However, nicotine alters the signal from the neurotransmitters distorting the sleep-wake cycle. In addition, cigarette smokers require a longer time to fall into a deep sleep. This period of deep sleep is when the body restores and regenerates. Therefore, cigarette smokers spend more time during light sleep than nonsmokers do.

Smoking cigarette throws the sleep-wake rhythm into disharmony. Smoking affects sleep latency, and they take more time to fall asleep. Nevertheless, they spend little time sleeping compared to nonsmokers. Cigarette smokers have a shorter sleep frequency. The effect is that they do not wake up well-rested in the morning. Adequate sleep is important because it makes one revitalized and energized for the new day. However, this cannot be said for cigarette smokers. They are incapable of getting the adequate sleep that the body needs because of cigarette smoke. When the nicotine leaves their system, their body automatically carves for more. This may disrupt the length of sleep because they may wake up for a stick before going back to bed. Due to the effects of nicotine on the sleep-wake cycle, smokers tend to experience daytime drowsiness. 

CONCLUSION:  ASSOCIATION BETWEEN CIGARETTE SMOKING AND QUALITY OF SLEEP

Several studies have shown the debilitating effects of cigarette smoking on the quality, pattern, frequency, and sleep duration. Cigarette smoke contains compounds that can cross the blood-brain barrier, thus influencing the activities of the brain. The brain is responsible for voluntary and involuntary activities. Sleep pattern is influenced by the circadian rhythm, which is controlled by the brain. For cigarette smokers, they are bound not to enjoy adequate rest and sleep. Nicotine interacts with the brain to increase sleep latency, decreased sleep efficiency, sleep fragmentation, and increased daytime sleepiness. 

The only solution to enjoy sleep and adequate rest is to quit smoking. Smoking poses several health challenges to smokers and those in the immediate environment. There is a possibility that a smoker could fall asleep with a cigarette lit, and this could result in a fire outbreak. Smokers with children living in the same house expose them to several health hazards. These children may become predisposed to asthma, coughing, wheezing, and ear infections. Apart from children, any individual exposed to cigarette smoke is predisposed to one form of illness or the other. All these conditions may impair sleeping patterns in children and affect their development. In severe cases, it may cause the death of these children.

Individuals who smoke tobacco spend too much time in the stage of light sleep. Thus, they experience less time sleeping deep, and thus their bodies do not rest well. They feel tired and irritated when they wake in the morning, unlike non-smokers who wake up refreshed. 

Finally, smoking cigarette, irrespective of age, marital status, employment status, or residential area, has progressive effects on the quality of sleep. However, the frequency of consuming nicotine may influence nighttime sleep quality. The number of years a person has been smoking and the extent of cigarette craving may also affect how the sleep-wake cycle is affected by nicotine. Night-time cigarette cravings may cause a relapse for those trying to quit. Having to wake up several times in the night can be quite frustrating. Quitting smoking after several years is not a day’s journey. It requires commitment, focus, and support from friends and family. There may be a relapse after a few successful weeks of abstaining, but this is very normal. If you want to have the best sleep quality throughout life, the best choice is never to smoke. For individuals who are trying to quit but have trouble sleeping, they could try sleep therapy. 

Reference and Footnotes:

Original publication: Sleep quality in cigarette smokers and nonsmokers: findings from the general population in central China

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6591832/#Abs1title

By Yanhui Liao, Liqin Xie, Xiaogang Chen, Brian C. Kelly, Chang Qi, Chen Pan, Mei Yang, Wei Hao, Tieqiao Liu, and Jinsong Tang

Published in 2019 in China by BMC Public Health

Footnote: No potential conflict of interest relevant to this article was reported.

References:

  1. Benowitz NL. Pharmacology of nicotine: addiction, smoking-induced disease, and therapeutics. Annu Rev Pharmacol Toxicol. 2009;49:57–71. [PMC free article] [PubMed] [Google Scholar]

  2.  Baglioni C, Spiegelhalder K, Lombardo C, Riemann D. Sleep and emotions: a focus on insomnia. Sleep Med Rev. 2010;14(4):227–238. [PubMed] [Google Scholar]

  3. Banks S, Dinges DF. Behavioral and physiological consequences of sleep restriction. J Clin Sleep Med. 2007;3(5):519. [PMC free article] [PubMed] [Google Scholar]

  4. Bellatorre A, Choi K, Lewin D, Haynie D, Simons-Morton B. Relationships between smoking and sleep problems in black and white adolescents. Sleep. 2016;40(1):zsw031. [PMC free article] [PubMed] [Google Scholar]

  5. Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh sleep quality index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2):193–213. [PubMed] [Google Scholar]

  6. Babson KA, Boden MT, Harris AH, Stickle TR, Bonn-Miller MO. Poor sleep quality as a risk factor for lapse following a cannabis quit attempt. J Subst Abus Treat. 2013;44(4):438–443. [PubMed] [Google Scholar]

  7. Collaborators GT. Smoking prevalence and attributable disease burden in 195 countries and territories, 1990-2015: a systematic analysis from the global burden of disease study 2015. Lancet. 2017;389(10082):1885–1906. [PMC free article] [PubMed] [Google Scholar]

  8. Control CfDPrevention: smoking-attributable mortality, years of potential life lost, and productivity losses--United States, 2000-2004. MMWR Morb Mortal Wkly Rep. 2008, 57(45):1226. [PubMed]

  9. Cohrs S, Rodenbeck A, Riemann D, Szagun B, Jaehne A, Brinkmeyer J, Gründer G, Wienker T, Diaz-Lacava A, Mobascher A. Impaired sleep quality and sleep duration in smokers—results from the German multicenter study on nicotine dependence. Addict Biol. 2014;19(3):486–496. [PubMed] [Google Scholar]

  10. Chiu HF, Leung T, Lam LC, Wing Y, Chung DW, Li S, Chi I, Law W, Boey K. Sleep problems in Chinese elderly in Hong Kong. Sleep. 1999;22(6):717–726. [PubMed] [Google Scholar]

  11. Chung K-F, Cheung M-M. Sleep-wake patterns and sleep disturbance among Hong Kong Chinese adolescents. Sleep. 2008;31(2):185–194. [PMC free article] [PubMed] [Google Scholar]

  12. Davey A, Edwards DG, Patterson F, Grandner MA, Malone SK, Rizzo A. Sleep as a target for optimized response to smoking cessation treatment. Nicotine Tob Res. 2017;21(2):139–148. [PMC free article] [PubMed] [Google Scholar]

  13. Griesar WS, Zajdel DP, Oken BS. Nicotine effects on alertness and spatial attention in non-smokers. Nicotine Tob Res. 2002;4(2):185–194. [PubMed] [Google Scholar]

  14. Hughes JR, Hatsukami DK, Pickens RW, Krahn D, Malin S, Luknic A. Effect of nicotine on the tobacco withdrawal syndrome. Psychopharmacology. 1984;83(1):82–87. [PubMed] [Google Scholar]

  15. Haseli-Mashhadi N, Dadd T, Pan A, Yu Z, Lin X, Franco OH. Sleep quality in middle-aged and elderly Chinese: distribution, associated factors and associations with cardio-metabolic risk factors. BMC Public Health. 2009;9(1):130. [PMC free article] [PubMed] [Google Scholar]

  16. Hwang J-W, Sundar IK, Yao H, Sellix MT, Rahman I. Circadian clock function is disrupted by environmental tobacco/cigarette smoke, leading to lung inflammation and injury via a SIRT1-BMAL1 pathway. FASEB J. 2014;28(1):176–194.  [PubMed] 

  17. J-y C, J-p C, Y-c W, Li S-q, Z-z W. A new measure for assessing the intensity of addiction memory in illicit drug users: the addiction memory intensity scale. J Clin Med. 2018;7(12):467.  [PubMed] 

  18. Kim K, Uchiyama M, Okawa M, Oida T, Minowa M, Ogihara R. Lifestyles and sleep disorders among the Japanese adult population. Psychiatry Clin Neurosci. 1999;53(2):269–270. [PubMed] [Google Scholar]

  19. Kabrita CS, Hajjar-Muça TA, Duffy JF. Predictors of poor sleep quality among Lebanese university students: association between evening typology, lifestyle behaviors, and sleep habits. Nat sci sleep. 2014;6:11. [PMC free article] [PubMed] [Google Scholar]

  20. Li Q, Hsia J, Yang G. Prevalence of smoking in China in 2010. N Engl J Med. 2011;364(25):2469–2470. [PubMed]

  21. Liu X, Chen H, Bo Q-G, Fan F, Jia C-X. Poor sleep quality and nightmares are associated with non-suicidal self-injury in adolescents. Eur child & adolescent psychiatry. 2017;26(3):271–279. [PubMed]

  22. Liu X, Liu L. Sleep habits and insomnia in a sample of elderly persons in China. Sleep. 2005;28(12):1579–1587. [PubMed] 

  23. Liu X, Uchiyama M, Okawa M, Kurita H. Prevalence and correlates of self-reported sleep problems among Chinese adolescents. Sleep. 2000;23(1):27–34. [PubMed]

  24. Liu X, Ma Y, Wang Y, Jiang Q, Rao X, Lu X, Teng H. Brief report: an epidemiologic survey of the prevalence of sleep disorders among children 2 to 12 years old in Beijing, China. Pediatrics. 2005;115:266–268. [PubMed]

  25. Lohsoonthorn V, Khidir H, Casillas G, Lertmaharit S, Tadesse MG, Pensuksan WC, Rattananupong T, Gelaye B, Williams MA. Sleep quality and sleep patterns in relation to consumption of energy drinks, caffeinated beverages, and other stimulants among Thai college students. Sleep and Breathing. 2013;17(3):1017–1028. [PMC free article] [PubMed] 

  26. Milrad SF, Hall DL, Jutagir DR, Lattie EG, Ironson GH, Wohlgemuth W, Nunez MV, Garcia L, Czaja SJ, Perdomo DM. Poor sleep quality is associated with greater circulating pro-inflammatory cytokines and severity and frequency of chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) symptoms in women. J Neuroimmunol. 2017;303:43–50. [PMC free article] [PubMed] [Google Scholar]

  27. Ma L, Kou C, Chang L, Meng X, Yao Y, Shi J, Shan G, Yu Y. Sleep quality survey and related factors analysis of residents in Changchun City, Jilin Province. J Jilin Univ. 2010;36(4):787–793. [Google Scholar]

  28. Mottola CA. Measurement strategies: the visual analogue scale. Adv Skin Wound Care. 1993;6(5):56–66. [PubMed]

  29. McNamara JP, Wang J, Holiday DB, Warren JY, Paradoa M, Balkhi AM, Fernandez-Baca J, McCrae CS. Sleep disturbances associated with cigarette smoking. Psychology, health med. 2014;19(4):410–419. [PubMed]

  30. Middelkoop HA, Smilde-van den Doel DA, Neven AK, Kamphuisen HA, Springer CP. Subjective sleep characteristics of 1,485 males and females aged 50–93: effects of sex and age, and factors related to self-evaluated quality of sleep. J Gerontol Ser A Biol Med Sci. 1996;51(3):M108–M115. [PubMed] 

  31. Newman AB, Enright PL, Manolio TA, Haponik EF, Wahl PW. Sleep disturbance, psychosocial correlates, and cardiovascular disease in 5201 older adults: the cardiovascular health study. J Am Geriatr Soc. 1997;45(1):1–7. [PubMed] [Google Scholar]

  32. Nair US, Haynes P, Collins BN: Baseline sleep quality is a significant predictor of quit-day smoking self-efficacy among low-income treatment-seeking smokers. J Health Psychol. 2017:1359105317740619. 10.1177/1359105317740619. [Epub ahead of print]. [PubMed]

  33.  Peters EN, Fucito LM, Novosad C, Toll BA, O'malley SS. Effect of night smoking, sleep disturbance, and their co-occurrence on smoking outcomes. Psychol Addict Behav. 2011;25(2):312. [PMC free article] [PubMed] [Google Scholar]

  34. Phillips BA, Danner FJ. Cigarette smoking and sleep disturbance. Arch Intern Med. 1995;155(7):734–737. [PubMed]

  35. Riedel BW, Durrence HH, Lichstein KL, Taylor DJ, Bush AJ. The relation between smoking and sleep: the influence of smoking level, health, and psychological variables. Behav Sleep Med. 2004;2(1):63–78. [PubMed]

  36. Rieder A, Kunze U, Groman E, Kiefer I, Schoberberger R. Nocturnal sleep-disturbing nicotine craving: a newly described symptom of extreme nicotine dependence. Acta Med Austriaca. 2001;28(1):21–22. [PubMed] 

  37. Strine TW, Chapman DP. Associations of frequent sleep insufficiency with health-related quality of life and health behaviors. Sleep Med. 2005;6(1):23–27. [PubMed]

  38. Schubert CR, Cruickshanks KJ, Dalton DS, Klein BE, Klein R, Nondahl DM. Prevalence of sleep problems and quality of life in an older population. Sleep. 2002;25(8):48–52. [PubMed] 

  39. Tang J, Liao Y, He H, Deng Q, Zhang G, Qi C, Cui H, Jiao B, Yang M, Feng Z. Sleeping problems in Chinese illicit drug dependent subjects. BMC psychiatry. 2015;15(1):28. [PMC free article] [PubMed] 

  40. Tang J, Liao Y, Kelly BC, Xie L, Xiang Y-T, Qi C, Pan C, Hao W, Liu T, Zhang F. Gender and regional differences in sleep quality and insomnia: a general population-based study in Hunan Province of China. Sci Rep. 2017;7:43690. [PMC free article] [PubMed] 

  41. Thomas M, Sing H, Belenky G, Holcomb H, Mayberg H, Dannals R, Wagner J, Thorne D, Popp K, Rowland L. Neural basis of alertness and cognitive performance impairments during sleepiness. I. Effects of 24 h of sleep deprivation on waking human regional brain activity. J Sleep Res. 2000;9(4):335–352. [PubMed] 

  42. Tsai P-S, Wang S-Y, Wang M-Y, Su C-T, Yang T-T, Huang C-J, Fang S-C. Psychometric evaluation of the Chinese version of the Pittsburgh sleep quality index (CPSQI) in primary insomnia and control subjects. Qual Life Res. 2005;14(8):1943–1952. [PubMed] 

  43. Trenchea M, Deleanu O, Suta M, Arghir OC. Smoking, snoring and obstructive sleep apnea. Pneumologia (Bucharest, Romania) 2013;62(1):52–55. [PubMed]

  44. Wang M, Wang JW, Cao SS, Wang HQ, Hu RY. Cigarette smoking and electronic cigarettes use: a meta-analysis. Int J Environ Res Public Health. 2016;13(1):120. [PMC free article] [PubMed] 

  45. Wang G, Cheng Q, Zeng J, Bai L, Liu G-D, Zhang Y, Tan Y-Y, Pan J, Hong Z, Wang Y. Sleep disorders in Chinese patients with Parkinson's disease: validation study of a Chinese version of Parkinson's disease sleep scale. J Neurol Sci. 2008;271(1):153–157. [PubMed]

  46. Wong WS, Fielding R. Prevalence of insomnia among Chinese adults in Hong Kong: a population-based study. J Sleep Res. 2011;20(1pt1):117–126. [PubMed]

  47. Zhou X, Nonnemaker J, Sherrill B, Gilsenan AW, Coste F, West R. Attempts to quit smoking and relapse: factors associated with success or failure from the ATTEMPT cohort study. Addict Behav. 2009;34(4):365–373. [PubMed] 

  48. Zhang J, Li A, Kong A, Lai K, Tang N, Wing Y. A community-based study of insomnia in Hong Kong Chinese children: prevalence, risk factors and familial aggregation. Sleep Med. 2009;10(9):1040–1046. [PubMed]

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