The Relation Between Cigarette Smoking and Sleep Disturbance

Background. There is little epidemiological or clinical information on the relation between smoking and sleep disturbance, despite evidence suggestive of a relationship. The present study tested the hypothesis that cigarette smoking is associated with sleep disturbance. Methods. Survey data from 3,516 adults were collected as part of a longitudinal, epidemiologic study of sleep-disordered breathing. Symptoms of insomnia, hypersomnia, and parasomnia were assessed using diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., revised). Results. Among both mates and females, smoking was associated with difficulty initiating sleep, and difficulty waking up. Excessive daytime sleepiness was related to smoking only for females while nightmares and disturbing dreams were related to smoking only among males. Conclusions. Smoking was associated with difficulty initiating sleep and with a constellation of symptoms suggestive of sleep fragmentation. Sleep disturbance may be more prevalent among smokers due to the stimulant effects of nicotine, nightly withdrawal, an increased prevalence of sleep disordered breathing relative to nonsmokers, and/or an association with psychological disturbance. These results have important clinical and public health implications for reduction of the disease and disability associated with smoking and sleep disturbance.