Improved sleep as an adjunctive treatment for smoking cessation

Declining national rates of current tobacco use to an all-time low of 15.1% represents a public health victory. Undermining this progress, however, are smoking rates of up to 50% among high-risk, low-income populations. Current FDA-approved treatments for nicotine dependence are ineffective with 70%-95% of treatment-seekers relapsing within the first year of attempted abstinence. Thus, identification of novel intervention targets to optimize response to currently available treatments for nicotine dependence is a critical next step. One such target may be sleep disturbances and insomnia. Insomnia is a clinically verified nicotine withdrawal symptom but, to date, addressing insomnia or other sleep disturbance symptoms as an adjunctive smoking cessation therapy has yet to be fully considered. To this end, this manuscript presents a narrative review of: (a) the epidemiology of cigarette smoking; (b) sleep continuity and architecture in smokers versus nonsmokers; (c) effects of nicotine abstinence on sleep; (d) possible mechanisms linking sleep with smoking and cessation outcomes; (e) plausible adjunctive sleep therapies to promote smoking cessation; and (f) directions for future research. Taken together, this chapter will provide conceptual support for improved sleep as an adjunctive treatment for smoking cessation.