Elsevier

Sleep Medicine Reviews

Volume 12, Issue 5, October 2008, Pages 381-389
Sleep Medicine Reviews

Clinical Review
Effect of illicit recreational drugs upon sleep: Cocaine, ecstasy and marijuana

https://doi.org/10.1016/j.smrv.2007.12.004Get rights and content

Summary

The illicit recreational drugs cocaine, ecstasy and marijuana have pronounced effects upon sleep. Administration of cocaine increases wakefulness and suppresses REM sleep. Acute cocaine withdrawal is often associated with sleep disturbances and unpleasant dreams. Studies have revealed that polysomnographically assessed sleep parameters deteriorate even further during sustained abstinence, although patients report that sleep quality remains unchanged or improves. This deterioration of objective sleep measures is associated with a worsening in sleep-related cognitive performance. Like cocaine, 3,4-methylenedioxymethamphetamine (MDMA; “ecstasy”) is a substance with arousing properties. Heavy MDMA consumption is often associated with persistent sleep disturbances. Polysomnography (PSG) studies have demonstrated altered sleep architecture in abstinent heavy MDMA users. Smoked marijuana and oral Δ-9-tetrahydrocannabinol (THC) reduce REM sleep. Moreover, acute administration of cannabis appears to facilitate falling asleep and to increase Stage 4 sleep. Difficulty sleeping and strange dreams are among the most consistently reported symptoms of acute and subacute cannabis withdrawal. Longer sleep onset latency, reduced slow wave sleep and a REM rebound can be observed. Prospective studies are needed in order to verify whether sleep disturbances during cocaine and cannabis withdrawal predict treatment outcome.

Introduction

“Recreational drug use” is a term for a substance use pattern that has become highly prevalent. Recreational drug users are generally well-integrated and may belong to any social class. They usually resort to illegal drugs at weekend parties, in order to reduce stress and to escape from the daily routine. Also, the substances are welcome for their socializing properties, and some of them for their enhancement of dancing capabilities.

This review considers the illicit recreational drugs cocaine, ecstasy and marijuana. Further examples of substances used in the described manner are amphetamine, methamphetamine, LSD, psilocybin mushrooms, ketamine and gamma-hydroxybutyrate. Many of these drugs, in particular cocaine, are clearly not restricted to a recreational pattern of use.

It is estimated that 42% of US American adolescents have experience with marijuana before the end of secondary school, 9% with cocaine and 7% with ecstasy.1 An estimated 4.2 million Americans are classified with current dependence on or abuse of marijuana, and almost 1.7 million with dependence on or abuse of cocaine.2 These numbers are higher than the corresponding figures for prescription-type pain relievers used nonmedically (1.6 million), prescription-type tranquilizers (400,000) and heroin (300,000).2

We carried out a search in the electronic databases Medline (since 1966), Embase, PsycINFO, Psyndex and the Cumulative Index to Nursing and Allied Health Literature (CINAHL). The key words included “cocaine”, “3,4-methylenedioxymethamphetamine”, “MDMA” and “ecstasy” as well as “cannabis”, “marijuana”, “tetrahydrocannabinol” and “THC”. These terms were entered into the databases in conjunction with the term “sleep”. Articles published until August 2007 were eligible, and reference lists of relevant articles were screened for further related studies.

Section snippets

Acute cocaine administration

The competitive inhibition of presynaptic dopamine transporters in the nucleus accumbens and prefrontal cortex, leading to an increase in dopamine availability, has been proposed to constitute the primary neurophysiologic equivalent of central cocaine effects.3 Acute subjective effects of cocaine intake are euphoria, orgiastic feelings, restlessness, motor activation and increased alertness.

Trouble sleeping is a frequently cited adverse effect of cocaine intake.4, 5 Polysomnography (PSG)

Acute and subacute ecstasy effects

3,4-Methylenedioxymethamphetamine (MDMA; “ecstasy”) is a drug that is frequently used by visitors of raves or techno parties in large dance clubs. MDMA induces rapid release of serotonin via interaction with presynaptic serotonin uptake carriers.25 MDMA also induces rapid dopamine release and binds to a variety of neurotransmitter receptors, especially serotonin 5-HT2 receptors.25 MDMA effects such as feelings of closeness to others, increased empathy and self-perception are summarized as the

Acute and chronic cannabis administration

The cannabis plant contains over 60 cannabinoids. Δ-9-Tetrahydrocannabinol (THC) is the constituent that is mainly responsible for the psychotropic effects of marijuana.36 These psychotropic effects are mediated mostly by cannabinoid CB1-receptors, which can be found in high concentrations in the frontal cortex, cerebellum and basal ganglia.37 CB1-receptors activate a variety of signal transduction pathways and interact with numerous neurotransmitters and neuromodulators. Acute subjective

Outlook

Every year, a combined 2.2 million Americans receive treatment for cocaine or cannabis abuse in specialized facilities, compared to 2.5 million alcoholics receiving specialized treatment.2 Treatment of cocaine and cannabis dependence is difficult and expensive.66, 67 More research on potential pharmacotherapies is warranted.

It can be hypothesized that the poor sleep quality during cocaine withdrawal has detrimental effects upon treatment outcome. The demonstrated impairments of vigilance and

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