Smoke at night and sleep worse? The associations between cigarette smoking with insomnia severity and sleep duration

Published:November 18, 2020DOI:



      Insomnia is a clinically verified nicotine withdrawal symptom. As nicotine is a stimulant, it is plausible that smoking at night could disturb sleep more than smoking at earlier times of the day, but this remains empirically unclear. This study examined smoking status and its associations with insomnia severity and sleep duration while considering the potential role of smoking time.


      Data were derived from the Sleep and Healthy Activity Diet Environment and Socialization study, a community-based study of 1007 adults (n nonsmokers = 818; n smokers = 189) aged 22-60 from the Philadelphia area. Smoking status and time of smoking were self-reported. Insomnia was assessed with the Insomnia Severity Index and categorized as none, mild, and moderate-to-severe. Sleep duration was assessed with one item from the National Health and Nutrition Examination Survey and categorized as very short, short, normal, and long. Ordinal and multinomial logistic regressions were used to determine the association of smoking status including smoking time with insomnia severity and sleep duration controlling for sociodemographic covariates.


      Compared to nonsmoking, smoking was associated with experiencing increased insomnia (odds ratio = 2.5, 95% confidence interval [CI] 1.9, 3.4, P < .001) as well as very short (relative risk ratio = 1.9, 95% CI 1.1, 3.3) and short (relative risk ratio = 1.5, 95% CI 1.0, 2.3) sleep (vs normal sleep duration). Night-time smoking was significantly associated with greater insomnia and shorter sleep duration.


      Findings provide evidence that smoking is associated with increased insomnia severity and shorter sleep duration, particularly nightly smoking. Sleep health should be considered in smoking cessation efforts.


      To read this article in full you will need to make a payment


        • Creamer MR
        • Wang TW
        • Babb S
        • et al.
        Tobacco product use and cessation indicators among adults—United States, 2018.
        MMWR Morb Mortal Wkly Rep. 2019; 68: 1013-1019
        • Jamal A
        • King B
        • Neff L
        • Whitmill J
        • Babb S
        • Graffunder C
        Current cigarette smoking among adults—United States, 2005-2015.
        Morb Mortal Wkly Rep. 2016; 65: 1205
        • Weinberger AH
        • Platt J
        • Jiang B
        • Goodwin RD
        Cigarette smoking and risk of alcohol use relapse among adults in recovery from alcohol use disorders.
        Alcohol Clin Exp Res. 2015; 39: 1989-1996
        • Patterson F
        • Grandner MA
        • Malone SK
        • Rizzo A
        • Davey A
        • Edwards DG
        Sleep as a target for optimized response to smoking cessation treatment.
        Nicotine Tob Res. 2019; 21: 139-148
        • Chattu V
        • Manzar M
        • Kumary S
        • Burman D
        • Spence D
        • Pandi-Perumal S
        The global problem of insufficient sleep and its serious public health implications.
        Healthcare. 2018; 7: 1
        • Domínguez F
        • Fuster V
        • Fernández-Alvira JM
        • et al.
        Association of sleep duration and quality with subclinical atherosclerosis.
        J Am Coll Cardiol. 2019; 73: 134-144
        • Fernandez-Mendoza J
        • He F
        • Calhoun SL
        • Vgontzas AN
        • Liao D
        • Bixler EO
        Objective short sleep duration increases the risk of all-cause mortality associated with possible vascular cognitive impairment.
        Sleep Heal. 2020; 6: 71-78
        • Fernandez‐Mendoza J
        • He F
        • Vgontzas AN
        • Liao D
        • Bixler EO
        Interplay of objective sleep duration and cardiovascular and cerebrovascular diseases on cause‐specific mortality.
        J Am Heart Assoc. 2019; 8
        • Short NA
        • Mathes BM
        • Gibby B
        • Oglesby ME
        • Zvolensky MJ
        • Schmidt NB
        Insomnia symptoms as a risk factor for cessation failure following smoking cessation treatment.
        Addict Res Theory. 2017; 25: 17-23
      1. American Sleep Association. Sleep and sleep disorders statistics. 2020. Available at:

        • Liu Y
        • Wheaton AG
        • Chapman DP
        • Cunningham TJ
        • Lu H
        • Croft JB
        Prevalence of healthy sleep duration among adults—United States, 2014.
        MMWR Morb Mortal Wkly Rep. 2016; 65: 137-141
        • Taddei-Allen P.
        Economic burden and managed care considerations for the treatment of insomnia.
        Am J Manag Care. 2020; 26: S91-S96
        • Hafner M
        • Stepanek M
        • Taylor J
        • Troxel WM
        • van Stolk C
        Why sleep matters-the economic costs of insufficient sleep: a cross-country comparative analysis.
        Rand Heal Q. 2017; 6: 11
      2. Centers for Disease Control and Prevention. Tobacco-related mortality. 2018. Available at:

        • U.S. Department of Health and Human Services
        Department of health and human services centers for disease control and prevention, national center for chronic disease prevention and health promotion office on smoking and health.
        The Health Consequences of Smoking: 50 Years of Progress. A Report of the Surgeon General Smoking and Health. 2014
        • Gamble S
        • Mawokomatanda T
        • Xu F
        • et al.
        Surveillance for certain health behaviors and conditions among states and selected local areas—behavioral risk factor surveillance system, United States, 2013 and 2014.
        MMWR Surveill Summ. 2017; 66: 1-144
        • Jacobs EJ
        • Newton CC
        • Carter BD
        • et al.
        What proportion of cancer deaths in the contemporary United States is attributable to cigarette smoking?.
        Ann Epidemiol. 2015; 25: 179-182
        • Xu X
        • Bishop EE
        • Kennedy SM
        • Simpson SA
        • Pechacek TF
        Annual healthcare spending attributable to cigarette smoking.
        Am J Prev Med. 2015; 48: 326-333
        • Sahlin C
        • Franklin KA
        • Stenlund H
        • Lindberg E
        Sleep in women: normal values for sleep stages and position and the effect of age, obesity, sleep apnea, smoking, alcohol and hypertension.
        Sleep Med. 2009; 10: 1025-1030
        • Zhang L
        • Samet J
        • Caffo B
        • Punjabi NM
        Cigarette smoking and nocturnal sleep architecture.
        Am J Epidemiol. 2006; 164: 529-537
        • Branstetter SA
        • Horton WJ
        • Mercincavage M
        • Buxton OM
        Severity of nicotine addiction and disruptions in sleep mediated by early awakenings.
        Nicotine Tob Res. 2016; 18: 2252-2259
        • Jaehne A
        • Unbehaun T
        • Feige B
        • Lutz UC
        • Batra A
        • Riemann D
        How smoking affects sleep: a polysomnographical analysis.
        Sleep Med. 2012; 13: 1286-1292
        • Liao Y
        • Xie L
        • Chen X
        • et al.
        Sleep quality in cigarette smokers and nonsmokers: findings from the general population in central China.
        BMC Public Health. 2019; 19: 808
        • Mehari A
        • Weir NA
        • Gillum RF
        Gender and the association of smoking with sleep quantity and quality in American adults.
        Women Health. 2014; 54: 1-14
        • Patterson F
        • Malone SK
        • Lozano A
        • Grandner MA
        • Hanlon AL
        Smoking, screen-based sedentary behavior, and diet associated with habitual sleep duration and chronotype: data from the UK Biobank.
        Ann Behav Med. 2016; 50: 715-726
        • Patterson F
        • Grandner MA
        • Lozano A
        • Satti A
        • Ma G
        Transitioning from adequate to inadequate sleep duration associated with higher smoking rate and greater nicotine dependence in a population sample.
        Addict Behav. 2018; 77: 47-50
        • Patterson F
        • Malone SK
        • Grandner MA
        • Lozano A
        • Perkett M
        • Hanlon A
        Interactive effects of sleep duration and morning/evening preference on cardiovascular risk factors.
        Eur J Public Health. 2018; 28: 155-161
        • Grandner MA
        • Schopfer EA
        • Sands-Lincoln M
        • Jackson N
        • Malhotra A
        Relationship between sleep duration and body mass index depends on age.
        Obesity. 2015; 23: 2491-2498
        • Lee J
        • Taneja V
        • Vassallo R
        Cigarette smoking and inflammation.
        J Dent Res. 2012; 91: 142-149
        • Yildiz D
        Nicotine, its metabolism and an overview of its biological effects.
        Toxicon. 2004; 43: 619-632
        • 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: 312-319
        • Sofuoglu M
        • Herman AI
        • Nadim H
        • Jatlow P
        Rapid nicotine clearance is associated with greater reward and heart rate increases from intravenous nicotine.
        Neuropsychopharmacology. 2012; 37: 1509-1516
        • Hughes J
        • Hatsukami D
        Signs and symptoms of tobacco withdrawal.
        Arch Gen Psychiatry. 1986; 43: 289-294
        • Bover MT
        • Foulds J
        • Steinberg MB
        • Richardson D
        • Marcella SW
        Waking at night to smoke as a marker for tobacco dependence: patient characteristics and relationship to treatment outcome.
        Int J Clin Pract. 2008; 62: 182-190
        • Scharf D
        • Dunbar M
        • Shiffman S
        Smoking during the night: prevalence and smoker characteristics.
        Nicotine Tob Res. 2008; 10: 167-178
        • Baker T
        • Piper M
        • et al.
        • Transdiciplinary Tobacco Use Research Center Tobacco Dependence
        Time to first cigarette in the morning as an index of ability to quit smoking: implications for nicotine dependence.
        Nicotine Tob Res. 2007; 9: 555-570
        • Spadola CE
        • Guo N
        • Johnson DA
        • et al.
        Evening intake of alcohol, caffeine, and nicotine: night-to-night associations with sleep duration and continuity among African Americans in the Jackson Heart Sleep Study.
        Sleep. 2019; 42: 1-7
        • Bastien C
        Validation of the insomnia severity index as an outcome measure for insomnia research.
        Sleep Med. 2001; 2: 297-307
      3. National Center for Health Statistics (NCHS). National Health and Nutrition Examination Survey 2013-2014. Available at:

        • Grandner MA
        • Chakravorty S
        • Perlis ML
        • Oliver L
        • Gurubhagavatula I
        Habitual sleep duration associated with self-reported and objectively determined cardiometabolic risk factors.
        Sleep Med. 2014; 15: 42-50
        • Duncan DT
        • Kawachi I
        • Redline S
        The Social Epidemiology of Sleep.
        Oxford University Press, 2019
        • Bixler EO
        • Vgontzas AN
        • Lin H-M
        • Calhoun SL
        • Vela-Bueno A
        • Kales A
        Excessive daytime sleepiness in a general population sample: the role of sleep apnea, age, obesity, diabetes, and depression.
        J Clin Endocrinol Metab. 2005; 90: 4510-4515
        • Grandner MA
        • Petrov MER
        • Rattanaumpawan P
        • Jackson N
        • Platt A
        • Patel NP
        Sleep symptoms, race/ethnicity, and socioeconomic position.
        J Clin Sleep Med. 2013; 09: 897-905
        • Zhang B
        • Wing Y-K.
        Sex differences in insomnia: a meta-analysis.
        Sleep. 2006; 29: 85-93
        • Patel SR
        • Blackwell T
        • Redline S
        • et al.
        The association between sleep duration and obesity in older adults.
        Int J Obes. 2008; 32: 1825-1834
        • Fucito LM
        • Redeker NS
        • Ball SA
        • Toll BA
        • Ikomi JT
        • Carroll KM
        Integrating a behavioural sleep intervention into smoking cessation treatment for smokers with insomnia: a randomised pilot study.
        J Smok Cessat. 2014; 9: 31-38
        • 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. 2019; 24: 1484-1493
        • Davila DG
        • Hurt RD
        • Offord KP
        • Harris CD
        • Shepard Jr, JW
        Acute effects of transdermal nicotine on sleep architecture, snoring, and sleep-disordered breathing in nonsmokers.
        Am J Respir Crit Care Med. 1994; 150: 469-474
        • Gillin JC
        • Lardon M
        • Ruiz C
        • Golshan S
        • Salin-Pascual R
        Dose-dependent effects of transdermal nicotine on early morning awakening and rapid eye movement sleep time in nonsmoking normal volunteers.
        J Clin Psychopharmacol. 1994; 14: 264-267
        • Mathews HL
        • Stitzel JA.
        The effects of oral nicotine administration and abstinence on sleep in male C57BL/6J mice.
        Psychopharmacology. 2019; 236: 1335-1347
        • Schulenberg JE
        • Johnston LD
        • O'Malley PM
        • Bachman JG
        • Miech RA
        • Patrick ME
        Monitoring the Future National Survey Results on Drug Use, 1975–2017: Volume II, College Students and Adults Ages 19–55.
        Institute for Social Research, The University of Michigan, Ann Arbor2018
        • Brett EI
        • Miller MB
        • Leavens ELS
        • Lopez S V.
        Wagener TL, leffingwell TR. Electronic cigarette use and sleep health in young adults.
        J Sleep Res. 2020; 29: 1-8