Association between coffee, tobacco, and alcohol daily consumption and sleep/wake cycle: an actigraphy study in euthymic patients with bipolar disorders

ABSTRACT

Individuals with bipolar disorder (BD) have higher than average rates of coffee, tobacco and alcohol use. These substances may have deleterious effects on sleep quality and quantity, which may destabilize sleep/wake cycles and negatively impact the clinical course and prognosis of BD. The use of these substances may also be perceived as a self-medication attempt, for example, to induce sleep or to increase vigilance during the day. The objective of the current study was to investigate associations between the self-reported daily use of coffee, tobacco, and alcohol, and objective measures of sleep and activity patterns in adult individuals with BD. A sample of 147 euthymic individuals with BD were assessed for daily coffee, tobacco and alcohol consumption and 21 days of actigraphy monitoring. Actigraphic measures of sleep quantity and daytime activity were compared between groups classified as coffee+/coffee-, tobacco+/tobacco- and alcohol+/alcohol-, defined according to their current daily use. Then, we examined potential correlations between sleep/wake cycle parameters and the amount of daily consumption of each substance. Multivariable analyses identified associations between the use of coffee, tobacco, and alcohol and several sleep and activity parameters, such as between coffee, alcohol, and the relative amplitude of activity (respectively, p = .003 and p = .005), between alcohol and M10 onset (onset time of the 10 most active hours during the 24-h cycle) (p = .003), and between coffee and sleep duration (p = .047). This study supports the hypothesis that there is a relationship, whose direction would be bidirectional, between the daily use of these substances and the sleep/wake cycle in euthymic individuals with BD. These preliminary results require replications in other retrospective and prospective samples. They may have a clinical impact on psycho-education strategies to be proposed to individuals with BD.

KEYWORDS:

• Bipolar disorder
• coffee
• tobacco
• alcohol
• actigraphy
• sleep
• activity
• circadian rhythms

Acknowledgments

We thank the individuals with bipolar disorder who agreed to participate in this study. We thank the staff at the inclusion sites in Paris Fernand-Widal/Lariboisière and Paris-Creteil (France).

Declaration of interest

The authors report no financial affiliation or other relationship relevant to the subject matter of this article.

Supplementary material

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Additional information

Funding

This work was supported by Institut National de la Santé et de la Recherche Médicale (INSERM – Research Protocol C0829), Assistance Publique des Hôpitaux de Paris (APHP – Research Protocol GAN12). This research was also supported by the Investissements d’Avenir, program managed by the Agence Nationale de la Recherche (ANR) under reference ANR-11-IDEX-0004 and Fondation FondaMental (RTRS Santé Mentale).