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

Alicia Nuñez PhD, Joshua Unbin Rhee, Patricia Haynes, Subhajit Chakravorty, Freda Patterson, William D.S. Killgore, Rebecca A. Gallagher, Lauren Hale, Charles Branas, Nancy Carrazco, Pamela Alfonso-Miller, Jo Ann Gehrels, Michael A. Grandner*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

27 Citations (Scopus)


OBJECTIVE: 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.

METHODS: 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.

RESULTS: 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.

CONCLUSIONS: 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.

Original languageEnglish
Pages (from-to)177-182
Number of pages6
JournalSleep Health
Issue number2
Early online date18 Nov 2020
Publication statusPublished - 1 Apr 2021
Externally publishedYes


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