Study: Smokers can learn to dislike cigarettes while sleeping

A study claims that smokers can be taught to dislike cigarettes while they are sleeping.

Bad smells during sleep may teach smokers to dislike cigarettes and help them cut back, a new study hints.

Smokers who were exposed to the smell of cigarettes along with an unpleasant odor during a single night of sleep smoked less for days afterward, the researchers found.

This study shows that "sleep learning can influence later wake behavior," says Anat Arzi. She's a PhD student at the Weizmann Institute of Science in Rehovot, Israel.

She presented the study at the Society for Neuroscience 2014 Annual Meeting in Washington, D.C.

Subliminal Messages

"This research stems from recent findings suggesting that novel associations can be learned during human sleep and retrieved upon awakening," Arzi said during a media briefing.

The researchers chose this method because the brain’s reward system, which is activated during addictive behavior, shares traits with the olfactory system, or sense of smell.

The study involved 76 adult smokers who wanted to quit. During 1 night in the sleep lab, they were exposed to cigarette smells and the smell of rotten fish or rotten eggs during light sleep (known as stage 2 sleep) or during "rapid eye movement" (REM) sleep, when people tend to dream. The odors didn't wake up the participants, Arzi said.

The experiment was also done while the smokers were awake. 

They kept a diary of how many cigarettes they smoked for 7 days before and 7 days after the experiment.

The linking of the cigarette smell to the rotten food smell is called aversive conditioning. The smokers who had aversive conditioning during stage 2 sleep reduced smoking by 34% in the following week. When conditioning was done during REM sleep, they cut back on smoking by 12%.

"The reduction in smoking was significantly larger and longer-lasting following conditioning during stage 2 sleep in comparison to REM sleep," Arzi said.

Aversive conditioning while smokers were awake did not lessensmoking.

"We know that behavioral approaches can help treat nicotine addiction, but none have been remarkably successful," Arzi said in a conference statement.

More study is needed to figure out whether the tactic could work as a quit-smoking aid and a potential treatment for addiction in general, she said during the briefing.

Useful Tool

Marina Picciotto, PhD, from Yale University, said the findings "could be a very useful tool to both motivate and assist people in quitting who might not otherwise have even thought about quitting. This study used smokers, but you could imagine that this could be applied to any addiction."

"We don't know yet from this early study how long the effect lasts and how useful it will be to actually induce quitting, but … the potential as a treatment is there," Picciotto said.

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Tips to get a better night's sleep

This article provides seven tips on how to get a better night's sleep, and discusses the importance of getting a good night's sleep.

"Extreme sleep deprivation may affect brain health in later life."

"Sleep may aid chronic pain sufferers."

"Sleep apnea linked with blood sugar levels"

Dr. Paul Walting, a sleep specialist in the Department of Neurology at Baystate Medical Center, acknowledged the media attention “a good night’s sleep” is getting today.

“We are learning more and more, especially with increased research being published, that lack of sleep appears to be associated with a variety of medical problems from cardiovascular disease to Alzheimer’s. We also know that lack of sleep is associated with an increase in accidents and injuries, and for kids it can affect their school performance,” Walting said. “There are so many reasons to be sleep deprived today from overwork to staying up late and watching television or surfing the Internet on your computer, to medical reasons such as a sleep disorder.”

The body requires a good night’s sleep to gain energy for the day, which is essential for cognition, mood and overall health, he added.

According to the National Sleep Foundation, newborns should be getting 12-18 hours of sleep, infants 3-11 months need 14-15 hours, toddlers 1-3 years should get 12-14 hours, preschoolers 3-5 years need 11-13 hours, school-age children 5-10 years require 10-11 hours, teens 10-17 need 8.5-9.25 hours, while adults can survive with 7-9 hours of good ZZZs.

Baystate Medical Center’s Neurodiagnostics and Sleep Center and the
American Academy of Sleep Medicine offer the following additional tips on how to get a good night’s sleep:

• Avoid nicotine, alcohol, food or drinks that contain caffeine, and any medicine that has a stimulant prior to bedtime.


• Follow a consistent bedtime routine.


• Establish a relaxing setting at bedtime.


• Avoid any rigorous exercise within two hours of your bedtime.


• Make your bedroom quiet, dark and a little bit cool.


• Don’t watch the clock at night, but use an alarm to help wake you up.


• Get up at the same time every morning.

Some people with sleep deprivation are not actually suffering from a sleep disorder that Walting and other physicians in Baystate’s Sleep Clinic treat, such as sleep apnea, insomnia or narcolepsy. Instead, it may just be a matter of prioritizing sleep over other activities.

For those with a significant sleep disorder, like Teresita Alicea, a former criminal defense attorney in Springfield, there is treatment.

“I was falling asleep in front of some of my guests that I had over for dinner or even in the afternoon,” said Alicea.

After constantly being exhausted, Alicea had enough and in 2009, after retiring from work, she decided to have a sleep study at Baystate Medical Center. The diagnosis was sleep apnea.

“After they did the testing, they found out my breathing stopped 102 times per hour,” said Alicea. Since getting her BiPAP breathing machine and face mask, she now stops breathing just 0.7x per hour.

“I’m like a new person. I can sit through a concert, I can read a book, I don’t fall asleep in conversation anymore,” she said.

One of the most common sleep disorders, sleep apnea affects more than 18 million Americans, with the most common treatment being CPAP and BiPAP machines, which some patients cannot tolerate.

Now, there is good news for those who find the machines troublesome. The FDA in May approved a pacemaker-like device that can be implanted into the chest region which zaps airways open with an electrical current. The new device, to be available on the market later this year, is for those with moderate to severe obstructive sleep apnea. The new device is not for everyone, and patients should consult with their physician about its safety and viability for them.

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Treating ADHD lowers the chance that a child will smoke

A study shows that treating ADHD lowers the chances that children with ADHD will smoke.

Children taking medications to treat attention-deficit/hyperactivity disorder (ADHD) -- such as Adderall, Ritalin and Vyvanse -- are less likely to smoke, according to a new analysis.

Kids with ADHD who were treated with these so-called stimulant medications were about half as likely to smoke as children with this disorder who weren't treated with these medications, researchers found.

"We found an association between getting treated with stimulant medications and having a lower risk of smoking in adolescence and adulthood," said study researcher Erin Schoenfelder, clinical psychologist at Duke University School of Medicine in Durham, N.C.

The study, which was funded by the U.S. National Institute on Drug Abuse, is published online May 12 and in the June print issue of the journalPediatrics.

About 11 percent of American children aged 4 to 17 have a diagnosis of ADHD, according to the U.S. Centers for Disease Control and Prevention (CDC). Children with ADHD can be impulsive, have trouble concentrating and may have other behavior problems. About 70 percent to 80 percent of children respond to stimulant medicine, according to the CDC. Behavior therapy can also help.

Experts have long known that children with ADHD have a higher risk of starting to smoke cigarettes. Teens with ADHD are two to three times more likely to smoke cigarettes than their friends who don't have the diagnosis, according to Schoenfelder, citing previous research.

But, research on the effects of ADHD stimulant medicine on the risk of smoking has been conflicting.

To try to better answer the question of whether or not these medications could help prevent kids from smoking, the Duke researchers re-analyzed the results of 14 studies of cigarette smoking and ADHD treatments. The studies included more than 2,300 children with ADHD. About 1,400 of the kids were being treated with stimulant medications, according to the new analysis.

The studies were published between 1980 and 2013. The average follow-up time was about seven years. The researchers compared the teens treated with stimulants to those who weren't to see which group was more likely to smoke.

Overall, those on medications were about half as likely to smoke as those not on the medications, Schoenfelder said.

"Those who took their medication consistently and for a longer period of time had an even lower risk of smoking," she added.

The data she analyzed overwhelmingly showed that medications appear to decrease the risk of smoking, according to Schoenfelder.

Like all medications, ADHD medicines have side effects. This analysis showed a "slight effect" on growth, she said. However, that finding must be weighed against the many positive long-term benefits, she explained.

Schoenfelder pointed out that the researchers "can't say based on this study that the treatment caused the lower rate of smoking, but there is an association we found."

However, association does not prove a cause-and-effect relationship.

One potential reason medication might have an effect is that both nicotine and the stimulant medications used to treat ADHD operate on the same pathways in the brain. They both improve the same processes that are disrupted in ADHD, according to Schoenfelder.

"Kids who have ADHD know that something is not quite right," said Dr. Trevor Resnick, chief of the department of neurology at Miami Children's Hospital, who commented on the study.

"They try to self-medicate," he explained, and "cigarettes would be an example of self-medication." As a result, children with ADHD have a much higher risk in general of turning to cigarettes, pot or illicit drugs, he said.

"What this study shows, similar to previous research, is that successful treatment of ADHD with stimulant medication decreases the risk of self-medication in these children," Resnick noted.

While stimulant medications do have several possible side effects, Resnick said, "most kids are able to tolerate" the medication.

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Smoking rates lower with ADHD treatment

A study found that treating ADHD is associated with a lower rate of smoking.

Treating attention deficit hyperactivity disorder (ADHD) with stimulant medication may reduce smoking risk, especially when medication is taken consistently, according to an analysis led by researchers at Duke Medicine.

The findings appear online May 12, 2014, in the journal Pediatrics.

"Given that individuals with ADHD are more likely to smoke, our study supports the use of stimulant treatment to reduce the likelihood of smoking in youth with ADHD," said senior author Scott Kollins, Ph.D., professor of psychiatry and behavioral sciences and director of the Duke ADHD Program. "The risk is further lowered when adherence to medication treatment is consistent, presumably since this increases the chances that symptoms are managed effectively."

ADHD is a common childhood disorder that can continue through adolescence and adulthood, and is characterized by hyperactivity, difficulty paying attention and impulsivity. It is most commonly treated with stimulant medication (such as Vyvanse or Concerta), as well as with behavior therapy or a combination of the two.

Individuals with ADHD smoke at rates significantly higher than the general population, and they often start earlier. Studies have shown that youth with ADHD are two to three times more likely to smoke cigarettes than their peers, and 40 percent of adults with ADHD smoke regularly, more than twice the rate among adults without ADHD.

Research on how stimulant medications influence smoking behaviors in individuals with ADHD has led to mixed results. Some studies suggest an increase in smoking among those treated with stimulant medications, while others showed no effect or a decrease in smoking.

"Nicotine operates on the same pathways in the brain as stimulant medications, and the relationship between stimulants and smoking has been controversial," said lead author Erin Schoenfelder, Ph.D., clinical associate and a psychologist in the Duke ADHD Program.

"It has been suggested that some people with ADHD 'self-medicate' their attention deficits using nicotine," Schoenfelder said. "Our findings show that treating ADHD effectively with medication may prevent young people from picking up the habit."

The researchers examined 14 longitudinal studies of cigarette smoking and ADHD treatment, including a total of 2,360 individuals with ADHD, making this the largest meta-analysis on the issue to date.

Some of the studies used nicotine dependence to measure smoking behaviors, although nicotine dependence may not be found in adolescents who recently started smoking. In order to capture an accurate picture of smoking behaviors, the researchers expanded their criteria beyond nicotine dependence to include smoking frequency and whether participants currently smoked.

The analysis revealed a significant association between stimulant treatment and lower smoking rates. The effect was larger in those with more severe ADHD and when participants took stimulant medications continuously.

The researchers noted that based on the design of the study, they were able to identify an association but not a causal relationship between reduced smoking risk and stimulant treatment. Additional studies are needed to determine the recommended timing and duration of stimulant treatment to help lower smoking risk.

"This study may debunk the perception that stimulants will increase one's risk for smoking," Kollins said. "It gives us more confidence when we talk with parents to reassure them that consistent ADHD treatment won't increase their children's risk of smoking, and in fact, may actually do the opposite."

"My hope is that this research can help inform our efforts to prevent negative outcomes for kids with ADHD, including cigarette smoking," Schoenfelder said. "This population hasn't been targeted for smoking prevention efforts, despite the well-known connection between ADHD and smoking."

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Genes can Predict the Brain's Reaction to Smoking and other Addictions

A new study shows that genetics may play a role in how well people respond to smoking and other addicting behaviors.

Have you ever wondered why some people find it so much easier to stop smoking than others? New research shows that vulnerability to smoking addiction is shaped by our genes. A study from the Montreal Neurological Institute and Hospital -- The Neuro, McGill University shows that people with genetically fast nicotine metabolism have a significantly greater brain response to smoking cues than those with slow nicotine metabolism.

Previous research shows that greater reactivity to smoking cues predicts decreased success at smoking cessation and that environmental cues promote increased nicotine intake in animals and humans. This new finding that nicotine metabolism rates affect the brain's response to smoking may lead the way for tailoring smoking cessation programs based on individual genetics.

Smoking cues, such as the sight of cigarettes or smokers, affect smoking behavior and are linked to relapse and cigarette use. Nicotine metabolism, by a liver enzyme, also influences smoking behavior. Variations in the gene that codes for this enzyme determine slow or fast rates of metabolism and therefore, the level of nicotine in the blood that reaches the brain. In the study smokers were screened for their nicotine metabolism rates and their enzyme genotype. Participants were aged 18 -- 35 and smoked 5-25 cigarettes daily for a minimum of 2 years. People with the slowest and fastest metabolism had their brain response to visual smoking cues measured using functional MRI. Fast metabolizers had significantly greater response to visual cigarette cues than slow metabolizers in brain areas linked to memory, motivation and reward, namely the amygdala, hippocampus, striatum, insula, and cingulate cortex.

"The finding that nicotine metabolism rate has an impact on the brain's response to smoking cues supports our hypothesis that individuals with fast nicotine metabolism rates would have a greater brain response to smoking cues because of close coupling in everyday life between exposure to cigarettes and surges in blood nicotine concentration. In other words they learn to associate cigarette smoking with the nicotine surge," says clinician-scientist Dr. Alain Dagher, lead investigator at The Neuro. "In contrast, individuals with slow metabolism rates, who have relatively constant nicotine blood levels throughout the day, are less likely to develop conditioned responses to cues. For them, smoking is not associated with brief nicotine surges, so they are smoking for other reasons. Possibilities include maintenance of constant brain nicotine levels for cognitive enhancement (ie, improved attention, memory), or relief of stress or anxiety."

Future research could focus on improving smoking cessation methods by tailoring treatments for different types of smokers. One possibility is to measure the rate of nicotine metabolism as part of the therapeutic decision-making process. For example, targeting cue-induced relapse risk may not help those with slow nicotine metabolism, who are more likely to benefit from long-acting cholinergic drugs such as the nicotine patch, consistent with previous clinical trials. Conversely the use of non-nicotine based therapies aimed at reducing craving may help fast metabolizers, as demonstrated for buproprion, an anti-depressant that has been used for smoking cessation.

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Impulsiveness Has Different Brain Localization in ADHD Than Substance Use

Teens with attention-deficit/hyperactivity disorder (ADHD) and teens who start using cigarettes, drugs or alcohol tend to share at least one personality trait: impulsiveness, experts say.

But a new brain-imaging study of nearly 1,900 14-year-olds finds that the brain networks associated with impulsivity in teens with ADHD are different compared to those who use drugs or alcohol.

What that finding suggests is that multiple underlying mechanisms drive impulsivity -- in other words, the impulsivity that leads kids to blow off their homework and the impulsiveness that drives kids to take a drag off a joint aren't the same, neurologically speaking.

"The behavior of the two groups might look the same, but it's driven by different brain networks," said lead study author Robert Whelan, a postdoctoral research fellow at the University of Vermont.

Moreover, the findings, published in the April 29 online issue of Nature Neuroscience, could suggest that the brain is primed to push some teens -- but not others -- toward substance abuse.

ADHD is a neurobehavioral disorder marked by excessive levels of activity, inattention and impulsiveness beyond what's normal for a child's age.

People with ADHD are at higher risk of substance abuse and alcoholism. The explanation was thought to lie in the lack of self-control or inability to curb impulses that are part of the disorder, Whelan said.

But the brain-imaging study suggests that from a neurological standpoint, ADHD and substance use may not be nearly as closely tied as previously believed, Whelan said.

In the study, researchers used data from an ongoing study of European teens who underwent brain imagining tests every two years starting at age 14. The youths were asked about symptoms of ADHD and if they had tried alcohol, cigarettes or other drugs.

While having their brains scanned, the students took a test used to measure self-control, or inhibition: Participants were told to press a button when they saw a right or a left arrow flash on a screen, but not to press the button when the arrow pointed up.

The kids with ADHD and those who had tried various substances didn't perform any worse on the test of self-control than other kids. However, researchers did find distinct patterns of brain activity in ADHD and in kids who'd tried alcohol, cigarettes or drugs while taking the test.

Among the kids who had tried alcohol, cigarettes or other drugs (mostly marijuana), scans showed different patterns of brain activity in the right inferior frontal gyrus and in the orbital frontal cortex compared to teens who had abstained. Prior research has found the inferior frontal gyrus is involved with inhibition. For example, people with head injuries that damaged that area of the brain have problems with inhibition, Whelan said, while the orbital frontal cortex has been implicated in drug use.

Even teens who reported having only tried a drink or two by age 14 showed a different pattern of activity in the orbital frontal cortex, suggesting the brain differences aren't caused by the substances, but are already present and play a role in what drives certain teens to experiment with alcohol and others to abstain, Whelan said.

In the teens who had symptoms of ADHD, different networks lit up during the self-control test. Kids with ADHD symptoms showed differences in the bilateral frontal lobe and the basal ganglia.

"The fact that we found there were different networks lends credence to the argument that ADHD and substance abuse are not so tightly coupled," Whelan said.

Dr. Lukshmi Puttanniah, director of child and adolescent psychiatry at Lenox Hill Hospital in New York City, said the study strongly suggests that impulsiveness can have many underlying explanations.

"It's adding to a body of knowledge that the fundamental thing underlying both ADHD and substance use is difficulty controlling impulses," Puttanniah said. "Some people thought that whatever neurobiological pathway that underlies it is common between ADHD and substance abuse. But what this study shows is the neurobiological pathways underlying the impulsivity of ADHD and substance use disorders are actually distinct."

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