Thanks to S. Black for a good synposis and integration of two recent threads. I have been describing to students the newer findings on 'REM/dream isomorphism' (or lack thereof) since I learned of them here on TIPS. This is another example for students of the lag time between the publication of important primary research, and the inclusion of such information in textbooks. . . due, perhaps at times, to the resistance of mainstream science to new data or perspectives (the old skepticism - humility balance again). . . or as E. Pollack pointed out, just simply the lack of time to keep up with it all ! This is one reason I have found time spent with TIPS so useful. The references provided previously by nicotine researchers on the topic of dreams following nicotine withdrawal and/or patch treatment are: (see Hajek, P. & Belcher, M. (1991) The dream of absent-minded transgression. A cognitive withdrawal symptom. Journal of Abnormal Psychology, 100, 497 491). Leischow, S.J., Valente, S.N., Hill, A.L., Otte, P.S., Aickin, M., Holden, T., Kligman, E., & Cook, G. (1997). The effects of nicotine dose and administration method on withdrawal symptoms and side effects during short-term smoking abstinence. Experimental and Clinical Psychopharmacology, 5(1), 54-64. I am also forwarding (with Glover's permission, of course) a message from the SRNT listserv that summarizes the previous comments concerning nicotine and dreams. The information is primarily clinical and anectodal, but even S.B. has argued on occasion for the relevance of case studies. If anyone is interested, I can send another nicotine researcher's description of a multivariate experiment, designed to clarify the as of yet ambiguous relationship between nicotine and dreams. Subj: Weird Dreams Date: 2/16/99 12:27:58 PM Eastern Standard Time From: [EMAIL PROTECTED] (Elbert Glover) Sender: [EMAIL PROTECTED] (Nicotine, tobacco , and smoking) Reply-to: [EMAIL PROTECTED] To: [EMAIL PROTECTED] To the SRNT Listserv: In the patch clinical trials we've conducted, we found vivid/weird dreams both in persons using the patch and persons on placebo, however, always statistically significant in favor of active subjects versus placebo subjects. Persons using the patch are receiving nicotine when they typically don't smoke (night), therefore--vivid/weird dreams which are usually accompanied by insomnia. A logical response to this situation is to remove the patch before going to bed as Saul suggested. Moreover, we also find vivid dreams with persons on placebo as Liro suggested. I find that most smoking cessation interventionist immediately upon hearing of the patient experiencing weird/vivid dreams, or insomnia, assume that it's too much nicotine and have the patient remove the patch before going to bed or reduce to a lower dose patch, again logical. However, we tend to forget that nicotine withdrawal can cause weird dreams as well (as Liro noted), so how can you tell if the weird dreams are the result of getting too much nicotine (overdose) or too little (withdrawal)? Our experience is that rather than overreact and have the patient remove the patch or reduce the amount of nicotine by moving to a lower dose patch that through simple probing that you try to determine whether the problem is too much or too little nicotine. We find, though not proven as of yet, that persons who are having difficulty with insomnia and the vivid/weird dreams usually have two types of insomnia problems: (1) having difficulty falling asleep or (2) waking up earlier than normal. Through simple probing of the insomnia problem, we find that persons who are accustomed to going to bed at say, 10pm and are now having difficulty falling asleep, that this is typically the result of too much nicotine so you have the patient remove the patch before going to sleep or have them titrate to a lower dose patch (Saul's suggestion). However, if the person is accustomed to say, waking up at 6am and is now waking at 4am (earlier than normal) then this is the result little nicotine (Liro's inference), so the patch you are using may not be providing sufficient nicotine replacement to assist with withdrawal therefore, we provide higher doses of the patch. So if the patient is wearing a 21mg patch, we move them to 28mg (2 patches). Even though 22mg is the highest dose patch, there are researchers and clinicians on record as having used much higher doses than 22mg per day to reach sufficient levels of NRT to stop withdrawal and ultimately increase efficacy. I realize that I'm stepping outside of FDA indication but we have found this to work for us. If I remember correctly, in a conversation several years ago with Dr. John Hughes (I could be wrong, so please correct me John) that he also found that through simple probing (as suggested) that he too could determine whether the insomnia (and ultimately vivid dreams) was the result of too much or too little nicotine. Has anyone found similar experiences? Glover Elbert D. Glover, PhD, FAAHB Professor, Department of Behavioral Medicine & Psychiatry Professor, Department of Family Medicine Director, Tobacco Research Center Mary Babb Randolph Cancer Center West Virginia University School of Medicine Robert C. Byrd Health Sciences Center 1 Medical Center Drive, PO Box 9300 Morgantown, WV 26506-9300 Voice: 304-293-7597 Fax: 304-293-4693 ****Please visit our Tobacco Research Center web site: http://www.hsc.wvu.edu/mbrcc/tobaccoresearch.html ****Visit the American Academy of Health Behavior web site: http://www.ajhb.siu.edu ****************************************************************************** * Sandra Nagel Randall, Ph.D. Wayne County Community College District, MI Department of Human and Community Development Athabasca University, Alberta, Canada Biopsychology Consultant [EMAIL PROTECTED] Off: 248-948-8162 Fax: 248-948-5090 <A HREF="http://members.aol.com/snrandall">http://members.aol.com/snrandall </A> ****************************************************************************** *****
