Using ecological momentary assessment to assess the temporal relationship between sleep quality and cravings in individuals recovering from substance use disorders.

INTRODUCTION

The causal direction of the relationship between sleep disturbance and drug cravings is unknown. Based on resource depletion literature, we hypothesized that sleep difficulties lead to cravings. We tested whether sleep quality predicts craving at the within- or between-person level, with perceived willpower as a multilevel mediator.

METHODS

We used ecological momentary assessments (EMA) to compare two models of temporal precedence. Participants in addiction treatment (N=122) were sent four surveys each day for three weeks. Participants rated previous night's sleep quality and level of cravings and willpower.

RESULTS

The between- (β=-0.18, SE=0.06) and within-person (β=-0.02, SE=0.02) effects of maximum daily craving on sleep quality were significant, as were the between- (β=-0.33, SE=0.08) and within-person (β=-0.08; SE=0.03) effects of daily sleep quality on maximum daily cravings. In the mediation analysis of the indirect effect of sleep quality on cravings via willpower, both the indirect effect for the between-person pathway (β=-0.27, SE=0.07) and the indirect within-person pathway (β=-0.01, SE=0.01) were significant.

CONCLUSIONS

EMA methodology allowed for disentanglement of the temporal relationship between sleep and cravings. We found support for the resource depletion hypothesis, operationalized by linking sleep quality to cravings via willpower. However, the magnitude of the association between sleep quality and cravings was stronger at the between-person level, suggesting a potentially cumulative effect of poor sleep on cravings. These results suggest that clinicians should ask patients about chronic sleep problems, as these may pose a risk for relapse.