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Introduction
An estimated 75-80% of smokers who attempt to quit will relapse within six months of initiating abstinence (Zhou et al., 2009). Predictors of smoking quit attempts and relapse include demographic, psychological, biological and behavioural factors (Hyland et al., 2004; Vangeli, Stapleton, Smit, Borland, & West, 2011). Sleep disturbance is emerging as a potential neurobiological factor in smoking relapse (Brower & Perron, 2010; Peters, Fucito, Novosad, Toll, & O'Malley, 2011). In this randomised pilot study we evaluated the effects of a standard smoking counselling intervention in comparison with counselling enhanced with cognitive-behavioural therapy for insomnia on smoking and sleep outcomes.
Compared to non-smokers, smokers are at increased risk for insomnia and poor sleep quality (Jaehne et al., 2012; Riedel, Durrence, Lichstein, Taylor, & Bush, 2004; Wetter & Young, 1994). Among smokers, insomnia may be primary or secondary to other conditions such as depression (Ford & Kamerow, 1989) or nicotine dependence (Wetter & Young, 1994). As a stimulant, nicotine lengthens sleep latency and decreases total sleep duration, particularly during deeper sleep stages (Phillips & Danner, 1995; Soldatos, Kales, Scharf, Bixler, & Kales, 1980; Wetter & Young, 1994; Zhang, Samet, Caffo, & Punjabi, 2006). Nicotine withdrawal also fragments sleep resulting in daytime sleepiness, impaired cognitive functioning and dysphoric mood (Fortier-Brochu, Beaulieu-Bonneau, Ivers, & Morin, 2012; Hughes, 2007; Wetter & Young, 1994). These symptoms may account for many smokers' reports of awakening at night to smoke (Scharf, Dunbar, & Shiffman, 2008). In turn, smoking upon waking may have stimulating effects that further disrupt smokers' sleep (Wetter & Young, 1994).
Sleep disturbance prior to quitting smoking and during nicotine withdrawal predicts smoking cessation failure (Augustson et al., 2008; Boutou et al., 2008). Likewise, awakening during the night to smoke, a potential marker of nicotine dependence, also increases the risk for smoking relapse (Bover, Foulds, Steinberg, Richardson, & Marcella, 2008; Foulds et al., 2006; Scharf et al., 2008). Preliminary research suggests that smokers who report both awakening at night to smoke and sleep disturbance are less successful at quitting smoking (Peters et al., 2011).
Quitting smoking requires substantial self-control (Chiou, Wu, & Chang, 2013) defined as overriding impulses and resisting temptations to maximise one's long-term goals (Baumeister, Vohs, DeWall, & Zhang, 2007)....