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    • Given the Figs and Table it was found that

    2018-10-26

    Given the Figs. 1–3 and Table 2, it was found that the quality of sleep did not change considerably within the subacute phase of amphetamine withdrawal syndrome rather the early days of the treatment. McGregor et al. pointed that the subacute phase of methamphetamine withdrawal syndrome is characterized by the slighter symptoms of the acute phase syndrome [34]. But in the present study, sleep disturbances remained in subacute phase and no improvement was observed between the first and second evaluation of sleep quality (P=0.63). Even it seems that some patients have experienced worse sleep quality in subacute phase of withdrawal that the acute phase, therefore in patients with methamphetamine dependence disorder, even fourteen-day duration after the last use of the drug is not sufficient for restoring the neurobiological damages in metabolic enzymes centers regulating the sleep-wake cycle and the patients could not clinically feel any improvement in their quality of sleep. Thus, it can be concluded that the neuronal damage is intensive and the recovery phase is slow for those who suffer from methamphetamine-induced sleep disorders. It is noteworthy that due to polysomnography protocols it is recommended that the patients with the background of stimulant use should stop using the drug at least for one week before polysomnography. Based on the given results, it seems that polysomnographic evaluation for the methamphetamine users should not be conducted even in the second week of abstinence. Also, the positive correlation between sleep disorders and craving in patients with methamphetamine dependency demonstrates the importance of managing patients\' sleep problems during either acute or subacute phases of the treatment. Results showed that more than half of the participants still suffered from the severe disturbances in their sleep even in the fifth week after reaching abstinence from amphetamines and amphetamine-like derivates. This finding does not support the results observed after prescribing amphetamines for the rhesus macaque. In a study conducted on methamphetamine self-administration in the rhesus macaque, Anderson et al. showed that the quality of sleep will be normal again immediately after stopping methamphetamine prescription [7]. A disturbed sleeping condition lingering for more than a month after quitting methamphetamine showed that in methamphetamine dependents, behavioral symptoms attributed to withdrawal from methamphetamine are not simply an opposite form of behavioral symptoms which are present in the course of using these drugs. This can support the hypothesis that the neurobiological pathways affecting by using drugs, which are in charge of the behavioral phenomena of substance use disorders, are separated from those affecting during withdrawal syndromes. It seems that a kind of adaptation is developed in sleep-wake cycle-related systems in brain during abusing amphetamine and amphetamine-like substances, so withdrawal from methamphetamine is not simply an opposite form of using it. According to some studies, this adaptation is caused by the formation of a secondary pacemaker as an opponent process to regulate sleep-wake cycle out of the suprachiasmatic nucleus. As a result, quitting amphetamines, while activation of the opponent processes remained in this system, results in some more durable symptoms in patients\' sleep-wake cycle [13]. Present study showed that the patients\' quality of sleep variation was independent from the patients\' affective symptoms. These affective symptoms could be generated in the patients of residential centers, because of a maladaptive reaction to a strange and not familiar environment which staying at, because of the natural course of abstinence of any drugs which affect the reward pathway and stress axis of the human brain or because of stopping any beloved and habitual behavior. Within five weeks of this study, not only the quality of sleep was improved, but also the severity of depression and anxiety reported by patients was reduced. The results demonstrated that only 15% of the recovery occurred in patients\' sleep quality can be attributed to their reduced depression and anxiety symptoms within the first four weeks of quitting methamphetamine (Table 4). Regarding this fact that the current data are not sufficient to understand how amphetamine users’ sleep pattern changes, the above finding seems to be the most important finding of the present study. The independent recovery of sleep quality in methamphetamine users not only highlights the independent neurobiological damages caused across the brain circuits linked to sleeping process, but also revives hopes to treat the sleep disorders in patients with amphetamine dependency. Although more than half of the participants still suffered from sleep disorders within the fifth week after quitting amphetamines, it must be considered that their sleep quality was improved significantly (P=0.00). Since we used the cut-off score of 5 for PSQI, the eight-score reduction in the average score of patients\' sleep quality (according to Tables 2, 13.6±3.3change into 5.5±2.6, which is close to the cut point of 5), can support a good prognosis for amphetamine-induced sleep disorder. However, the amphetamine addicts need to be warned about the long period of time needed to reach full recovery.