Diurnal variations in first lapses to smoking for nicotine patch users

Amongst those not using nicotine replacement therapy (NRT), first lapses to smoking have been shown to be more common in the afternoons and evenings than the mornings. The present study investigated whether first lapses amongst those using 16 h nicotine patches follow a similar pattern. This is of interest because 16 h patches may not provide sufficient nicotine early in the morning to meet the needs of smokers. 200 male and female smokers attended a cessation programme combining behavioural support and 16 h nicotine patches. During the first 2 weeks of smoking abstinence 70 smokers reported first lapses. The frequency of first lapses was significantly higher in the afternoons (12.00-18.00 h, 30 lapses) and evenings (18.00-24.00, 35 lapses) than in the mornings (24.00-12.00, five lapses, p < 0.001 for both comparisons). There was no detectable difference between the rates of first lapse in the afternoon and evening. In conclusion, abstaining smokers using 16 h nicotine patches are more likely to experience their first lapse in the afternoon or evening rather than in the morning. Despite nicotine patches providing limited nicotine replacement for the first few hours after waking, there is no evidence that this undermines quit attempts by failing to prevent lapses during that time.