Chronic opioid therapy can result in a number of unwanted effects. With chronic opioid therapy, sleep architecture can change and the risk for sleep-disordered breathing can increase. To better identify those who are at risk for sleep problems, it crucial that patients are both screened and tested in order for healthcare professionals to provide the best course of treatment.
Pain and sleep will often co-exist with one another and result in a vicious cycle that keeps on repeating. When you don’t get enough sleep, pain is even more evident. When pain is worse, you are more likely to take more opioids to help alleviate pain. However, by taking opioids, you are more likely to experience sleeping problems and get even less sleep. Therefore the pain you are experiencing will be worse, and you will take more opioids, and the cycle keeps repeating itself.
The regular and chronic use of opioids can reduce sleep efficiency and disrupt sleep stage distribution. The effects of opioids on sleep are usually dose-dependent. In addition, to disrupting your sleeping quality, chronic opioid is linked to sleep-disordered breathing, like snoring, sleep-related hypoventilation, central sleep apnea, and obstructive sleep apnea.
One study found that in a sample of 200 chronic pain patients taking opioids, almost 60% of the patients experienced sleep-disordered breathing. Compared to the general population, this is much higher. Of the 200 patients, 20% had experienced central sleep apnea which less than 1% of the general population experiences.
Most often the best option for opioid-associated sleep-disordered breathing is withdrawing from opioids. However, health providers run into a challenge managing the underlying disorder while keeping the patient safe. Another treatment option is positive airway pressure therapy. This type of therapy can be quite effective for those patients with chronic pain on opioids.
Since the release of the 2016 CDC guidelines, many physicians have interpreted that the best course of action is to stop prescribing opioids or have their patients taper off from them completely. While this may be beneficial for some patients, it doesn’t apply to every single patient. In some cases, opioids and sleep work well together. Patients diagnosed with severe refractory restless leg syndrome who are prescribed opioids are able to sleep well without any complications. This is most likely due to the lower dose of opioids the patient receives.
When addressing sleep problems with opioid patients, the first thing a primary care physician should ask questions about their patient’s sleep. Questions can range from: How is your sleep? Do you suffer from insomnia? Has anyone told you that you snore? Are you sleepy during the day?
Getting the answers to these questions can help you decide if a patient on chronic opioid therapy needs to evaluated further or directed to a sleep physician.