Can Opioid Addiction Negatively Affect Sleep Habits?

According to the National Institute on Drug Abuse (NIDA), individuals that have a Substance Use Disorder are 5 to 10 times more likely to also have a co-morbid sleep disorder. Long-term substance abuse physically changes the brain’s sleep architecture, disrupting both sleep patterns and quality. This causes people to rely on their substance of choice not only to function during the day, but also to sleep at night. This is particularly true of Opioid addiction, as chronic pain can prevent sleep. Many people rely on prescription Opioid medications to numb pain in order to fall asleep.

Although it may seem like Opioids help patients to induce sleep, the medications themselves can also negatively affect sleep patterns. Research has demonstrated that Opioids can actually increase wakefulness and decrease total sleep time, sleep efficiency, delta sleep, and rapid eye movement (REM) sleep. In fact, one study found that up to 85% of people taking Opioid medications suffer from some form of sleep disorder.

The Relationship Between Pain and Sleep

Among people who have chronic pain, more than half experience sleep disturbances. The relationship between sleep and pain is a two-way correlation: pain often results in disruptions in sleep and impaired sleep itself is a risk factor for pain and pain sensitivity. Whether it’s from a sore lower back or throbbing arthritis, pain can make falling and staying asleep more difficult, and may lead to more restless, lighter sleep with more frequent awakenings. Even the quiet environment of someone’s bedroom can increase the severity of symptoms and keep those with pain up at night. A poor night’s sleep then exacerbates pain symptoms into the next day, creating a vicious cycle.

Pain can be the main reason that someone wakes up multiple times a night, and this results in a decrease in sleep quantity and quality, and on the flip side, sleep deprivation can lower your pain threshold and pain tolerance and make existing pain feel worse.

Charles Bae, MD
Neurologist at the Sleep Disorders Center at the Cleveland Clinic, 2019

Human bodies are not equipped to handle intense levels of pain, which is why Opioids like Oxycodone and Morphine are available in prescription form. Opioids work by attaching to dopamine receptors in the brain, enabling the brain to better handle the pain. As such, many people turn to Opioid medications in an effort to reduce their pain to sleep at night. When someone attempts to stop taking Opioids, their pain returns and make it impossible to sleep. This leads to another vicious cycle: individuals will begin using pain medications in order to sleep and then still receive bad sleep because of the effects that Opioids have on the sleep cycle.

How Opioids Affect Sleep

One of the main ways in which Opioid medications affect sleep is that it can cause users to experience less REM sleep. It’s important that individuals get adequate, uninterrupted REM sleep as this sleep stage stimulates the area of the brain that is in charge of learning, making and retaining memories. Additionally, deep sleep (the stage of sleep where your body repairs and restores your muscles and body tissues) is essentially cut in half due to Opioid side effects. For people who use Opioids regularly, more time is spent in light sleep – which is much less restorative and reparative.

Studies have also shown that Opioids cause users to get less sleep overall and put people at an increased risk for central sleep apnea.

Additionally, sleep-related breathing disturbances from sleep apnea may become aggravated, resulting in increased impairment in daytime functioning and added risk of cardiovascular disease. All of these effects combine to cause sleep deprivation that affects those suffering from Opioid addiction both mentally and physically during the day, worsening their memory and eroding their tolerance for pain. Even without abuse, chronic as-prescribed use of Opioids can interfere with an individual’s sleep architecture to such an extent that is causes constant fatigue.

Types of Sleep Disorders Caused by Opioid Addiction

There are four different categories of sleep problems. Some people may only suffer from one type of co-morbid sleep disorder, while others have more than one of the following:

Insomnia is defined as a repeated difficulty with sleep initiation, duration, consolidation, or quality that occurs despite adequate opportunity for sleep, and results in daytime impairment. People taking Opioids suffer from sleep deprivation due to the medication side effects that lead to trouble falling asleep, difficulty staying asleep, and not getting restful sleep.
Parasomnia is a group of sleep disorders that disrupt sleep and lead to sleep deprivation, such as sleep-walking and REM Sleep Behavior Disorder. Opioids interfere with sleep patterns and can also cause individuals to engage in abnormal behaviors during sleep that are characteristic of these disorders.
Shift-Work Disorder
Shift-Work Disorder is a circadian rhythm sleep disorder that is characterized by insomnia and excessive daytime sleepiness. The sleep-disrupting effects of Opioids can cause someone to experience the intense fatigue and irregular sleep times that contribute to the disorder.
Sleep Apnea
Sleep apnea is a disorder that causes breathing to periodically stop during the night for lapses of time that can occur for up to ten seconds or more and can happen hundreds of times in a night. Opioid medications cause respiratory depression and up to 90% of long-term Opioid patients display signs of central apnea.

If you regularly use Opioids and experience any of these symptoms, you could have an Opioid-induced sleep disorder. These can cause significant issues with daytime functioning and cognitive performance. The sleep-related complications of Opioid medications can also cause individuals to fall victim to other medical conditions, including obesity and heart disease. If cutting back on your medication in order to reverse these effects causes you serious distress, then it may be time to seek professional help as you may also have an Opioid use disorder.