ANCSLEEP BLOG

Opiate use is at an all-time high in the US. It is a serious epidemic in many cities, especially in Anchorage. Opiate dependency can have dramatic effects on someone’s psychological and physical health. Chronic use of opiate medications can considerably disrupt normal sleep cycles. Unfortunately, downstream effects of sleep problems can exacerbate many of the side effects of chronic opiate use, such as:

• Mood problems
• Impulsivity
• Cognitive disruptions
• Physical underperformance

Let’s look at how opiate medications affect sleep in more detail.

Relationship Between Opiate Side Effects and Sleep

Opiates are strange in that they have properties that both make us feel tired but also promote wakefulness [1]. The result is the frustrating feeling of wanting to sleep, being ready to sleep, but being unable to actually sleep well.

Hence, chronic use of opiates usually is accompanied by the following symptoms [3]:

• Insomnia:
  • Waking up feeling that sleep wasn’t restful
  • Problems staying asleep at night (characteristic of insomnia)
  • Problems falling asleep (characteristic of insomnia)
• Daytime sleepiness
• Highly vivid dreams that disrupt sleep
• General tiredness

For example, researchers at St. George’s Hospital Medical School found that opiate users [4] were:

• More than five times as likely to report difficulty falling asleep
• More than nine times as likely to report not sleeping well

It’s unclear how short-term opiate medication use may affect sleep, as well as the extent to which sleep-related side effects are a risk factor for perpetuating opiate use.

How Opiate Medications Disrupt Sleep

There are four stages to sleep. REM sleep (rapid eye movement), the fourth stage, is where:

• Memories are consolidated
• Dreams occur
• Muscles become immobilized
• 20% of total sleep occurs

The other important sleep stage is NREM (non-REM) stage three, where deep sleep occurs.

Opiates disrupt both of these stages of sleep because of their complex interaction with a chemical called adenosine – an interaction that is dose and receptor-dependent [3]. Hence, even if you take opiates and get a “full night's rest,” you may still feel physically fatigued in the morning.

Relationship Between Opiate Medications and Sleep Apnea

Prolonged use of opiates may contribute to sleep apnea. Sleep apnea is a medical condition where one breathes shallowly or experiences pauses in breathing, causing a person to wake in order to begin breathing again. This may happen many times during the night, essentially crippling one’s ability for restful sleep.

Opiates depress respiration by slowing down the breathing rate or reducing the fullness of breaths taken – resulting in decreased oxygen in the blood. For people who already have a variant of sleep apnea, or are at risk for developing it (i.e., people with obesity or diabetes), taking opiate medications can increase the risk of developing or exacerbate existing sleep apnea:

Final Thought: What to do If You’re On Opiate Medications

For many people, taking opiate medications is necessary. To see how opiate medications are affecting your ability to get restful sleep, we highly suggest that consult with a sleep specialist or get a sleep study. Please click the orange button below to take a free online sleep test and get in contact with one of our sleep health specialists.

References

[1] 6. De Andrés I, Caballero A. Chronic morphine administration in cats: Effects on sleep and EEG. Pharmacol Biochem Behav. 1989;32:519–26. [PubMed]

[2] Jason T Moore, Max B Kelz. Opiates, Sleep, and Pain: The Adenosinergic Link. Anesthesiology. 2009 Dec; 111(6): 1175-1176. [NCBI]

[3] Porkka-Heiskanen T, Strecker RE, Thakkar M, Bjorkum AA, Greene RW, McCarley RW. Adenosine: A mediator of the sleep-inducing effects of prolonged wakefulness. Science. 1997;276:1265–8. [PMC free article] [PubMed]

[4] James Elander, Sally Porter & Sally Hodson (1994) What role for general practitioners in the care of opiate Users?, Addiction Research, 1:4, 309-322, D

Shift Work and Sleep

A shift worker is anyone whose work schedule does not follow the typical 9-5 business day. The most typical example of this are businesses that operate 24 hours per day. This is increasingly common as modern demands and competition push businesses production and customer service. Millions of Americans are working non-traditional hours (about one-fifth of the US population [1]) – are you?

The most common risk of shift work are persistent sleep problems, generally resulting in either excessive sleepiness and/or nighttime sleep interruptions [2]. Only 63% of shift workers report that their work schedule allows them to get enough sleep (compared to 89% for non-shift workers) [3]. If you are a shift worker, are you getting enough sleep?

Who Suffers from Jet Lag Most?

Anyone who has traveled has dealt with jet lag. Some people cope with jet lag better than others. Some people seem to suffer from jet lag only when traveling in one direction – it’s not a problem going to a destination, but it’s a significant problem after going home.

So – who’s at risk for suffering from jet lag? Not surprisingly, people with existing sleep disorders tend to have the biggest problem with jet lag. These disorders include:

• Insomnia
• Sleep apnea
• Restless leg syndrome

The reasons people with sleep disorders are particularly at risk for jet lag is because beating jet lag is largely about:

• Having a flexible sleep schedule
• Being able to get a good night’s rest before traveling
• Being able to get a good night’s rest after traveling

If you have a sleep disorder, you know how dreamy it sounds to be able to get a good night’s rest and have a flexible sleep schedule with little to no effort. As it stands, sleep disorders have a way of making sleep a particular fragile, hard-won effort.  Here are how people with sleep disorders can beat jet lag.

Are you a night owl and your spouse is an early bird? Or, perhaps, are you the early bird and your significant other falls asleep as the sun is rising?

Many couples face the struggle of going to bed and waking at different times. In some cases, bed partners' agendas only differ by minutes. In more extreme situations, couples' waking and sleeping patterns may be completely flip-flopped.

Roughly 70% of adults living in the United States report that they share a bed with another person. Of that 70%, about 25% rise early while another 25% tend to sleep in. (The other 50% fall somewhere in between.) As these statistics show, a large number of individuals who bed share experience differences in sleep routines.

Individuals who struggle with diabetes could also be struggling with obstructive sleep apnea (OSA). Over the past two decades, more research has illuminated the fact that many symptoms of diabetes are common to those in OSA. These similarities include:

• Metabolic conditions

• Obesity

• Glucose intolerance

• Cardiovascular complications

Because both OSA and diabetes present many of the same symptoms, untreated OSA can significantly aggravate diabetes risk factors if OSA is left untreated. Fortunately, there are paths to a diagnosis and a variety of OSA treatment options available that can alleviate symptoms and potentially save lives for those suffering from OSA and diabetes.

Those who know little about sleep apnea oftentimes don't know how exactly it relates to changes in blood pressure. However, sleep apnea can cause a significant and sometimes dangerous increase in blood pressure.

Sleep apnea is defined by the National Sleep Foundation as "a sleep disorder in which breathing is briefly and repeatedly interrupted during sleep." Blood pressure is technically defined as the strength of one's blood pushing against the sides of blood vessels (also known as one's systolic blood pressure).

If an individual has untreated sleep apnea, there is a much greater chance that he or she may develop high blood pressure. Both sleep apnea and high blood pressure can lead to the development of life-threatening conditions.

More and more research is being released indicating a connection between sleep apnea and diabetes. Specifically, obstructive sleep apnea (also known as OSA and defined as when the muscles in the throat relax and block the airway during sleep) has been proven time and time again to play a direct part in causing insulin resistance, glucose intolerance, and type 2 diabetes. Individuals who are diagnosed with or may have obstructive sleep apnea are therefore at risk for developing both symptoms of OSA in addition to a long-term metabolic disorder.

Sleep apnea, a disorder where an individual's breathing recurrently starts and stops, impacts an estimated 22 million Americans. Shockingly, approximately 80% of those affected have moderate or severe obstructive sleep apnea and are undiagnosed. Given these statistics, it's alarming to know that sleep apnea can trigger side effects that can cause harm to a critical organ in your body: the brain.

In this day and age, there are plenty of reasons to stay awake. Our workaholic, technology-infused culture is constantly tempting us to sacrifice sleep for stimulation. In 2016, the Center for Disease Control published a study finding that as many as a third of adults living in the United States of America are not getting enough sleep at night.

Wayne Giles, M.D. and director of the CDC's Division of Population Health, stated, "As a nation, we are not getting enough sleep."

In the wake of this news, we're driven to ask the following questions:

• Why aren't Americans getting enough sleep?
• How much sleep do I need and why?
• What can I do to get a quality night's rest?