Opioid Therapy and Sleep Disorders: Risks and Mitigation Strategies

Abstract

Objective Patients with chronic pain frequently experience concomitant sleep disorders. There has been controversy on whether opioids have a beneficial or deleterious effect on sleep quality, duration and efficiency. There is also concern regarding the association between chronic opioid therapy and sleep disordered breathing and the increased risk for unintentional opioid related overdose. This article provides a narrative review of the literature on the effect of opioids on sleep disorders and discusses risk assessment and mitigation strategies. Design A narrative review of the current literature on the effect of prescription opioids on sleep quality and efficiency, the relationship between opioids and sleep disorders and potential risk factors in patients with chronic pain. Results There is conflicting evidence regarding the benefit of opioids in improving sleep quality, duration and efficiency with several studies and reviews suggesting a beneficial effect of opioids on sleep and other studies demonstrating the opioids can cause sleep disturbance leading to hyperalgesia. There was credible evidence of a strong relationship between opioids and sleep disordered breathing with noted risk factors including use of methadone, high opioid dosing (> 200 mg MED) and combining opioids with benzodiazepines. Conclusions Further research is required to elucidate the effect of prescription opioids on sleep quality and pain intensity and the risks associated with opioids and sleep disordered breathing. The risk of sleep disordered breathing should be routinely assessed in patients on chronic opioid therapy.

Opioid prescribing and adverse events in opioid-naive patients treated by emergency physicians versus family physicians: a population-based cohort study

“…[18][19][20] Independent risk factors that have been associated opioidrelated harms include a history of psychiatric illness or substance use disorder, sleep disorders and the use of nonopioid medications with sedating properties, especially benzodiazepines. [21][22][23] In Research our study, a large number of patients in both the emergency physician and family physician groups had known risk factors associated with adverse outcomes related to opioid use. Nearly half of patients in both groups had documented anxiety or sleep disorders, and about one-fifth had received a prescription for a benzodiazepine within the previous 180 days (13.5% and 17.3% of emergency physician and family physician patients, respectively, had active prescriptions for benzodiazepines when they were first prescribed opioids).…”

Responsible, Safe, and Effective Prescription of Opioids for Chronic Non-Cancer Pain: American Society of Interventional Pain Physicians (ASIPP) Guidelines

“…Assessment of sleep disturbances is important in patients with chronic pain problems, specifically in the elderly. Furthermore, opioid therapy, along with other psychoactive drug therapy, may induce or exacerbate multiple sleep disturbances (571)(572)(573)(574)(575)(576)(577). Thus, conditions related to sleep disturbances, including that of obstructive sleep apnea syndrome, are crucial in assessing the patient condition prior to initiation of opioid therapy (571-577).…”

Practicing opioid-free anesthesia for laparoscopic cholecystectomy opioid-free anesthesia

“…Here we present the case of a patient who was perioperatively managed with OFA as an example that this method is reasonably used in patients with previously experienced opioid's side effects. Although opioids are the strongest analgesics and an essential part of most general anesthesias, they have numerous side-effects, short and long term consequences 2 , including respiratory depression 3 , nausea 4 , vomiting 5 , dizziness 6 , sedation 7 , ileus 7 , delirium 8 , pruritus 4 , urinary retention 7 , hyperalgesia 7,9 , opioid tolerance 7 , opioid-induced immunosuppression 10 , and sleep disorders 11 .…”