Both laypeople and care providers sometimes make the mistake of focusing on the biological and psychological effects of opiate dependency without noting other lifestyle problems. In particular, getting uninterrupted sleep is one of the most important predictors of overall mental health and well-being. Unfortunately, chronic use of heroin or opiate pain medications can seriously disrupt sleep. In turn, insufficient sleep can exacerbate many of the problems with mood, impulsivity, thinking abilities, and physical symptoms that characterize opiate dependence.
Association between Opiate Use and Sleep
Opiates cross the blood-brain barrier and bind to special receptors in brain areas associated with reward. Over time, receptors may change their sensitivity to opiate molecules. As a result, the structure and function of brain circuitry changes after long term opiate use. This causes many people using opiates to report the following symptoms:
- Insomnia or difficulty falling asleep.
- Problems staying asleep during the night
- Feeling as though sleep is fragmented or not restful
- Need to take sleep medications to get a good night of sleep
- Daytime sleepiness
- Vivid dreams that may have disturbing or unsettling content
- Difficulty concentrating at work or school because of tiredness
- Rapidly fluctuating emotions
This cluster of sleep-related symptoms is a direct result of opiates’ impact on the brain. In fact, a study conducted by researchers at St. George’s Hospital Medical School in London compared individuals experiencing opiate addiction to drug-free controls. The researchers found that opiate users were more than 5 times as likely to report difficulty falling asleep and 9 times as likely to say they didn’t get good sleep quantity or quality. Thus, sleep problems are a common condition among opiate users but may be under-assessed by medical professionals.
Physiological Explanation for Sleep Disturbance
Healthy sleep cycles through a series of stages throughout the night. Scientists can measure these stages by measuring the electrical potentials produced during sleep. Particularly important are the rapid eye movement (REM) sleep stages, in which dreams occur and memories are consolidated, and deep, restorative phases of non-REM sleep. Opiates disrupt both of these stages of sleep, setting the stage for fragmented sleep that does not leave a person feeling refreshed in the morning.
So how do opiates have their sleep disrupting effects? According to scientists at the University of Pennsylvania School of Medicine, this seems to be a result of a brain chemical called adenosine. Adenosine is the main chemical that causes us to feel sleepy. Caffeine, for example, blocks the action of adenosine to prevent us from realizing we’re tired.
Scientists now realize that opiates may have similar effects as caffeine on the adenosine system. Interestingly, opiates appear to have both sleep-promoting and wake-promoting effects. The sleep-promoting effects lead to opiates’ characteristic sedating qualities, while the wake-promoting effects disrupt ability to get a good night of sleep.
Opiates May Contribute to Sleep Apnea
One one other effect of opiates on sleep is that prolonged use may contribute to sleep apnea. Sleep apnea is a medical condition in which a person breathes shallowly or experiences pauses in breathing during sleep. These breathing pauses may occur dozens of times in an hour.
Upon waking, people with sleep apnea often report that they are very sleepy and feel as though they have not gotten enough rest. Although sleep apnea is not dangerous in and of itself, it increases risk for a variety of other medical conditions, including diabetes, cognitive problems, or daytime accidents. As a person receives treatment for opiate dependence, the symptoms of sleep apnea may gradually go away.
Despite the fact that sleep affects many aspects of daily life, health care providers often fail to ask substance users about their sleep quality. The Waismann Method center helps individuals struggling with opiates find ways to get better quality, restful sleep.
Opiates, Sleep, and Pain: The Adenosinergic Link. Anesthesiology. Retrieved, March 17, 2015.
Subjective sleep–wake parameters in treatment-seeking opiate addicts. Drug and Alcohol Dependence. Retrieved, March 17, 2015.