The opioid epidemic in the United States has claimed the lives of over 500,000 people since 2000. But for those who depend on opioid use for long-term pain management, there is a new call for alarm. Recent research shows a concerning connection between opioid use and a variety of sleep-related breathing disorders, including obstructive sleep apnea.

Opioids are a drug class that includes synthetic opioids such as fentanyl, the illegal drug heroin and legally prescribed medications for severe pain including oxycodone, hydrocodone, codeine, morphine and others. Opioids are most often prescribed to treat moderate to severe pain resulting from various incidents ranging from headaches and back pain to post-surgical and cancer pain. According to the American Society of Anesthesiologists, opioids work by first attaching to receptors located throughout the body. These receptors block the messages of pain that travel from the spine to the brain. The result is a dulling of the perception of pain and increased feelings of pleasure. The Mayo Clinic reports that while low-dose opioids may cause feelings of drowsiness, higher doses can slow breathing and heart rate, which can be deadly. 

Opioids adversely affect the quality of sleep by disrupting the architecture or critical four stages of sleep. The “falling asleep” or drowsy stage of sleep is known as Stage One. Breathing and heart rate begin to slow and progress through the following stages. The light sleep of Stage Two is considered to be the first true stage of sleep. Stages Three and Four are considered deep sleep. According to Healthline, these stages are critical to many restorative processes, including cell regeneration, tissue repair and growth, and strengthening of the immune system. The following stage of sleep, REM (rapid eye movement), accounts for 20-25% of sleep each night and is associated with learning and memory retention. Scientists are discovering that while opioid use may help a patient fall asleep, they disrupt the REM stage of sleep, causing a disruption to the restorative deep sleep needed for overall good health. The resulting daytime sleepiness and brain fog are also associated with sleep apnea. Obstructive Sleep (OSA), the most common type of sleep apnea, occurs when the airway is blocked during sleep, resulting in interrupted breathing throughout the night. Because these interruptions cause breathing to stop and start, sometimes hundreds of times throughout the night, sleep apnea can threaten pulmonary and respiratory health.

The Cleveland Clinic Journal of Medicine confirms opioid use can contribute to sleep-disordered breathing conditions such as sleep apnea. In fact, the numbers show that 75-85% of patients taking opioids have mild sleep apnea, and about 40% have severe sleep apnea. Studies have also found a correlation between higher daily doses of the pain medication and an increase in apnea events. It is likely that patients taking more opioids have more severe sleep apnea. An article in Practical Pain Management also cites that two of the classic components of OSA, sleep fragmentation and the drop of oxygen levels in the blood, can enhance pain. 

When opioids are used and managed appropriately, they can play a successful role in pain management. The risks of opioid use must be weighed against the benefits, and for those patients who develop sleep apnea, alternative therapies for pain management should be considered and discussed with their physicians.