The effect of opioids on sleep architecture

Department of Psychiatry, University of California, San Diego, USA.
Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine (Impact Factor: 3.05). 02/2007; 3(1):33-6.
Source: PubMed


The effect of opioid medications on sleep architecture has been demonstrated in patients with comorbid pain or opioid addiction. This study examined whether commonly used opioid medications have an adverse effect on sleep architecture in healthy adults.
Forty-two healthy subjects were examined with polysomnography after a bedtime dose of placebo, sustained-release morphine sulfate (15 mg), or methadone (5 mg) on each of 3 different nights in a double-blind multiple crossover study in a sleep laboratory in the General Clinical Research Center at an academic medical center.
Both opioid drugs significantly reduced deep sleep and increased stage 2 sleep (both p < .01); neither had an effect on sleep efficiency, wake after sleep onset, or total sleep time.
Single doses of oral opioid medications can significantly affect sleep architecture in healthy adults, and observed reductions in slow-wave sleep following opioid administration may have important implications for the pathogenesis of opioid-use related fatigue.

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    • "Although drowsiness and reduced arousal are commonly observed after administration of opiates [36], morphine paradoxically increases the time spent in wakefulness and decreases the time spent in REM sleep in humans [37,38]. Oral administration of morphine or methadone significantly reduces slow wave sleep and increases stage 2 of NREM sleep [39]. Opioid receptors mediate opiate-induced sleep disruptions [40,41]. "
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    ABSTRACT: Clinical and experimental evidence demonstrates that sleep and epilepsy reciprocally affect each other. Previous studies indicated that epilepsy alters sleep homeostasis; in contrast, sleep disturbance deteriorates epilepsy. If a therapy possesses both epilepsy suppression and sleep improvement, it would be the priority choice for seizure control. Effects of acupuncture of Feng-Chi (GB20) acupoints on epilepsy suppression and insomnia treatment have been documented in the ancient Chinese literature, Lingshu Jing (Classic of the Miraculous Pivot). Therefore, this study was designed to investigate the effect of electroacupuncture (EA) stimulation of bilateral Feng-Chi acupoints on sleep disruptions in rats with focal epilepsy. Our result indicates that administration of pilocarpine into the left central nucleus of amygdala (CeA) induced focal epilepsy and decreased both rapid eye movement (REM) sleep and non-REM (NREM) sleep. High-frequency (100 Hz) EA stimulation of bilateral Feng-Chi acupoints, in which a 30-min EA stimulation was performed before the dark period of the light:dark cycle in three consecutive days, further deteriorated pilocarpine-induced sleep disruptions. The EA-induced exacerbation of sleep disruption was blocked by microinjection of naloxone, mu- (naloxonazine), kappa- (nor-binaltorphimine) or delta-receptor antagonists (natrindole) into the CeA, suggesting the involvement of amygdaloid opioid receptors. The present study suggests that high-frequency (100 Hz) EA stimulation of bilateral Feng-Chi acupoints exhibits no benefit in improving pilocarpine-induced sleep disruptions; in contrast, EA further deteriorated sleep disturbances. Opioid receptors in the CeA mediated EA-induced exacerbation of sleep disruptions in epileptic rats.
    Full-text · Article · Nov 2013 · Journal of Biomedical Science
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    • "Importantly, we recognize that opioids are powerful agents to reduce postoperative pain, and rather than contraindicating their use, the aim is instead to raise awareness of the potential effects on sleep architecture, continuity, and breathing. Much evidence supports the potentially deleterious influence of opioids on sleep [31] [32] [90]. With acute administration to healthy, pain-free volunteers , opioids (morphine and methadone) reduced both SWS and REM sleep duration and promoted wakefulness [31]. "
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    ABSTRACT: Despite the substantial advances in the understanding of pain mechanisms and management, postoperative pain relief remains an important health care issue. Surgical patients also frequently report postoperative sleep complaints. Major sleep alterations in the postoperative period include sleep fragmentation, reduced total sleep time, and loss of time spent in slow wave and rapid eye movement sleep. Clinical and experimental studies show that sleep disturbances may exacerbate pain, whereas pain and opioid treatments disturb sleep. Surgical stress appears to be a major contributor to both sleep disruptions and altered pain perception. However, pain and the use of opioid analgesics could worsen sleep alterations, whereas sleep disruptions may contribute to intensify pain. Nevertheless, little is known about the relationship between postoperative sleep and pain. Although the sleep-pain interaction has been addressed from both ends, this review focuses on the impact of sleep disruptions on pain perception. A better understanding of the effect of postoperative sleep disruptions on pain perception would help in selecting patients at risk for more severe pain and may facilitate the development of more effective and safer pain management programs.
    Full-text · Article · Sep 2013 · Sleep Medicine Reviews
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    • "A large proportion (60%) of patients received opioid medications, potentially affecting their sleep. SWS has been found to be reduced by opioids, with a concomitant increase in stage 2 sleep [35]. A large percentage of patients in our study received benzodiazepines or propofol (53%) (however, only lightly sedated patients were enrolled; the mean VICS score was 27.06 (SD: 3.80)). "
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    ABSTRACT: Introduction Many intensive care patients experience sleep disruption potentially related to noise, light and treatment interventions. The purpose of this study was to characterise, in terms of quantity and quality, the sleep of intensive care patients, taking into account the impact of environmental factors. Methods This observational study was conducted in the adult ICU of a tertiary referral hospital in Australia, enrolling 57 patients. Polysomnography (PSG) was performed over a 24 hour period to assess the quantity (total sleep time: hh:mm) and quality (percentage per stage, duration of sleep episode) of patients' sleep while in ICU. Rechtschaffen and Kales criteria were used to categorise sleep. Interrater checks were performed. Sound pressure and illuminance levels and care events were simultaneously recorded. Patients reported on their sleep quality in ICU using the Richards Campbell Sleep Questionnaire and the Sleep in Intensive Care Questionnaire. Data were summarized using frequencies and proportions or measures of central tendency and dispersion as appropriate and Cohen's Kappa statistic was used for interrater reliability of the sleep data analysis. Results Patients' median total sleep time was 05:00 (IQR: 02:52-07:14). The majority of sleep was stage 1 and 2 (medians: 19 and 73%) with scant slow wave and REM sleep. The median duration of sleep without waking was 00:03. Sound levels were high (mean Leq 53.95 dB(A) during the day and 50.20 dB(A) at night) and illuminance levels were appropriate at night (median <2lux) but low during the day (median: 74.20lux). There was a median 1.7 care events/h. Patients' mean self-reported sleep quality was poor. Interrater reliability of sleep staging was highest for slow wave sleep and lowest for stage 1 sleep. Conclusions The quantity and quality of sleep in intensive care patients are poor and may be related to noise, critical illness itself and treatment events that disturb sleep. The study highlights the challenge of quantifying sleep in the critical care setting and the need for alternative methods of measuring sleep. The results suggest that a sound reduction program is required and other interventions to improve clinical practices to promote sleep in intensive care patients. Trial registration: Australian New Zealand clinical trial registry ( ACTRN12610000688088.
    Full-text · Article · Mar 2013 · Critical Care
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