Opiates & Sleep


Among patients with chronic pain, more than 50% experience sleep disturbances. Some reports say as many as 70%-88% patients with chronic pain report sleep trouble. People with chronic pain and insomnia report having a poorer quality-of-life and have increased healthcare utilization.

Narcotic Use and Sleep Apnea

How your pain medication can affect your breathing

Narcotics have several effects on your respiratory system, especially during sleep. In addition to creating abnormal patterns of breathing (a phenomenon known as Cheyne-Stokes breathing) they also increase airway resistance and block your airway. This, in turn, can produce irregularities in normal breathing patterns, and gasping may occur leading to erratic breathing and significant variability in respiratory rate and effort. This is known as “ataxic” breathing and is observed in the majority of patients with long-term opiate use leading to a condition known as sleep apnea.

Sleep apnea is a serious disorder that occurs when your breathing is interrupted during sleep. People with untreated sleep apnea stop breathing repeatedly during their sleep, sometimes hundreds of times. Left untreated, sleep apnea can have serious and life-shortening consequences: high blood pressure, heart disease, stroke, automobile accidents caused by falling asleep at the wheel, diabetes, depression, and other ailments.

There are two types of sleep apnea

Obstructive Sleep Apnea (OSA) is a mechanical problem and occurs when there are repeated episodes of complete or partial blockage of the upper airway during sleep.

Central Sleep Apnea (CSA) is more challenging because the signal to the body to inhale is not being transmitted from the breathing center in the brain.

Sleep experts report that the great majority of chronic pain medication patients suffer from Central Sleep Apnea in addition to Obstructive Sleep Apnea.


Answer these simple questions. If you answer YES to 3 or more, tell your clinician.

Help is on the way!


Are you currently taking medication for pain?
Is controlling your blood pressure difficult?
Do you have trouble concentrating?
Are you often tired during the day?
Do you fall asleep while reading or watching TV?

Have you been told you snore loudly?
Have you been told that you stop breathing at night?
Do you awaken with shortness of breath?
Have you been diagnosed with sleep apnea?

If you answered YES to 3 or more questions, let your clinician know.


The Vicious Cycle

A two-way relationship exists between pain and sleep disturbances. Pain destroys sleep stability, damages sleep quality, and disrupts normal sleep. Additionally, poor quality or insufficient quality of sleep decreases your pain threshold and worsens recovery from injuries while aggravating your response to pain. This, in turn, may necessitate higher doses of pain medication further aggravating your sleep problem generating a vicious cycle.

Treatment of Opioid-Induced Sleep-Disordered Breathing

The treatment of opioid-induced sleep disordered breathing is similar to that for other causes of OSA and CSA, with continuous positive airway pressure (CPAP) being the most effective therapeutic option since opioid-induced OSA may be more stubborn to positive airway pressure (PAP) therapy alone due to the common coexistence of central events that require further management. Although CSA may resolve or diminish with CPAP therapy, persistent events often require a more sophisticated treatment known as bi-level PAP (Bi PAP) or adaptive servo-ventilation (ASV).

How does Continuous Positive Airway Pressure (CPAP) work?

CPAP is a machine that will help you breathe more easily during sleep. The machine increases air pressure in your throat so that your airway does not collapse when you breathe in. When you use CPAP, your bed partner may sleep better too. Using CPAP every night while you sleep will result in feeling rested and more alert during the day.

The CPAP machine will have one of
the following:

  • A mask that covers your nose and mouth
  • A mask that covers your nose only–(called nasal continuous positive airway pressure, or NCPAP, this type of mask is most common)
  • Prongs that fit into your nose


Long-term use of pain medications, anti-anxiety, muscle relaxants, and/or sleep aids in combination with sleep deprivation can slow your recovery.