Sleep disorder due to opioids
August 12, 2022

Opioid abuse leads to a high mortality rate, with respiratory depression being the leading cause of death. Animal and human studies suggest that opioid use can lead to sleep-disordered breathing. Opioids affect respiratory control and impair upper airway function, causing central apnea, upper airway obstruction, and hypoxemia during sleep. The presence of obstructive sleep apnea (OSA) increases the risk of opioid-induced respiratory depression. However, although the relationship between opioids and central sleep apnea is firmly established, the question of whether opioids can worsen OSA remains unanswered.


Sleep Architecture – Limited data suggest that opioids disrupt sleep architecture, despite their sedative effects. Acute opioid use causes more frequent shifts in sleep states, increased awakenings from sleep, increased non-rapid eye movement (NREM) stage 2 sleep and decreased total sleep time, amount of slow-wave sleep (stage N3), and rapid eye movement (REM) sleep.

With chronic opioid use, there is a tendency for the percentage of time spent in REM and slow-wave sleep to normalize, but there is an increase in daytime sleepiness and reported fatigue. Cessation of chronic opioid use can lead to insomnia, increased awakenings from sleep and reversion to REM, and slow-wave sleep.

What are some alternatives to opioids?

There are many non-opioid pain relievers available over the counter or by prescription, such as ibuprofen (Motrin), acetaminophen (Tylenol), aspirin (Bayer), and steroids, and some patients find that these are all they need. Other people find relief from non-drug therapies that can be used alone or in combination with medication. These include:

  • Physical therapy – A physical therapist or doctor who specializes in physical medicine and rehabilitation may be able to create an exercise program to help improve your ability to function and reduce pain. Hot tubs, ultrasound, and deep muscle massage can also help.

  • Acupuncture – You may find relief from acupuncture, where very fine needles are inserted into various places on your skin to interrupt pain signals.

  • Surgery – When other treatments are not effective, surgery can be done to correct abnormalities in your body that may be responsible for your pain.

  • Injections or nerve blocks – If you have muscle spasms or nerve pain, injections with local anesthetics or other drugs can help reduce the pain.

Many patients also find relief from massage and other relaxation techniques, as well as biofeedback, where you learn to control involuntary functions such as heart rate.