Compared with patients who do not complain of sleep problems, the patients with chronic pain and sleep issues report lower quality of life and visit healthcare providers more often. Chronic pain and disrupted sleep are commonly associated, and they share a clear cause-and-effect relationship. Pain fragments sleep, and poor sleep worsens the pain response. The prevalence of sleep disorders and the number of patients experiencing chronic pain continue to increase.
Studies have shown that long-term narcotic use causes, precipitates, or exacerbate sleep-disordered breathing; as the use of these agents continues to grow, so will the number of individuals with opioid-induced apnea.
Most Common Symptoms of OSA
- Morning headaches
- Waking up sweating
- Excessive daytime sleepiness
- Frequent trips to the bathroom during the night
- Problems staying asleep (insomnia)
- Waking up and gasping for air
- Bed partner witnesses apneas
Risk Factors/Predictors of OSA:
- Obesity/BMI >30
- Neck line circumference >17 male/>15” female
- Advanced age (0ver 40)
- Male gender
- Narrow airway
- Enlarged tonsils
- Cranio-facial abnormalities
- Retrognathia (recessed chin)
- Downs syndrome
- Shift workers and commercial truck drivers
- African-Americans have twice the risk versus Caucasians, additionally Asian ethnicity and Hispanic Women show a higher prevalence.
How do Sleep Disturbance and Chronic Pain Inter-relate?
- A bidirectional relationship exists between pain and sleep disturbances.
- Among patients with chronic pain, more than 50% experience sleep disturbances. Some reports say as many as 70%-88% of patients with chronic pain report sleep trouble.
- In patients with fibromyalgia, complaints of poor sleep quality and fatigue are more prominent than pain. The prevalence of insomnia, restless legs syndrome (RLS), and hypersomnia are higher among patients with fibromyalgia than within the general population. Similarly, OSA is significantly more common, with observed rates of 46%-80% reported among patients with fibromyalgia.
- Several studies have shown a marked increase in sleep-disordered breathing with both acute and chronic use of narcotics, regardless of the agent used, dose, duration of therapy, or individual risk factors for OSA.
- Studies have shown a higher than expected prevalence of sleep disordered breathing in opioid-treated chronic pain patients. Obstructive and central sleep apnea syndromes occurred in the studied population at a far greater rate (75%) than is observed in the general population where obstructive sleep apnea is known to be under-diagnosed but has been estimated at roughly 2% to 4%. Narcotics are often used to treat pain, and these drugs are known to affect breathing.
- Treating sleep-disordered breathing in chronic pain patients who are taking pain medications that affect breathing can improve pain levels and overall quality of life, and it may also reduce healthcare usage for chronic pain patients.
Detailed references available upon request.