The Hidden Dangers of Opioids and Sleep Apnea
Opioid addiction and abuse are at the center of a well-publicized health crisis. In 2019 opioid overdoses caused 49,860 deaths, 70.6% of all overdose deaths in that year, according to the CDC.
Research is uncovering additional risks of opioid use for people with sleep apnea. The powerful painkillers, most often used to help those with chronic pain and to manage post-operative pain, can exacerbate sleep apnea and in some cases, even cause sleep apnea where none was present prior.
“Because of the complex relationship between pain, sleep, daytime functioning, and opioid therapy, a strong collaboration between pain specialists, sleep physicians, and primary care providers is needed to optimize patient benefit and minimize complications when opioids are part of chronic therapy,” says Dr. R. Nisha Aurora, associate professor of medicine at Rutgers Robert Wood Johnson Medical School in New Jersey.
Dr. Aurora, the co-author of a paper studying the connection between sleep-disordered breathing and opioids, published in the Journal of Clinical Sleep Medicine. The study resulted in a statement on chronic opioid therapy, published by the American Academy of Sleep Medicine in November 2019 intended to make physicians aware of the risks * and guide their care for patients.
Obstructive Sleep Apnea and Opioids
Obstructive Sleep Apnea (OSA) is the most common type of sleep-disordered breathing, making up 90% of sleep apnea cases. OSA is the result of airflow cessation as a result of airway closure in spite of adequate respiratory muscle effort and is often the result of:
- excessive weight
- advanced age
- structural issues with airway
- high blood pressure
- chronic nasal congestion
- gender (men are more likely to have OSA than women)
- family history
As a depressant, opioids suppress the central nervous system and make it harder for your body to breathe while sleeping, which is compounded by sleep apnea. Research from the American Academy of Sleep Medicine (AASM) also shows a connection between long-term opioid use and the risk of respiratory depression during sleep. The powerful drugs disrupt and cause irregular breathing during sleep, while also decreasing REM and slow-wave sleep.
Central Sleep Apnea and Chronic Opioid Use
Central Sleep Apnea (CSA) is disruptive breathing while sleeping because of irregular brain function. It makes up 10% of sleep apnea cases and is typically associated with severe illnesses. Recently, there have been connections which link chronic opioid use and opioid therapy, with the development of CSA where none previously existed.
A study published in the Journal of Clinical Sleep Medicine by Shahrokh Javarheri, MD and Sanjiv Patel, MD found removing patients from opioid therapy resolved their CSA in some cases.
The study hypothesizes a connection between CSA and overdose deaths from opioids saying, “Many young individuals on opioids are found deceased in bed without any apparent cause. Opioids (at times with other drugs) are found in the bloodstream at autopsy, but the actual cause of death remains unknown. It is suspected that a terminal apnea could be a potential cause of death.”
If I Have Sleep Apnea, What Medications Should I Avoid?
If you do have sleep apnea it’s wise to avoid opioids in all forms. Opioids are any medication containing opium, the drug produced by the poppy plant, or synthetic versions which are manufactured in a lab. Opioids are commonly prescribed by physicians but are also sold illegally as heroin and more recently are being manufactured illicitly as fentanyl and added to other illegal drugs.
Prescription opioids have a high risk of addiction, abuse, and overdose. Taking too many prescription opioids can cause a person to stop breathing, which leads to death. According to the CDC, many times prescription opioid deaths also involve benzodiazepines, a central nervous system depressant. This combination is deadly, even without sleep apnea. With sleep apnea, the combination is incredibly dangerous.
Because opioids are highly addictive, they are also prone to misuse and abuse. If you are prescribed an opioid:
- Don’t take them in a dose or frequency other than prescribed.
- Don’t share your medication or use it for the purpose of getting high.
- Keep out of reach of children, teens and others for whom it isn’t prescribed.
- Only take medication prescribed to you, and take it as directed. Anyone who takes opioids, even as prescribed, is at risk of becoming addicted.
Opioids have different formulas and brand names, but the most commonly prescribed prescription opioids are:
- oxycodone (OxyCotin®)
- hydrocodone (Vicodin®)
- fentanyl (Actiq®)
Fentanyl is a powerful synthetic opioid, similar to morphine, but 50 to 100 times more potent. It is sometimes prescribed by a doctor, but more often is made illegally in a lab and added to other drugs to increase the resulting high. Even small dosages of fentanyl can be deadly.
Heroin is an opioid, and should not be taken, but is not a medication, but a drug. Many people who become addicted to prescription opioids continue to feed the addiction by using heroin.
If you or someone you love is struggling with opioid addiction, reach out for help to the Substance Abuse and Mental Health Services Administration (SAMHSA) at 1-800-622-HELP (4357).
What if I’m having surgery and have sleep apnea?
If you have sleep apnea, it’s important to know the risks of taking prescribed opioids, even if you’re not abusing them. Be sure to discuss this information with your doctor. You may require longer monitoring in the hospital with oxygen support after surgery.
When prescribed, using an opioid for a short amount of time, can be a safe way to relieve severe pain. If you are prescribed an opioid by your doctor, ask about the potential dangers because of the higher risk these drugs present for people with sleep apnea.
Continuing to follow your prescribed treatment for sleep apnea after surgery will give you the best support while you sleep and give your body the rest it needs to heal.
Not sure if you have sleep apnea?
If you are one of the 70 million Americans who suffer from a sleep disorder, 95% of whom are undiagnosed, it’s important to know the health risks of sleep deprivation including heart disease, heart attacks, stroke, depression and memory loss.
Undiagnosed and untreated sleep apnea and opioids are an even more dangerous mix. If you suspect you have sleep apnea, the best way to know is to schedule an assessment. Even if you don’t take opioid medications, better sleep leads to better health!