How Does Opioid
Addiction Affect Sleep?

Mary the AuthorMary Sweeney RN, BSN, CEN, ONN-CG
Updated: April 11, 2020

Opioid use and Your Sleep Cycle

When you think about opioid use, your mind probably goes to pain relief. But, did you know that opioids can affect other systems in your body? Did you know that using opioids (both prescription and illegal) can affect the human sleep-wake cycle? Opioid use affects the human body in many ways, and the sleep cycle is no exception. 

What are Opioids?

Opioids (often called narcotics) are a type of medication that are prescribed to treat pain. You may use opioids if you have had surgery recently, if you suffer from chronic pain, or if you have cancer (this is not an all-inclusive list). Opioids have several different effects, only one of which is relieving pain in the body. They come in many different forms, and can be found in both prescription form and as “street drugs” (source).  Some common examples of opioids include:

  • Prescription painkillers (oxycodone, Percocet, Vicodin)
  • Fentanyl
  • Morphine
  • Heroin
  • Cocaine

Prescription opioids can be an effective, short-term way to relieve pain. However, there is a risk in developing an addiction to them. According to the 2018 National Survey on Drug Use and Health, approximately 10.3 million people had misused opioids in the last year, with the majority of those people having misused prescription painkillers. In that same survey, it was reported that approximately 2 million people had an opioid use disorder. 

Opioids that are used recreationally are a standing problem in the United States. According to the Centers for Disease Control and Prevention, an estimated 130 Americans die each day from an opioid overdose. Injectable opioids like heroin put people at higher risk for developing diseases like HIV and hepatitis – in fact, in 2016, injectable drugs accounted for nine percent of all HIV diagnoses in the United States.

How Do Opioids Work?

Opioids decrease pain in the body by binding (attaching) to the receptors in your brain, spinal cord, and other parts of your body that receive messages of pain and blocking those messages. This means that it doesn’t take source of the pain away, but it prevents your brain from knowing it’s there. 

If you are taking opioids for an acute condition, it does not necessarily mean that you’ll become addicted to them. The risk of addiction becomes much higher if you are taking painkillers for a chronic condition. Your body may become accustomed to having a steady level of opioids in it, and you may require more narcotic medication over time to achieve the same pain relief.

Side Effects of Opioid Use

Common side effects of opioid use include:

  • Nausea
  • Vomiting
  • Constipation 
  • Sleepiness. 

While these side effects are relatively minor, opioids can also cause serious, life-threatening side effects including:

  • Slow or shallow breathing
  • Loss of consciousness
  • Slower heart rate

As we mentioned before, it’s possible that your body will become addicted to opioids – this means that your body may think that it needs opioids to survive. This can mean that over time, you’ll need more and more narcotics to achieve the same effect you got the first times you took it. Additionally, if you stop taking opioids abruptly, you may experience effects of withdrawal. Withdrawal symptoms include:

  • Feeling jittery
  • Insomnia

The Science Behind Opioid Addiction

Like we talked about earlier, opioid pain medications can be an effective way to relieve short-term pain, as long as they are used appropriately. It is not guaranteed that you will become addicted to painkillers, especially if you only take them for a couple of days. 

Addiction to opioids is more likely to happen after taking them for a couple of weeks, but that’s not a hard and fast rule for everyone – every individual reacts differently to narcotics. After regularly taking opioid medications for a couple of weeks, your body will begin to become physically dependent on them. That is, you will start to feel symptoms of withdrawal the moment the amount of opioids in your system starts to decrease. If you are physically dependent on opioids, it doesn’t necessarily mean you are addicted. For example, a cancer patient may be physically dependent on pain medications but not addicted. Addiction to pain medications is defined more by how the use of the opioid affects a person’s everyday life. When you begin using opioids recreationally, start to give up things that you enjoy or your work/family life suffers, those are signs that you may have an addiction.

How Opioids Affect Sleep

The sleep cycle has two stages: non-REM and REM (rapid eye movement) sleep. Within these two stages, there are three sub-stages. Here’s a quick breakdown:

Stage 1: This first stage of NREM sleep is very light, lasting only a few minutes or so. Here, your body is preparing to fall into a deeper sleep, your eye movements slow down, and your brain begins producing alpha and theta waves. During this stage, you can be awoken easily since you’re only lightly sleeping.

Stage 2: During this NREM stage, you’re lightly sleeping but your heart rate slows down, your muscles relax significantly and your body temperature decreases slightly. Eye movements will slow down during this stage, and your brain waves slow down with occasional increases in activity. 

Stage 3: This NREM stage is restorative sleep, the kind that makes you feel refreshed. If someone were to wake you up during this stage, you would likely feel disoriented for a few minutes before realizing your surroundings. Our eye movements slow down or stop, and it’s very difficult to wake us up. This stage is an important one – it’s where your body starts repairing muscle, strengthening your immune system, and other vital processes. 

Rapid eye movement (REM) sleep: During REM sleep, our eye movement increase dramatically, like the name suggests. REM sleep is the stage where dreaming happens, and researchers think that the rapid eye movements may be related to the dreaming that you’re doing. During this stage, most of your muscles are in a paralyzed state to keep you from acting out your dreams. 

You’d think that because opioids cause sleepiness, they would be good for your sleep cycle. Unfortunately, that’s simply not the case. You may feel more tired than usual and fall asleep more easily after taking an opioid medication, but the quality and quantity of your sleep will be affected negatively. Here are a few reasons why:

Your breathing slows down. Even at a regular dose, narcotic medications can cause your breathing to slow slightly. They may also cause you to take slightly shallower breaths, meaning you get a little less oxygen than you would if you were breathing normally. Research has shown that even one dose of a narcotic medication can cause you to develop sleep apnea, even if you didn’t have it before. If you have been diagnosed with sleep apnea in the past, narcotic medications will make those symptoms worse. 

Opioid withdrawal can cause insomnia. When you withdraw from opioids, you may feel jittery, nauseous, and may have trouble falling or staying asleep. If you’re taking narcotics throughout the day, you may feel tired and may be more likely to sleep for long periods during the day – this, in turn, will make it harder for you to fall and stay asleep at night.

Breakthrough pain may wake you up. If you take opioids regularly, your body expects to have a certain level of the drug in your body at all times. If you don’t wake up in the middle of the night to take another dose, your body may begin to withdraw. If you are taking it for a short-term, acute pain issue, you may have what’s called “breakthrough pain.” That means that pain that was managed by narcotics previously may come back and be harder to get control of. A sustained level of opioid in the body will continue to block those pain receptors in the brain, and it may take a little while to get back to that level of pain control if you miss a dose.

You are addicted to opiates. If you use opioids like heroin or fentanyl recreationally, your body becomes dependent on these very quickly. With regular use, you will begin to need more of the drug to achieve the feeling of the first high you got. If you fall asleep after using opioids recreationally and sleep through when your body needs it next, you will start to feel withdrawal symptoms. Those symptoms may not wake you right away, but they will definitely disrupt your sleep cycle.

The Bottom Line

Your sleep can definitely be affected by opioid use, and even more so by opioid addiction. If you think you may be addicted to opioids, help is available. The Substance Abuse and Mental Services Administration runs a national helpline that is open 24/7, 365 days a year at 1-800-662-HELP (4357). They can refer you to treatment facilities, group and individual counseling, and family support. Additionally, you can call your doctor or go to your nearest emergency room for treatment.

References and Continued Reading