By Stephanie James

Addiction and issues with sleep are closely related. Each affecting the other, either with
sleep issues and pain leading to addiction or addiction (and recovery) contributing to a
range of sleep disorders. Opioid addiction and abuse is now an epidemic affecting North
America, Australia and other western countries. What oftentimes starts out as a form of
pain management or a sleep aid, can quickly grow into an addiction that adversely impacts
sleep, digestion and relationships.

How Opioids Affect Sleep Health
Opiates work by blocking opiate receptors in the brain, thus promoting the release of
dopamine, the chemical that induces feelings of well-being and pleasure. While this makes
them great for pain relief, the other side of the opiate coin is the disruption to sleep
architecture, which on its own can exacerbate pain and cause hyperalgesia. This can
encourage an opiate user to increase their dosage, and in turn increases their risk of addiction; creating a cycle of poor sleep, increased pain and further increases in opioid
use.

Sleep Stages and Opiates
When we slumber through the night, we cycle through four stages of sleep. Stage one is
the lightest stage, Non-REM (NREM) sleep, and is easily disrupted. Stage two is slightly
deeper than the first stage and includes sleep spindles and K-complexes. Sleep spindles
are believed to inhibit mental processing to aid the continuation of a tranquil state while
the K-complexes that follow sleep spindles are thought to be a reaction to external
stimuli.

Stage three is also referred to as deep NREM and the most restorative phase of the sleep
cycle. This is when various chemicals and hormones are released to restore our bodies and
muscles from the day’s activities. It is also the time when it is most difficult to wake
someone.

The final stage of the sleep cycle is Rapid Eye Movement (REM) and when our most vivid
dreams take place. Muscle paralysis is a natural part of the REM sleep stage and prevents
us from acting out our dreams. It is thought this is also beneficial in consolidating
memories, emotional responses and learning.

All opioid use has an adverse effect on sleep architecture, reducing the amount of time
spent in the deeper stages of sleep by around 50% and increasing the time spent in lighter
stages of sleep. Those suffering from addiction or recovery miss out on the restorative
effects of deep sleep making them more prone to clinical depression, issues with their
immune system and cognitive ability.

Managing Sleep Disorders Associated with Opiate Use
A range of different sleep disorders have been associated with opiate use and abuse;
opioid withdrawal and sleep patterns are even regulated by some of the same brain
regions and neurochemical systems. Insomnia, parasomnia, daytime sleepiness and a
combination of all three issues are common in people who use opioids. Learning to
manage these disorders when taking opioids, or recovering from opioid addiction, is
integral to reaching full recovery. A few simple changes in behavior can help address sleep
issues, these include:

Regular exercise has a number of benefits for people experiencing problems with sleep – a
post-exercise drop in body temperature, decrease in anxiety and depression, and the ability to adjust the timing of circadian rhythms can all work to improve sleep quality and
quantity.

A sleep routine works to regulate your circadian rhythms and promote better sleep. Simply
going to bed and waking at the same time each day can help people to sleep better.

Eating well for sleep means avoiding some foods and indulging in others an hour or more
before you head to bed. Foods high in melatonin, tryptophan, and magnesium are all great
for promoting better sleep.