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Pain Medications and Their Effect on Sleep Architecture

Sleep is important to health.

There is no dispute about that, and quality of sleep is influenced by a wide variety of factors, including stress, diet, temperature, type of mattress and pillow, noise levels, physical ailments, medications, and overall health and hygiene.

Sleep problems are not age or gender specific, and may occur rarely or regularly. Disturbed sleep patterns can be habitual, and lack of regular sleep can affect not only mood and alertness, but can also have detrimental effects on learning, immune system function, metabolism and memory.

Chronic sleep deprivation, no matter what the cause, should be treated. Occasionally, prescription drug treatment for other conditions and diseases affects sleep patterns, including the ability to go to sleep and breathing while a person is asleep.

Some “sleep robbers” can be easily eliminated by altering environmental factors that disturb regular sleep — a room’s darkness and noisy distractions, the temperature or the firmness of a mattress or pillow — might have immediate and beneficial results. Restlessness, snoring and even sleep apnea, a breathing condition that interrupts restful sleep patterns, can be effectively addressed by medical professionals.

Sleep Needs Overall

While the need for sleep can ebb and flow over the course of a lifetime, it is generally acknowledged that school age children require between eight and 11 hours of restful sleep each night to ensure energy and promote learning.

Adults between the ages of 18 and 65, on average, perform at optimum efficiency when they get between seven and nine hours.

Seniors over the age of 65 are encouraged to aim for seven to eight hours each night, although many seniors report that they sleep fewer hours, have more trouble sleeping through the night, or routinely feel less than rested when they arise.

Medications prescribed for chronic pain can be the culprit, but specific causes are sometimes hard to track, and treatment of sleep disorders can be complicated. The quality of sleep is at least as important as the number of hours of sleep.

Understanding the Concept of Sleep Architecture

Over the course of a “sleep period,” according to sleep scientists, everyone experiences two recognizable patterns: non-rapid eye movement (NREM) and rapid eye movement (REM) sleep.

NREM sleep has three distinct stages, characterized by brain waves and physiology. Phase 1 NREM sleep is a transitional stage, followed by Phase 2, the pattern that represents between 45 and 55 percent of a good night’s total. Phase 3 is described as “deep sleep,” or “slow wave sleep,” representing up to about one quarter of the total.

Finally REM sleep follows the other phases, which recur in cycles of varied duration throughout any sleep period. Initial REM sleep may last only a few minutes, but periods gradually length during succeeding nighttime cycles. Dreams occur during REM sleep, and the brain is very active, although the body’s muscles are relaxed, sometimes to the point of near paralysis, except for the heart and lungs.

During each state, there are changes in blood pressure, heart rate, respiration, cerebral blood flow, renal function and endocrine secretion. Sharp increases in blood pressure and heart rate generally accompany awakening, and are part of the reason that a higher risk of myocardial infarction (heart attack) occurs in the morning, or when waking out of a period of deep sleep.

Pain Medications and Sleep

A host of common medications, including opioid painkillers, contribute to disturbed sleep patterns. If a physical cause has been ruled out, the next logical step is to take a look at changing medications in an effort to restore healthy sleep patterns.

Insomnia is defined as the inability to “fall asleep, stay asleep, or both,” according to the AARP. Older Americans are more inclined to suffer from chronic conditions or medical complaints that are treated by the varied classes of medication that disrupt sleep.

Lack of sleep is known to contribute to anxiety, depression, mood swings, memory problems or the physical distress of diabetes, obesity and heart disease. Sleep deprivation is a primary cause of falls and automobile accidents.

Classes of medication that are known as possible contributors to sleep problems include:

  • Opioid Painkillers: Studies have found that up to 75 percent of individuals prescribed opioid painkillers experience a type of sleep problem that results from a sort of “wiring short-circuit” between the brain and the muscles that control breathing. Known as Central Sleep Apnea, it can be life-threatening. Always discuss possible side effects and their signs and symptoms if you are prescribed painkillers.
  • Alpha-Blockers: Commonly prescribed to treat hypertension (high blood pressure) and other conditions that benefit from increased blood flow, this group of beneficial drugs interferes with REM sleep and results in daytime sleepiness. Because REM sleep decreases normally with aging, the additional effect of alpha-blockers can lead to severe sleep deprivation and result in memory problems.
  • Beta-Blockers: Another type of medication used to treat hypertension, beta-blockers are also prescribed for certain types of glaucoma, angina, arrhythmiasand migraines. They are associated with frequent nighttime awakening and nightmares, and are thought to inhibit melatonin production, a hormone that influences the body’s circadian rhythm.
  • Corticosteroids: Anyone with Rheumatoid arthritis, lupus, gout, Sjgren’s syndrome, asthma and some severe allergies likely knows the effect of corticosteroids on sleep. The drugs reduce inflammation effectively, but they can contribute to stress and sleeplessness. There may be alternatives, or a single dose taken early in the day might ease the problem. Ask your physician.
  • SSRI Antidepressants: Used to treat depression, these drugs often produce beneficial results. If, however, they contribute to sleeplessness, in particular the inability to sleep at night, they might exacerbate the problem because sleeplessness itself can cause depression. SSRI’s also delay REM sleep onset and total overall REM sleep time. SSRI’s have also been known to exacerbate Periodic Limb Movements in Sleep.
  • ACE Inhibitors: By preventing the body’s production of a substance that tends to narrow blood vessels and reduce blood flow, these drugs help treat high blood pressure and congestive heart failure. They can also cause a dry cough that is sometimes severe enough to keep people awake. Another potential side effect is a high level of potassium that sometimes leads to diarrhea, as well as leg cramps and bone or muscle aches.
  • Angiotensin II-receptor blockers (ARBs): This is another class of drugs prescribed to treat coronary artery disease,Type 2 diabetes or diabetes-related kidney disease. Many of the detrimental effects can be the same as with ACE inhibitors and can be severe enough to disrupt sleep on a continuing basis.
  • Cholinesterase Inhibitors: The primary side effects of these drugs that are commonly used to treat Alzheimer’s Disease and other forms of dementia include insomnia and abnormal dreams, but other adverse reactions can be heart rhythm abnormalities, diarrhea, nausea and vomiting, in addition to muscle spasms and leg cramps. As the diseases progress, the effectiveness of the drug therapy also decreases.
  • H1 Antagonists: Simply a “fancy name” for commonly-prescribed antihistamines, the second generation non-sedating class of medications used to treat allergic symptoms like itching, nasal congestion, sneezing, watery eyes, and hives, these drugs differ from first generation medications like Benadryl that cause severe drowsiness. These medications, including such common names as Zyrtec, Allegra, Clarinex and Claritin, can contribute to anxiety and sleeplessness.
  • Glucosamine and Chondroitin: These are often suggested for arthritis symptoms, and are available as over the counter medication to relieve minor joint pain and inflammation. Although their benefits are sometimes disputed, they both naturally occur in the body, even though additional doses can cause gastrointestinal complaints, headaches and loss of sleep.
  • Statins: Widely prescribed to lower high cholesterol, the primary side effects of statins are muscle pain. In susceptible individuals, daytime pain may be almost immobilizing, and nighttime sleep is sometimes nearly impossible. Even in milder cases, consult with your physician to alter dosage or find another way to lower cholesterol.

If you take any medication on a regular basis, it is wise to pay attention to sleep patterns and promptly notify your physician if you notice changes in the number of hours you sleep, unusual fatigue, or changes in daytime energy levels.

Sleep is meant to refresh and renew the body. If it does not do that, overall health and wellness suffer.

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