Anyone dealing with the ravages of a chronic pain condition knows how vital a good night of sleep can be. But is it possible that the very medications that manage chronic pain can play a role in destroying the possibility of restful slumber? Absolutely. There is a close and complex relationship between sleep apnea and pain management. Here’s what you should know.

What is sleep apnea?

Sleep apnea is a sleep disordered breathing condition. It affects an estimated one billion people globally (with 25 million in the U.S. alone). There are three types of sleep apnea.

  1. Obstructive sleep apnea: This is the most common form in which the muscles of the throat and tongue relax during sleep, obstructing the sleeper’s airway.
  2. Central sleep apnea: In this rare form, the reflexive part of the central nervous system essentially forgets to tell the body to breath.
  3. Complex sleep apnea: Thankfully the most rare of the three forms, complex sleep apnea is a dangerous combination of the first two types of sleep apnea.

Symptoms of sleep apnea include not only daytime fatigue and lack of alertness but also migraine, dry mouth, and morning aches and pains. For people who suffer from any other chronic pain condition, this nightly battle with sleep can exacerbate pain.

Can sleep apnea cause muscle and joint pain?

Sleep apnea and chronic pain are peas in a pod as far as comorbid conditions go. They are interconnected, with one heightening the other. People in pain struggle to sleep well, and people who don’t sleep well experience more pain. This is to say sleep apnea doesn’t cause pain, but it can intensify it if you’re already suffering.

A 2011 study found that patients in pain rated their pain higher on the days following nights when sleep was elusive, and elusive sleep on the nights that their pain was high. This bidirectional relationship of sleep apnea and chronic pain makes both difficult to manage effectively.

Other studies indicate that patients with obstructive sleep apnea and musculoskeletal pain suffer from poor sleep quality and quantity. Onset of sleep is also challenging.

There are other studies that suggest that sleep apnea plays a role in worsening pain symptoms (if not directly causing them). For example:

Does chronic pain cause sleep apnea?

Chronic pain does not necessarily lead to directly to sleep apnea, but sleep disruptions due to chronic pain is a fact of life for many people.

Additionally, some patients with fibromyalgia or other chronic pain conditions are being referred to sleep specialists for a polysomnography, the primary diagnostic tool of sleep apnea.

Anecdotally, chronic pain patients will tell you that some of their worst flare-ups occur after a poor night of sleep. When dealing with sleep apnea and chronic pain, it is crucial to focus on treatment and therapy for sleep apnea that addresses the poor sleep and the pain that occurs as a result.

Can pain medications cause sleep apnea?

While the chronic pain itself may not cause sleep apnea, there is a clear relationship between sleep apnea and pain management medications.

A 2007 study initially looked at the relationship between sleep apnea and pain management with opioids. Lynn R. Webster, MD, from Lifetree Clinical Research and Pain Clinic in Salt Lake City, Utah explained that:

“We found that sleep-disordered breathing was common when chronic pain patients took prescribed opioids. We also found a direct dose-response relationship between central sleep apnea and methadone and benzodiazepines, an association which had not been previously reported.”

Remember from above that central sleep apnea occurs when the central nervous system does not work properly to reflexively wake a sleeper who has stopped breathing. Opioids work on the central nervous system as well. They not only dampen the pain response but also suppress other reflexive behaviors. This can help explain why sleep apnea risks can increase after taking certain pain medications.

Other side effects of opioids

In 2017 (and in other studies in the interim), these results were further confirmed. Kirstie Anderson, BMedSci, MBBS, MRCP, DPhil, honorary senior lecturer at Newcastle University and consultant neurologist at Newcastle Hospitals NHS Foundation Trust, believes that overuse of opioids is not just about addiction – it’s also about other potentially fatal side effects.

In a study of the effects on non-cancer patients taking opiates for pain management, the findings of increased risk of sleep apnea were conclusive. Anderson notes:

“There has been recent concern about the addictive nature of opioids and a large number of side-effects, including worsening overnight breathing and therefore disturbing sleep. Few studies have looked at the impact of these drugs on metabolism. Our study is the largest of its kind to look at this group of drugs and show an association between obesity and poor sleep.”

The study above also found an increase in:

  • Body-mass index among 95% of participants
  • High-risk waist circumference in 82%,
  • Hypertension in 63%

All of these are primary indicators of an increased risk of sleep apnea, or worsening of symptoms in those already diagnosed.

Find help

Sleep apnea and pain management is a complex and delicate balancing act. The sleep apnea dentists at AZ Dentist have an advanced understanding of the relationship between pain and sleep apnea.

We are here to help you learn more about your sleep apnea treatment options. Visit us at any of our Phoenix Valley locations. Get in touch today!

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