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.
- 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.
- Central sleep apnea: In this rare form, the reflexive part of the central nervous system essentially forgets to tell the body to breath.
- 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:
- Patients with ankylosing spondylitis (a form of arthritis found primarily in the spine) have a significantly higher rate of sleep apnea than those without it
- Sleep disturbances are so prevalent among fibromyalgia patients that it was included in the diagnostic criteria in 2010
- Female patients with chronic widespread pain had a higher incidence of obstructive sleep apnea
- A 2018 review of literature found that life-threatening opioid-induced respiratory depression (OIRD) in sleep apnea patients is possible in the first 24 hours of administration (even one dose could be fatal)
- Neck pain and sleep apnea are related; sleepers in the best position for their sleep apnea may pinch nerves in the cervical spine, causing pain
- In some cases of sleep apnea and chest pain, sleep apnea may mimic symptoms of angina
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 sl