In Greek mythology, Scylla and Charybdis flanked either side of a narrow channel, commonly thought to be the Strait of Messina, and threatened all vessels that passed between them. Scylla, a monster with six heads, would reached down from her cave and grab sailors from ships, while Charybdis, was a monster that sucked in the water, creating a whirlpool that destroyed ships. When forced to sail these straits, sailors had to choose to face one or the other.
The same seems to be true of sleep problems, including sleep apnea, and chronic pain. Unfortunately, the most common treatment for chronic pain, opioid pain relievers, has been shown to result in increased risk of sleep apnea.
Chronic Pain and Opioid Medication
It used to be that opioids were considered largely as a palliative in patients that were seen as terminal cases, but recently doctors’ prescribing habits have changed. (Quite possibly related to marketing initiatives by pharmaceutical companies. Fentanyl, which was sold infused in a patch, saw the largest increase from 1990-1996, increasing nearly 1200%.) What used to be rare has become common. Even morphine prescriptions have increased significantly. As a result, opioid pain medications are now the most commonly prescribed medication.
All of this has come at a cost. Drug overdoses have increased five-fold in this country since 1990, when doctors began prescribing more opioids. Drug overdose is now the second leading cause of accidental death (after car accidents) in the US, and opioid pain relievers are responsible for the majority of deaths. About twice as many people are killed by overdosing on opioid pain relievers as on cocaine, and more than five times as many as are killed by heroin.
In addition, opioids have decreasing effectiveness. The longer people take them, the less effective they are, which contributes to overdose rates.
Finally, opioids can contribute to sleep apnea.
How Opioids Cause Sleep Apnea
Opioids are known to contribute to many types of sleep disorders, including sleep apnea. Like other muscle relaxants, such as alcohol, opioids can lead to reduced muscle tone in your airway, which leads to more constriction of the airway during sleep, increasing the risk of obstructive sleep apnea. However, opioids also affect your body’s breathing patterns. Your breathing becomes irregular. So irregular that it often transitions to central sleep apnea, in which your brain forgets to tell your body to breathe. Breathing only resumes when your brain awakens enough to restart it.
In a normal population, obstructive sleep apnea is about six times as common as central sleep apnea. Among long-term opioid users, the frequency of central sleep apnea is almost half that of obstructive sleep apnea. Central sleep apnea is much harder to treat than obstructive sleep apnea. Only CPAP can treat it, and often then not very well.
Take Opioid Prescriptions with Care
In trying to manage your chronic pain conditions, it’s important to talk to your doctor about other options and try them before you start using an opioid pain medication. If there are drug-free treatments that may help manage your pain, or other drugs with a better safety profile, consider them as well.
If you would like to learn more about managing your sleep apnea or chronic pain in the head or neck, please call (303) 691-0267 at the TMJ Therapy & Sleep Center of Colorado in Denver.
