The Science of Sleep is a newly emerging branch of neuroscience that has resulted in a deeper understanding of how important sleep is to our physical and mental health (https://www.nationalgeographic.com/magazine/2018/08/science-of-sleep/). One of the unfortunate side-effects of opioid use is a disruption in regular sleep patterns. Re-establishing a healthy structure of sleep after stopping opioid use is critical in a full recovery from addiction leading to a happy, healthy life.
Many patients begin taking opioids because they have developed chronic pain or have recently experienced trauma or a surgical procedure. We have all experienced some degree of pain and there is no question that pain disrupts sleep. Most patients initially experience the sweet bliss of a much needed full night’s sleep when they first take painkillers. Unfortunately, as time goes on there is a paradoxical backlash as opioids have significant detrimental effects on the sleep–wake cycle resulting in sleep disturbances. Addtionally, long-term opioid use may lead to sleep apnea and/or RLS (Restless Leg Syndrome), either of which will disrupt healthy sleep patterns; restless leg syndrome is one of the more annoying symptoms of opioid withdrawal.
How to Effectively Treat Insomnia Due to Opioid Use Naturally Using Acupuncture
The most common reason that someone visits my acupuncture clinic is because they are experiencing pain; the most common question pain patients ask of me is, “I sure am sleeping better! Could it be the acupuncture?” The answer is Yes; acupuncture is an effective insomnia treatment because of it’s direct effects on the autonomic nervous system. A study in the Journal of Sleep concluded that, “…acupuncture regulates various neurotransmitters and hormonal factors, including endorphins, serotonin, norepinephrine, adrenocorticotrophic hormone (ACTH), cortisol, acetylcholine (Ach), melatonin, substance P, other neuropeptides, gamma-aminobutyric acid (GABA), and nitric oxide, all of which play major roles in sleep regulation, higher cortical function, the hypothalamic-pituitary-adrenal axis, and the somatovisceral reflexes”.
In addition to acupuncture, my patients receive a supporting herbal prescription. Additionally, I instruct patients to use positive lifestyle practices such as meditation and regular exercise such as yoga and tai qi, or qi gong. It usually takes a few months, but we typically resolve the initial pain and resulting insomnia inside of 6 months time with regular acupuncture treatments. Considering the other possible alternatives such as sleep medications and their potential side effects, acupuncture and herbal therapy are an excellent natural healing modality for sleep disturbances due to opioid dependency.
Schweitzer PK. Chapter 46. Drugs that affect sleep and wakefulness. In: Kryger MH, Roth T, Dement WC, editors. (eds) Principles and practice of sleep medicine, 5th edn. St Louis: Elsevier Saunders, 2011, pp. 542–560.
Darnall, B. D., Stacey, B. R., & Chou, R. (2012). Medical and Psychological Risks and Consequences of Long-Term Opioid Therapy in Women. Pain Medicine (Malden, Mass.), 13(9), 1181–1211. http://doi.org/10.1111/j.1526-4637.2012.01467.x
Severino, A. L., Shadfar, A., Hakimian, J. K., Crane, O., Singh, G., Heinzerling, K., & Walwyn, W. M. (2018). Pain Therapy Guided by Purpose and Perspective in Light of the Opioid Epidemic. Frontiers in Psychiatry, 9, 119. http://doi.org/10.3389/fpsyt.2018.00119
Lavigne G, Zucconi M, Castronovo C, et al. Sleep arousal response to experimental thermal stimulation during sleep in human subjects free of pain and sleep problems. Pain 2000; 84(2–3): 283–290.
Drewes AM, Svendsen L, Taagholt SJ, et al. Sleep in rheumatoid arthritis: a comparison with healthy subjects and studies of sleep/wake interactions. Br J Rheumatol 1998; 37(1): 71–81.
Roehrs T, Diederichs C, Gillis M, et al. Nocturnal sleep, daytime sleepiness and fatigue in fibromyalgia patients compared to rheumatoid arthritis patients and health controls: a preliminary study. Sleep Med 2013; 14(1): 109–115. [PubMed]
Morin CM, Gibson D, Wade J. Self-reported sleep and mood disturbance in chronic pain patients. Clin J Pain 1998; 14(4): 311–314. [PubMed]
Bohra, M. H., Kaushik, C., Temple, D., Chung, S. A., & Shapiro, C. M. (2014). Weighing the balance: how analgesics used in chronic pain influence sleep? British Journal of Pain, 8(3), 107–118. http://doi.org/10.1177/2049463714525355
Kim SW, Shin IS, Kim JM, et al. Bupropion may improve restless legs syndrome: a report of three cases. Clin Neuropharmacol 2005; 28(6): 298–301. [PubMed]
Bayard M, Bailey B, Acharya D, et al. Bupropion and restless legs syndrome: a randomized controlled trial. J Am Board Fam Med 2011; 24(4): 422–428. [PubMed]
Edwards RR, Quartana PJ, Allen RP, et al. Alterations in pain processing in treated and untreated patients with restless legs syndrome: associations with sleep disruption. J Pain 2011; 12(6): 603–609.
Walker JM, Farney RJ. Are opioids associated with sleep apnea? A review of the evidence. Curr Pain Headache Rep 2009; 13(2): 120–126. [PubMed]
Mogri M, Khan MI, Grant BJ, et al. Central sleep apnea induced by acute ingestion of opioids. Chest 2008; 133(6): 1484–1488. [PubMed]
Walker JM, Farney RJ, Rhondeau SM, et al. Chronic opioid use is a risk factor for the development of central sleep apnea and ataxic breathing. J Clin Sleep Med 2007; 3(5): 455–461. [PMC free article] [PubMed]
Farney RJ, Walker JM, Cloward V, et al. Sleep-disordered breathing associated with long-term opioid therapy. Chest 2003; 123(2): 632–639. [PubMed]
Potkin, K. T., & Bunney, W. E. (2012). Sleep Improves Memory: The Effect of Sleep on Long Term Memory in Early Adolescence. PLoS ONE, 7(8), e42191.
Scullin, M. K., & Bliwise, D. L. (2015). Sleep, Cognition, and Normal Aging: Integrating a Half-Century of Multidisciplinary Research. Perspectives on Psychological Science : A Journal of the Association for Psychological Science, 10(1), 97–137.
Huang, W., Kutner, N., & Bliwise, D. L. (2011). Autonomic Activation in Insomnia: The Case for Acupuncture. Journal of Clinical Sleep Medicine : JCSM : Official Publication of the American Academy of Sleep Medicine, 7(1), 95–102.