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2 Epidemiology of Opioid Use and Smoking, Alcohol, and Polysubstance Use Among Persons Using Opioids
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Introduction Introduction
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Summary of the Empirical Literature Summary of the Empirical Literature
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Effects of Opioids on Sleep Effects of Opioids on Sleep
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Effects of opioid administration and withdrawal on sleep Effects of opioid administration and withdrawal on sleep
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Effects of opioid use on sleep in patients with chronic pain Effects of opioid use on sleep in patients with chronic pain
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Neurotransmitters associated with the effects of opioids on sleep Neurotransmitters associated with the effects of opioids on sleep
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The HPA axis, opioid exposure, and sleep The HPA axis, opioid exposure, and sleep
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The HPA axis and opioid use The HPA axis and opioid use
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The HPA Axis and Sleep The HPA Axis and Sleep
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Opioids, HPA/stress, and sleep Opioids, HPA/stress, and sleep
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Clinical Impact Clinical Impact
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Key Points Summary Key Points Summary
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Acknowledgement Acknowledgement
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References References
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12 Opioid Effects on Sleep: Review of the Literature and Consideration of the Hypothalamic-Pituitary-Adrenal Axis as a Relevant Mechanism
Get accessJennifer D. Ellis, Assistant Professor, Department of Psychiatry and Behavioral Sciences, Johns Hopkins, University School of Medicine
Chung Jung Mun, Assistant Professor, Edson College of Nursing and Health Innovation, Arizona State University
Patrick H. Finan, Professor of Anesthesiology, University of Virginia School of Medicine
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Published:22 May 2023
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Abstract
Sleep difficulties are pervasive among individuals chronically exposed to opioids, such as those with opioid use disorder (OUD) and/or individuals with chronic pain receiving long-term opioid therapy. This chapter reviews the comorbidity between chronic opioid exposure and sleep disturbance, including emphasis on the effects of opioids on sleep in persons with opioid physical dependence and/or chronic pain, and the neurotransmitter systems that are associated with those effects. We then synthesize a large literature suggesting that alteration of the hypothalamic-pituitary-adrenal (HPA) axis following chronic exposure to opioids may be a mechanism by which sleep difficulties persist among patients receiving long-term opioid therapy for chronic pain and/or patients with OUD. This section focuses on HPA function in the context of opioid use, opioids and circadian functioning, opioids and stress response, the role of the HPA axis in sleep, and the combined effects of opioids, HPA function, stress, and sleep. Finally, we outline the clinical impact of chronic opioid exposure on sleep and stress reactivity and recommend that providers treating individuals chronically exposed to opioids (1) routinely assess sleep disturbance and stress, and (2) consider adjunctive interventions that address sleep disturbance and stress, when appropriate.
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