Daily associations between sleep and opioid use among adults with comorbid symptoms of insomnia and fibromyalgia

Abstract

Study objectives: Disturbed sleep and use of opioid pain medication are common among individuals with chronic pain. Anecdotally, opioids are thought to promote sleep by relieving pain. This study aimed to determine whether opioid use is associated with daily sleep parameters (and vice versa) in adults with comorbid symptoms of insomnia and fibromyalgia.

Methods: Individuals reporting symptoms of insomnia and opioid use for fibromyalgia (n = 65, 93% women, 79% White) wore wrist actigraphy and completed daily diaries for 14 days (910 observations). Analyses examined daily associations between opioid dose (measured in lowest recommended dosage units) and three sleep parameters (actigraphy/self-reported total wake time and self-reported sleep quality). Multilevel models were used to account for the clustering of daily sleep and opioid assessments (level 1) within individuals (level 2).

Results: Opioid use did not have a significant daily effect on total wake time or sleep quality, and sleep parameters did not significantly impact opioid use the next day; however, participants reported worse sleep quality and greater doses of opioids on evenings that they experienced greater pain.

Conclusions: Among adults reporting symptoms of insomnia and opioid use for fibromyalgia pain, opioid use is not reliably associated with wake time or sleep quality that night, and these sleep parameters are not significantly associated with opioid use the next day; however, evening pain has an adverse daily impact on both sleep quality and opioid use. Studies identifying strategies to prevent and manage fibromyalgia pain are needed, especially for individuals reporting comorbid insomnia and opioid use.

Trial registration: ClinicalTrials.gov NCT02001077.

Keywords: chronic pain; daily; insomnia; opioid; sleep.

Conflict of interest statement

All authors contributed to and have approved the final manuscript. This research was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (R01AR055160 and R01AR055160-S1, PI McCrae). Data were collected as part of clinical trial NCT02001077 Sleep and Pain Interventions (SPIN) at the University of Florida (PI McCrae). Investigator effort was also supported by research grants from the Department of Defense (AR190047, PI McCrae) and the National Institute on Alcohol Abuse and Alcoholism (K23AA026895 and R21AA025175, PI Miller). The Department of Defense and National Institutes of Health had no role in the study design, collection, analysis, or interpretation of the data, writing the manuscript, or the decision to submit the paper for publication.

© 2021 American Academy of Sleep Medicine.