Opiate dependence and Sleep– You're not crazy; it never comes back to normal.

I was searching the literature this AM and I came across an article that reviews findings related to sleep and addiction.  On a side note, I always have so much fun with literature searches!  I did my PhD in the 1980’s using the latest technology-  a Mac computer with 128 K of RAM.  MacWrite was a 70 K program that fit on one side of a disk; no ‘DD’ or two sides!  I would click ‘save’ after writing a page, and then I’d take a walk, have some coffee, as it took 5-10 minutes to save al those words!  The funny thing– I thought it was incredible at the time.  A whole book the size of the bible could fit on– maybe 10 disks!  The librarian had some type of literature search that one could pay for;  she would call other libraries and ask over the phone if they had the book I wanted!  I looked things up in the ‘card catalog’, writing down the series of numbers and letters that directed me to the right part of ‘the stacks’, where books were shelved 3-4 floors down in the multiple levels of the basement.  I ran up and down the stairs in the stacks probably 20 or more times every day!  Each morning I would go to my list of journals, looking for any new editions to make sure my research hadn’t been ‘scooped’.  I would then go through ‘science citation index’ and find every new article about my topic– vasopressin and other peptide hormone receptors in the brain– and then hunt down the article.  I would eventually take my stack of journals and books to the copy machine, making copies at a nickel per page using a roll or nickels–  I always carried a roll of nickels back then… as I think about it, maybe that is why no women hit on me back then–   things did pick up when the copy machine started accepting quarters!
Compare that to now– I log on to the Medical College of Wisconsin library, where I was looking for info about ADD, relapse, and stimulants…. specifically whether relapse is more or less common when addiction is treated.  I search for ‘ADS’ and get a hundred-something thousand articles, then I screen for those that mention addiction as well, and end up with about 10,000 articles… then look for the ones that mention relapse and that were published since 2002, and end up with a manageable list of 62 articles.  I go through the titles, and if I find one I want I click on it, and download the PDF of the article onto my computer in about three seconds.
WOW.
I was reading one of the articles, and the next article in the journal discussed sleep, something that I am going to discuss on my radio show in a few weeks.  The article pointed out that addicts to all substances have altered sleep patterns that persist for years of abstinence, and that the worst, by far, are the opiate addicts.  Go ahead and check out the article yourself— it is ‘readable’ for the lay-person.  The most interesting point was in regard to people on methadone maintenance;  they found that sleep is disrupted in those people to a severe degree– almost as severe as in opiate addicts in detox!  I hear about sleep problems from addicts all the time;  when I worked in the prisons, poor sleep was a common complain as well.  Most docs probably refuse to deal with the issue too aggressively, maybe even considering the complaints to be ‘drug seeking’.  But the evidence suggests that NOT treating an addicts sleep complaints will increase the risk of relapse.
There were some questions about the findings in the studies, the most significant being whether the addicts had sleep problems BEFORE their addictions– for example, are the people who eventually become addicts people who also have sleep problems?
I am not picking on methadone here;  I hear about sleep complaints from people on buprenorphine as well.  I tend to treat with the usual things– ambien, trazodone, clonidine, hydroxyzine, seroquel…  even temazepam in some patients.  Most sleep agents unfortunately cause tolerance eventually, so the issue tends to come up repeatedly over time.  I don’t know whether patients on buprenorphine fair any better– but I’ll be sure to search out the answer to that question as well!
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