SLEEP PROBLEMS AMONG PATIENTS ON METHADONE MAINTENANCE TREATMENT

Authors

  • Liljana Ignjatova Psychiatric Hospital Skopje, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Republic of North Macedonia
  • Elizabet Miceva Velichkoska University Clinic of Psychiatry, Ss. Cyril and Methodius University in Skopje, Faculty of Medicine-Skopje, Republic of North Macedonia
  • Zoja Babinkostova University Clinic for Psychiatry, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Republic of North Macedonia
  • Gordana Kiteva- Trencevska University Clinic for Neurology, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Republic of North Macedonia

Keywords:

opioids, methadone-maintained patients, insomnia.

Abstract

Insomnia is the most prevalent sleep disorder in the general population, and is commonly encountered in medical practices. Subjective sleep complaints occur in 75-84% of methadone-maintained patients, and more than 50% of methadone-maintained patients reported use of medications to improve their sleep cycle. Studies of insomnia support a female predominance.

The Aim of this study was to evaluate insomnia and gender differences in insomnia among methadone-maintained patients in the Department for prevention and treatment of drug abuse and dependence, Psychiatric Hospital Skopje.

This was a cross-sectional study. Two groups of methadone-maintained patients were included: 73 males and 14 females. Participants were evaluated with Bergen Insomnia Scale (BIS), and Insomnia Severity Index.

The evaluation of subjects with BIS showed that 87.3% of subjects reported some sleep problems. There were significant differences between the groups related to item 3 on BIS with higher mean score for females. The total score for the Insomnia Severity Index scale showed that a larger number of females than males had moderate and severe insomnia. More females than males reported use of medications (90.5% used benzodiazepine), to help them with their sleep problems. Last month 36.8% of subjects used some substances and in 75% of cases it was alcohol, cannabis or both.

This study provided evidence that sleep disturbance and use of alcohol, cannabis, and benzodiazepines was highly prevalent among methadone-maintained patients. Female patients reported a significantly worse sleep cycle than males. Use/abuse of benzodiazepines in methadone-maintained patients does not resolve the problem of insomnia.

References

Bhaskar S, Hemavathy D, Prasad S. Prevalence of chronic insomnia in adult patients and its correlation with medical comorbidities. J Family Med Prim Care. 2016; 5(4):780-784. doi: 10.4103/2249-4863.201153.

Schutte-Rodin S, Broch L, Buysse D, Dorsey C, Sateia M. Clinical guideline for the evaluation and management of chronic insomnia in adults. J Clin Sleep Med. 2008; 4(5):487-504. PMID: 18853708; PMCID: PMC2576317.

Teplin D, Raz B, Daiter J, Varenbut M, Tyrrell M. Screening for substance use patterns among patients referred for a variety of sleep complaints. Am J Drug Alcohol Abuse. 2006; 32(1):111-20. doi: 10.1080/00952990500328695.

Hasler BP, Smith LJ, Cousins JC, Bootzin RR. Circadian rhythms, sleep, and substance abuse. Sleep Med Rev. 2012; 16(1):67-81. doi: 10.1016/j.smrv.2011.03.004.

Johnson EO, Roehrs T, Roth T, Breslau N. Epidemiology of alcohol and medication as aids to sleep in early adulthood. Sleep. 1998; 21(2):178-86. doi: 10.1093/sleep/21.2.178.

Brower KJ, Aldrich MS, Robinson EA, Zucker RA, Greden JF. Insomnia, self-medication, and relapse to alcoholism. Am J Psychiatry. 2001; 158(3):399-404. doi: 10.1176/appi.ajp.158.3.399.

Currie SR, Clark S, Rimac S, Malhotra S. Comprehensive assessment of insomnia in recovering alcoholics using daily sleep diaries and ambulatory monitoring. Alcohol Clin Exp Res. 2003; 27(8):1262-9. doi: 10.1097/01.ALC.0000081622.03973.57.

Brower KJ. Insomnia, alcoholism and relapse. Sleep Med Rev. 2003; 7(6):523-39. doi: 10.1016/s1087-0792(03)90005-0.

Dimsdale JE, Norman D, DeJardin D, Wallace MS. The effect of opioids on sleep architecture. J Clin Sleep Med. 2007; 3(1):33-6. PMID: 17557450.

Sharkey KM, Kurth ME, Corso RP, Brower KJ, Millman RP, Stein MD. Home polysomnography in methadone maintenance patients with subjective sleep complaints. Am J Drug Alcohol Abuse. 2009;3 5(3):178-82. doi: 10.1080/00952990902839786.

Stein MD, Herman DS, Bishop S, Lassor JA, Weinstock M, Anthony J, Anderson BJ. Sleep disturbances among methadone-maintained patients. J Subst Abuse Treat. 2004; 26(3):175-80. doi: 10.1016/S0740-5472(03)00191-0.

Peles E, Schreiber S, Adelson M. Variables associated with perceived sleep disorders in methadone maintenance treatment (MMT) patients. Drug Alcohol Depend. 2006; 82(2):103-10. doi: 10.1016/j.drugalcdep.2005.08.011.

Wang D, Teichtahl H. Opioids, sleep architecture and sleep-disordered breathing. Sleep Med Rev. 2007; 11(1):35-46. doi: 10.1016/j.smrv.2006.03.006.

Sharkey KM, Kurth ME, Anderson BJ, Corso RP, Millman RP, Stein MD. Assessing sleep in opioid dependence: a comparison of subjective ratings, sleep diaries, and home polysomnography in methadone maintenance patients. Drug Alcohol Depend. 2011; 113(2-3):245-248. doi: 10.1016/j.drugalcdep.2010.08.007.

Peles E, Schreiber S, Hamburger RB, Adelson M. No change of sleep after 6 and 12 months of methadone maintenance treatment. J Addict Med. 2011; 5(2):141-7. doi: 10.1097/ADM.0b013e3181e8b6c4.

Valentino, R.J., Volkow, N.D. Drugs, sleep, and the addicted brain. Neuropsychopharmacol.2020; 45: 3–5. https://doi.org/10.1038/s41386-019-0465-x

Nelson AM, Battersby AS, Baghdoyan HA, Lydic R. Opioid-induced decreases in rat brain adenosine levels are reversed by inhibiting adenosine deaminase. Anesthesiology. 2009; 111(6):1327-33. doi: 10.1097/ALN.0b013e3181bdf894.

Nan-Ying Chiu, Wen-Yu Hsu “Sleep Disturbances in Methadone Maintenance Treatment (MMT) Patients”. In: Preedy RV, editor. Neuropathology of Drug Addictions and Substance Misuse. London: Academic Press; 2016, p.608-15

Hallinan R, Elsayed M, Espinoza D, Veillard AS, Morley KC, Lintzeris N, Haber P. Insomnia and excessive daytime sleepiness in women and men receiving methadone and buprenorphine maintenance treatment. Subst Use Misuse. 2019;54(10):1589-1598. doi: 10.1080/10826084.2018.1552298.

Krishnan V, Collop NA. Gender differences in sleep disorders. Curr Opin Pulm Med. 2006;12(6):383-9. doi: 10.1097/01.mcp.0000245705.69440.6a.

Mallampalli MP, Carter CL. Exploring sex and gender differences in sleep health: a Society for Women's Health Research Report. J Womens Health (Larchmt). 2014;23(7):553-62. doi: 10.1089/jwh.2014.4816. Epub 2014 Jun 23. PMID: 24956068; PMCID: PMC4089020.

Pallesen S, Bjorvatn B, Nordhus IH, Sivertsen B, Hjørnevik M, Morin CM. A new scale for measuring insomnia: the Bergen Insomnia Scale. Percept Mot Skills. 2008;107(3):691-706. doi: 10.2466/pms.107.3.691-706.

Bastien C. Validation of the Insomnia Severity Index as an Outcome Measure for Insomnia Research. Sleep Medicine. 2001; 2 (4):297–307. doi:10.1016/S1389-9457(00)00065-4.

Hallinan R, Elsayed M, Espinoza D, Veillard AS, Morley KC, Lintzeris N, Haber P. Insomnia and excessive daytime sleepiness in women and men receiving methadone and buprenorphine maintenance treatment. Subst Use Misuse. 2019;54(10):1589-1598. doi: 10.1080/10826084.2018.1552298.

Hsu WY, Chiu NY, Liu JT, Wang CH, Chang TG, Liao YC, Kuo PI. Sleep quality in heroin addicts under methadone maintenance treatment. Acta Neuropsychiatr. 2012;24(6):356-60. doi: 10.1111/j.1601-5215.2011.00628.x.

Mahfoud Y, Talih F, Streem D, Budur K. Sleep disorders in substance abusers: how common are they? Psychiatry (Edgmont). 2009;6(9):38-42. PMID: 19855859; PMCID: PMC2766287

Roth, T. Does Effective Management of Sleep Disorders Reduce Substance Dependence? Drugs 2009; 69 (2):65–75 https://doi.org/10.2165/11531120-000000000-00000

Dimsdale JE, Norman D, DeJardin D, Wallace MS. The effect of opioids on sleep architecture. J Clin Sleep Med. 2007 Feb 15;3(1):33-6. PMID: 17557450.

Fathi HR, Yoonessi A, Khatibi A, Rezaeitalab F, Rezaei-Ardani A. Crosstalk between Sleep Disturbance and Opioid Use Disorder: A Narrative Review. Addict Health. 2020 Apr;12(2):140-158. doi: 10.22122/ahj. v12i2.249.

Roehrs TA, Roth T. Sleep Disturbance in Substance Use Disorders. Psychiatr Clin North Am. 2015 Dec;38(4):793-803. doi: 10.1016/j.psc.2015.07.008.

Brower KJ, Perron BE. Sleep disturbance as a universal risk factor for relapse in addictions to psychoactive substances. Med Hypotheses. 2010 May;74(5):928-33. doi: 10.1016/j.mehy.2009.10.020.

Vinkers CH, Olivier B. Mechanisms Underlying Tolerance after Long-Term Benzodiazepine Use: A Future for Subtype-Selective GABA(A) Receptor Modulators? Adv Pharmacol Sci. 2012; 2012:416864. doi: 10.1155/2012/416864.

Hirshkowitz M, Whiton K, Albert SM, Alessi C, Bruni O, DonCarlos L, Hazen N, Herman J, Katz ES, Kheirandish-Gozal L, Neubauer DN, O'Donnell AE, Ohayon M, Peever J, Rawding R, Sachdeva RC, Setters B, Vitiello MV, Ware JC, Adams Hillard PJ. National Sleep Foundation's sleep time duration recommendations: methodology and results summary. Sleep Health. 2015;1(1):40-43. doi: 10.1016/j.sleh.2014.12.010.

Suh S, Cho N, Zhang J. Sex Differences in Insomnia: from Epidemiology and Etiology to Intervention. Curr Psychiatry Rep. 2018;20(9):69. doi: 10.1007/s11920-018-0940-9.

Downloads

Published

2022-12-20

Issue

Section

Original Articles