APSS: Taking Pain Meds in the Morning Helps Patients Sleep Better at Night

MINNEAPOLIS, June 15 -- When arthritis patients took extended release morphine sulfate (Avinza) on awakening, they got to sleep more easily at night and slept better and longer, researchers found. Total sleep time increased from 367 minutes a night (six hours and seven minutes) to 402.5 minutes (six hours and 42.5 minutes) a night (P<0.05), Polly Moore, Ph.D., director of sleep research at California Clinical Trials, San Diego, reported at the Associated Professional Sleep Societies meeting here.
REM sleep latency -- the time it took patients to reach a deep sleep -- decreased from 113 minutes to 62.5 minutes (p<0.05).
"Frankly we were somewhat surprised at how well these patients did in improving their sleep," Dr. Moore said.
Dr. Moore and colleagues studied 34 patients who had moderate to severe pain caused by osteoarthritis that was having a profound effect on their ability to sleep. After placebo run-in, patients received A-MQD 30 mg/day for 6 days. At Day 6, patients who met the criteria for incomplete pain relief had their dose increased to 60 mg/day. Treatment continued for another 8 days at the new dose level (14 days for a subgroup at 60 mg/day).
After 14 days of therapy, patients' "sleep efficiency increased from 76.5% to 83.8%," Dr. Moore said.
While the difference was statistically significant at the P<0.05 level, she noted that even that sleep efficiency level is not great, indicating the burden of chronic pain in the population studied.
"It is sort of counterintuitive to think that by taking an opioid medication for pain in the morning that you would have an improved sleep at night," Dr. Moore said, "However, we have learned that opioids given at night before bedtime actually tend to interfere with sleep."
The researchers noted that the 30 mg dose of extended release morphine sulfate was most successful and that the medication caused no unexpected adverse side effects.
Dr. Moore suggested that prescribing physicians should feel confident that pain control in these patients will improve nighttime sleep quality and will increase total sleep time in patients who are experiencing sleep disruption because of chronic pain.