High-dose opioid use in older patients who have fibromyalgia with insomnia is associated with perceptions of worse sleep compared to younger patients, according to researchers.
The study, “Discrepancies in sleep diary and actigraphy assessments in adults with fibromyalgia: Associations with opioid dose and age,” was published in the Journal of Sleep Research.
Patients with fibromyalgia experience chronic widespread pain, and up to 80% of patients experience insomnia, a sleep disorder that’s characterized by difficulty falling asleep or staying asleep.
Symptoms of insomnia can be assessed through a number of methods. One subjective method is the use of a sleep diary. An objective method is called actigraphy.
Actigraphy is a noninvasive method of monitoring sleep patterns. A small portable device — called an actimetry sensor — is worn for a week or more to measure movement.
Older patients with insomnia generally report shorter estimates of insomnia in their diary compared to what is determined using actigraphy, suggesting that they underestimate their degree of insomnia.
But fibromyalgia patients with poor sleep quality typically report longer insomnia estimates in their diary compared to objective estimates, suggesting that they overestimate their level of insomnia.
Therefore, diary and actigraphic methods often produce different results. While the diary measures a patient’s perception regarding insomnia, actigraphy provides the actual physiological measure of insomnia.
Research also indicates that a number of different variables, including increasing age, use of sleep medications, and the presence of pain increase the discrepancies between diary and actigraphy measures.
Another potential source of variability between diary and actigraphy measurements in fibromyalgia patients is the use of pain medications, such as opioids.
Opioid use has been associated with changes in sleep in adults. Researchers set out to determine whether the dose of opioids and a patient’s age have an impact on the variability between the diary/actigraphy records in fibromyalgia patients with insomnia.
Researchers acquired data from a clinical trial that investigated the effectiveness of cognitive behavioral therapy for insomnia in patients with fibromyalgia (NCT02001077). Patients completed 14 days of baseline sleep diaries and actigraphy.
Researchers found that higher doses of opioids in fibromyalgia patients increased the magnitude of diary/actigraphy discrepancies.
Researchers investigated a number of sleep parameters including sleep onset latency (which measured the time it takes to transition from full wakefulness to sleep), wake after sleep onset (periods of wakefulness occurring after defined sleep onset), and sleep efficiency.
Interestingly, the direction of the discrepancy between the diary/actigraphy estimates was found to depend on age.
Higher opioid doses in younger adults (approximately age 40) was associated with shorter sleep onset latency and higher sleep efficiency in subjective reports than objective estimates. This indicates that younger patients had a more optimistic perception of their degree of insomnia compared to the actigraphy results.
However, higher opioid doses among older adults (approximately age 63) was associated with a longer subjective than objectively measured sleep onset latency. This indicates that older patients had a worse perception of their level of sleeplessness.
“The results suggest that associations between opioid dose and direction of diary/actigraphy discrepancies depend on patient age, with older adults most vulnerable to perceptions of worse sleep onset,” researchers wrote.
“[Because] self‐reported sleep is strongly associated with health outcomes in older adults, it may be important for clinicians to carefully monitor opioid dosage in older adults with [fibromyalgia],” they added.
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