Opioid misuse is at an all-time high, with 2020 marking the most overdoses ever seen, according to a new report from the U.S. Centers for Disease Control and Prevention. A ray of hope has emerged, however, as researchers begin to use EEG to study a vital piece of the opioid puzzle: sleep health.

Sleep, it turns out, is highly interwoven with opioid use, addiction, and withdrawal.  About 70 percent of people with opioid use disorder (OUD) have difficulty sleeping. Lack of sleep, in turn, impacts many factors that are correlated with the success of quitting and preventing relapse, including stress level, cravings, and mood.

A Promising Avenue

“Despite these links, sleep disturbance is not a primary consideration in most OUD treatment programs,” write the authors of a recently published meta-analysis. This, they argue, needs to change because current treatments are inadequate and “therapeutic interventions that target sleep are a promising avenue to improve OUD treatment.”

If sleep is to be the target, it needs to be better understood in the context of opioid use, abuse, withdrawal, and relapse. This includes studying a variety of objective sleep measures including its stages, quantity, quality, continuity, and its disruptors such as sleep apnea and restless leg syndrome.

Distinct Advantages

A team at Johns Hopkins School of Medicine is doing just that, using wireless sleep electroencephalography (EEG) on patients undergoing medical withdrawal from opioids. They published the results of a small pilot study this summer in the journal Experimental and Clinical Psychopharmacology.

The aim of this first study was to determine the feasibility of using a wireless EEG device on patients undergoing withdrawal. The researchers also wanted to compare the data collected by EEG with sleep diaries as well as subjective reports of withdrawal.

The study included seven participants, all male, in an inpatient facility who were being medically tapered off of opioids. Each participant was fitted with a three-channel wireless EEG unit called the Sleep Profiler. It includes a flexible headband to which three single-use and gelled snap electrodes were attached each night to record frontal EEG, pulse, and head movement.

Opening a New Door?

Compliance was good among participants, the authors found, at just over 85 percent. That was thanks to the wireless unit, which is less cumbersome during what can be a very uncomfortable treatment phase.

Using EEG also provided distinct advantages over a sleep diary. More intricate data was collected on sleep architecture associated with withdrawal severity, for example. EEG data also revealed that participants were fairly inaccurate in estimating how deeply they slept, how long it took them to go to sleep, and how many times they awoke in the night.

This study speaks to the viability of more accurately studying sleep in patients during different phases of opioid use disorder — while these results are preliminary, they are consistent with previous research. And this in turn may open the door to new treatments to help finally stem the tide of a runaway epidemic.