Anhedonia modulates benzodiazepine and opioid demand among persons in treatment for opioid use disorder.

Background: Benzodiazepine (BZD) misuse is a significant public health problem, particularly in conjunction with opioid use, due to increased risks of overdose and death. One putative mechanism underlying BZD misuse is affective dysregulation, exaggerated negative affect (e.g.

At the intersection of sleep deficiency and opioid use: mechanisms and therapeutic opportunities.

Due to the ongoing opioid epidemic, innovative scientific perspectives and approaches are urgently needed to reduce the unprecedented personal and societal burdens of nonmedical and recreational opioid use. One promising opportunity is to focus on the relationship between sleep deficiency and opioid use. In this review, we examine empirical evidence: (1) at the interface of sleep deficiency and opioid use, including hypothesized bidirectional associations between sleep efficiency and opioid abstinence; (2) as to whether normalization of sleep deficiency might directly or indirectly improve opioid abstinence (and vice versa); and (3) regarding mechanisms that could link improvements in sleep to opioid abstinence.

Current and potential pharmacological treatment options for insomnia in patients with alcohol use disorder in recovery.

Alcohol use disorder (AUD) is characterized by dysfunction in motivational, mood-stress regulation, and sleep systems that interact in complex ways to heighten the risk of relapse during abstinence. Emerging data suggest that excessive and chronic alcohol use disrupts sleep homeostasis and, in abstinence, subjects with AUD are known to experience insomnia that may persist for weeks to years, which we propose to refer to as insomnia associated with alcohol cessation (IAAC). The purpose of this review is to provide an update of pharmacological approaches to therapy including compounds in development, to raise awareness of the prevalence of and unmet need in IAAC and highlight differences in treatment consideration for IAAC as compared to insomnia disorder.

Increasing presurgery sleep reduces postsurgery pain and analgesic use following joint replacement: a feasibility study.

Study Objectives: To determine whether presurgery sleep extension in short-sleeping volunteers scheduled for total knee/hip replacement surgery would reduce postsurgery pain and analgesic use.

Methods: Eighteen short sleepers, defined by sleep times below the national mean (ie, ≤7 h) nightly, were randomized to one week of a 2-h nightly extension of their time in bed (EXT) or maintenance of their habitual time in bed (HAB) prior to knee or hip replacement surgery. Compliance was monitored by wrist actigraphy.

Sleep Disturbance in Substance Use Disorders.

This article discusses the role sleep and alertness disturbance plays in the initiation, maintenance and relapse of substance use disorders.

Gender Differences in the Efficacy and Safety of Chronic Nightly Zolpidem.

Study Objectives: Studies have shown pharmacokinetic differences for hypnotics in women compared to men, but few studies have assessed either short-or long-term differences in efficacy and safety.

Methods: To evaluate gender differences in the efficacy and safety of chronic nightly zolpidem (10 mg), we did a post hoc assessment of a large clinical trial. In the trial, participants with primary insomnia (n = 89), ages 23-70, meeting DSM-IV-TR criteria for primary insomnia were randomized, double blind, to nightly zolpidem, 10 mg (n = 47) or placebo (n = 42) 30 minutes before bedtime nightly for 12 months.

Characteristics of Disturbed Sleep in Patients With Fibromyalgia Compared With Insomnia or With Pain-Free Volunteers.

Objective: To investigate the differential nature of disturbed sleep in patients with fibromyalgia (FM) reporting sleep difficulties versus patients with primary insomnia (PI) and patients who do not report disturbed sleep (pain-free controls).

Materials And Methods: Patients (FM: n=132; PI: n=109; normals: n=52) were recruited for different studies. FM and PI patients were preselected to meet the sleep disturbance criteria.

Pain sensitivity and recovery from mild chronic sleep loss.

Study Objectives: To determine whether an extended bedtime in sleepy and otherwise healthy volunteers would increase alertness and thereby also reduce pain sensitivity.

Setting: Outpatient with sleep laboratory assessments.

Participants And Interventions: Healthy volunteers (n = 18), defined as having an average daily sleep latency on the Multiple Sleep Latency Test (MSLT) < 8 min, were randomized to 4 nights of extended bedtime (10 hr) (EXT) or 4 nights of their diary-reported habitual bedtimes (HAB).

Efficacy of eight months of nightly zolpidem: a prospective placebo-controlled study.

Study Objectives: To evaluate the long-term (8 months) efficacy of zolpidem in adults with chronic primary insomnia using polysomnography.

Design: Randomized, double-blind, placebo-controlled clinical trial.

Setting: Sleep disorders and research center.

Postsurgical patient-controlled opioid self-administration is greater in hospitalized abstinent smokers than nonsmokers.

Objective: To compare 24-hour postsurgical patient-controlled analgesia (PCA) in smokers and nonsmokers.

Design: Patients completed a presurgical questionnaire inquiring about sleep, nicotine and other substance use, and comorbid disorders. Nicotine use was discontinued on hospital admission on the day of surgery.

Continuous positive airway pressure in severe obstructive sleep apnea reduces pain sensitivity.

Study Objective: To evaluate effects of CPAP on pain sensitivity in severe OSA patients.

Design: Within-subject treatment study.

Setting: Hospital-based sleep disorders center.

MSLT in primary insomnia: stability and relation to nocturnal sleep.

Study Objectives: To assess the stability of the multiple sleep latency test (MSLT) in primary insomnia and its relation to total sleep time.

Design: Randomized, double-blind, placebo controlled, clinical trial.

Setting: Outpatient with sleep laboratory assessments in months 1 and 8 of treatment.

Twelve months of nightly zolpidem does not lead to rebound insomnia or withdrawal symptoms: a prospective placebo-controlled study.

Rebound insomnia, worsened sleep when discontinuing use of a hypnotic, is reported in some short-term studies. No study has prospectively assessed, using patient reports or nocturnal polysomnography (NPSG), the likelihood of rebound insomnia with chronic hypnotic use. The objectives of this study was to assess in primary insomniacs the likelihood of experiencing rebound insomnia and a withdrawal syndrome on repeated placebo substitutions over 12 months of nightly zolpidem use.

Twelve months of nightly zolpidem does not lead to dose escalation: a prospective placebo-controlled study.

Study Objectives: To assess hypnotic self-administration and likelihood of dose escalation over 12 months of nightly use of zolpidem versus placebo in primary insomniacs.

Design: Randomized, double-blind, placebo-controlled, clinical trial.

Setting: Outpatient with tri-monthly one-week, sleep laboratory assessments.

Differential effect of codeine on thermal nociceptive sensitivity in sleepy versus nonsleepy healthy subjects.

Basal sleepiness-alertness modulates drug effects. Sleepiness produced by sleep restriction leads to increased nociceptive sensitivity, suggesting opioid analgesia may also be modulated by sleepiness-alertness. This study compared thermal nociceptive sensitivity in sleepy versus nonsleepy participants after codeine or placebo.

Does effective management of sleep disorders improve pain symptoms?

Co-morbid insomnia is a much more frequent problem than primary insomnia. In co-morbid insomnia, management of the underlying disease can improve sleep difficulty. Conversely, treating the sleep disorder may also improve the co-morbid condition.

Using difficulty resuming sleep to define nocturnal awakenings.

Objective: Nocturnal awakenings are one of the most prevalent sleep disturbances in the general population. Little is known, however, about the frequency of these episodes and how difficulty resuming sleep once awakened affects subjective sleep quality and quantity.

Method: This is a cross-sectional telephone study with a representative sample consisting of 8937 non-institutionalized individuals aged 18 or over living in Texas, New York and California.

Pain sensitivity in sleepy pain-free normals.

Study Objective: Past studies have shown that acute experimental reduction of time in bed in otherwise healthy, non-sleepy people leads to hyperalgesia. We hypothesized that otherwise healthy, sleepy people may also exhibit hyperalgesia relative to their non-sleepy counterparts.

Design: Between-groups sleep laboratory study.

Sleep disturbance in menopause.

Objective: To determine the sources of sleep complaints in peri- and postmenopausal women reporting disturbed sleep.

Design: A total of 102 women, ages 44 to 56 years, who reported disturbed sleep were recruited through newspaper advertisements. They were assessed with the Pittsburgh Sleep Quality Index and the Hamilton Anxiety and Depression Rating Scales.

The Acute Hangover Scale: A new measure of immediate hangover symptoms.

Purpose: No psychometrically established measure of acute hangover symptoms is published and available to use in experimental investigations. The present investigation combined data across three studies of residual alcohol effects to establish the properties of a new Acute Hangover Scale (AHS) based on symptoms supported in previous lab studies.

Methods: Professional mariners from a Swedish maritime academy (n=54) and young adult students/recent graduates of urban U.

Effects of REM sleep and ambient temperature on hot flash-induced sleep disturbance.

Objective: To determine whether hot flashes produce sleep disturbance in postmenopausal women.

Design: This study was performed in a university medical center laboratory with 18 postmenopausal women with hot flashes, six with no hot flashes, and 12 cycling women, all healthy and medication free. Polysomnography, skin and rectal temperatures, and skin conductance to detect hot flashes were recorded for four nights.

An evaluation of the efficacy and safety of eszopiclone over 12 months in patients with chronic primary insomnia.

Background And Purpose: A double-blind placebo-controlled study of eszopiclone found significant, sustained improvement in sleep and daytime function. The 6-month open-label extension phase is described herein.

Patients And Methods: Adults (21-64) with primary insomnia who reported sleep duration <6.

Mu-opioid self-administration vs passive administration in heroin abusers produces differential EEG activation.

Psychoactive drug self-administration (SA) produces different neurobiological effects than passive administration (PA) in non-human animals; however, such consequences have never been examined in human drug abusers. The present study compared electroencephalographic (EEG) activation produced by intravenous PA and SA of the mu-opioid fentanyl in eight heroin-dependent, methadone-stabilized male participants. In phase 1, participants received cumulative PA of fentanyl (up to 1.

Lack of sleep disturbance from menopausal hot flashes.

Objective: To determine whether hot flashes produce disordered sleep in symptomatic postmenopausal women.

Design: Controlled laboratory study.

Setting: Healthy volunteers in a university medical center.