Dr. David B. Adams – Psychological Blog

Psychology of Illness, Pain, Anxiety and Depression

Sleep & Medication

Many medications designed to assist with pain management change the stages of sleep. The stages of sleep are referred to as sleep architecture. Individual whose sleep skips, prolongs or postpones various stages of sleep, awaken unrested, unrefreshed, with problems with energy, emotion and memory.

Patients in pain will tell you that they take their pain narcotics at bedtime to insure that they will not hurt and can sleep. However, the medication, while making them drowsy, can also disrupt the normal pattern of sleep. Quite often the medications are prescribed, but the patient is not asked if they are awakening refreshed and rested.

The following may be helpful to you.

Sleep is not a period of uniform inactivity. The two basic types of sleep, REM and Non-REM (NREM), include a total of five stages that we move into and out of as we sleep. The duration and quality of these stages can vary greatly, depending on age, health, sleep hygiene discussed last week, and the individual sleeper.


NREM (non-rapid eye movement): sleep contributes to physical rest and may bolster the immune system.

Researchers often group NREM stages 3 and 4 together, calling them delta sleep.
Stage 1 (Light Sleep): A transitional stage between waking and sleeping, usually lasting 5 or 10 minutes. Breathing becomes slow and regular, the heart rate decreases, and the eyes exhibit slow rolling movements.
Stage 2 (True Sleep): A deeper stage of sleep where fragmented thoughts and images pass through the mind. Eye movements usually disappear, muscles relax, and there is very little body movement.
Stage 3 (Deep Sleep): A further deepening of sleep with additional slowing of heart and breathing rates.
Stage 4 (Deep Sleep): This is the deepest stage of sleep, in which arousal is the most difficult. Typically, sleep walking and bed-wetting occur in this stage.

REM Sleep (rapid eye movement) : REM sleep contributes to psychological rest and long-term emotional well-being. It may also bolster memory.

REM Stage (Dream Sleep): A dramatic decrease in muscle tone and an essential paralysis characterize this stage of sleep. Other characteristics are irregular breathing, increased heart rate, and rapid eye movements. The brain’s oxygen consumption increases, and temperature regulatory mechanisms are absent. In this stage, people experience vivid, active dreams with complex symbols.

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