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By Kajal Jain

M. Pharm

13 December 2022
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A medicine is likely to cause side effects even when taken as directed. Most painkillers cause severe fatigue and sedation. Tramadol is an opioid agonist that helps in relieving pain. Is it true that a potent painkiller like Tramadol leads to disrupted sleep?

While most people in this world are taking sound sleep, some people remain awake due to insomnia. It is the most common sleep problem, with nearly one-third of adults experiencing its symptoms at any time. Around 10 % have severe insomnia, which is considered a full-fledged disorder.

Let us find out in this blog the association between the opioid analgesic Tramadol and sleep deprivation disorder.

What Is Tramadol?

Tramadol is a prescription opioid analgesic medicine for moderate pain. It is also used for chronic pain from conditions like Fibromyalgia and other pain caused after surgery.

Tramadol is available as an immediate-release and extended-release tablet in 50mg, 100mg, 150mg, 200mg, and 300mg tablets. Brand names of Tramadol include Ultram, Ultram ER, ConZip, and Ryzolt. Common street names for Tramadol include Ultras and Chill Pills. 

Children below 12 years should not consume Tramadol, and those aged between 12 and 18 should take precautions. Tramadol is a controlled substance. This means it can only be used with a doctor’s close supervision, based on their medical use in treatment, the potential for misuse, and dependence.

How Does Tramadol Work?

Tramadol belongs to a class of opioid agonists. It shows its therapeutic action by altering how your brain senses pain. It acts on the brain chemicals norepinephrine and serotonin to relieve moderate-to-severe pain. Tramadol is similar to endorphins (substances in your brain). Endorphins bind to receptors, which then decrease the pain. These chemicals send messages to your brain. Tramadol also works in a similar way to reduce the amount of pain your brain thinks you’re having.

Although Tramadol is effective at treating mild-to-moderate pain, it is one of the least potent analgesics available. However, this drug can still be addictive or habit-forming, especially when taken for extended periods or in doses larger than prescribed.

How Much Should You Take?

Tramadol is available as:

  • Slow-release tablets – these include 50mg, 75mg, 100mg, 150mg, 200mg, 300mg, or 400mg of Tramadol (usually once or twice a day)
  • Slow-release capsules – these include 50mg, 100mg, 150mg, or 200mg of Tramadol (usually once or twice a day)
  • Standard tablets – these include 50mg of Tramadol (usually 3 to 4 times a day)
  • Standard capsules – these include 50mg of Tramadol (usually 3 to 4 times a day)
  • Soluble tablets – these include 50mg of Tramadol
  • Orodispersible tablets – these contain 50mg of Tramadol
  • an injection (usually given in the hospital)

Dosages may vary with the individual. Your doctor will decide the adequate dose for you, depending on how bad your pain is, how sensitive you are to hurt, or how you responded to previous painkillers. If you're 65 or over or have kidney or liver disorders, your doctor might ask you to take Tramadol less often.

Tramadol injections and some tablets/capsules will begin to work within 30 to 60 minutes. Usually, its lowest dose is prescribed to be taken for the short term. Tablets or capsules shall be swallowed whole with a glass full of water.

What is Insomnia?

Insomnia is the most common sleep disorder that makes it hard to fall asleep and stay asleep. You may also feel tired when you wake up. Insomnia can drain your energy level, mood, work performance, health, overall quality of life, and well-being. Adequate sleep hours vary with the individual, but adults generally require seven to eight hours for sound health.

Sooner or later, many adults experience acute insomnia, which lasts for a few days or weeks. It is usually the consequence of stress or a traumatic event. But some people have chronic insomnia that goes on for months or more. 

Sleep deprivation or insomnia may be the primary problem, but it is associated with other medical conditions. Apart from various medications for insomnia, simple lifestyle changes can also help. Insomnia symptoms may include:

  • Irritability, depression, or Anxiety
  • Difficulty falling asleep at night
  • Not feeling well-rested after a night's sleep
  • Waking up during the night
  • Waking up too early
  • Daytime tiredness or sleepiness
  • Increased errors or accidents
  • Difficulty paying attention or concentrating
  • Ongoing worries about sleep

Does Tramadol Cause Insomnia?

Opioids like tramadol cause sleepiness, fatigue, and sedation. Same time an opioid, namely Tramadol, is likely to cause insomnia. Although Tramadol is a depressant, mainly relaxing, and gives calming effects, higher doses can also produce euphoric feelings. People who Abuse this drug or mix it with other substances can make Tramadol a stimulant, having mild euphoric effects comparable to heroin.

In one recent double-blind study on Tramadol and sleeplessness, some participants were randomly given placebos one night and then given 50 mg or 100 mg of Tramadol the other night. Researchers discovered that 100 mg of Tramadol significantly impaired Rapid Eye Movement (REM) sleep for two complete nights. Rapid Eye Movement sleep is a unique sleep phase characterized by random rapid eye movements and vivid dreams. REM sleep is essential for a whole night's rest and learning, making, and retaining memories. This sleep phase tends to shorten as we get older, which may partly explain why memory problems tend to occur in the elderly.

The study also confirmed that when a participant was given 50 mg of Tramadol, their sleep was interrupted that night. When they were given 100 mg of the medication, sleep was significantly impaired for two whole nights.

Additionally, it should be noted that opioids can make you feel sleepy, so taking them during the day may cause you to fall asleep. Sleeping more during the day often means you will sleep less at night.

Insomnia is one of the most common symptoms of tramadol withdrawal. Like other drugs of the same class, detoxing from Tramadol can lead to nausea, sleeplessness, vomiting, muscle aches, diarrhea, cold sweats, and more.

Tramadol Withdrawal Symptoms

Drug withdrawal commonly occurs in individuals who have developed a dependence on a drug, which is a significant danger when taking opioids. This usually happens when users take more frequent and larger doses than prescribed. Once a person develops a tolerance to the drug, quitting the pill may cause unpleasant withdrawal symptoms. Tramadol withdrawal symptoms vary from person to person. Generally, symptoms last between 5-7 days. It is best to taper off the drug over time as Tramadol detox to minimize the negative withdrawal symptoms. 

Common Tramadol withdrawal symptoms include:

  • Abdominal cramps
  • Agitation
  • Anxiety
  • Blurred vision
  • Cravings
  • Confusion
  • Depression
  • Diarrhea
  • Headaches
  • Insomnia
  • Loss of appetite
  • Muscle pain
  • Mood swings
  • Nausea and vomiting
  • Nightmares
  • Sweating

If you notice that the dosage of Tramadol you’re taking no longer provides pain relief, or if you have to use more of it to experience pain relief, speak to your doctor immediately to avoid addiction.

Does Tramadol Abuse Cause Insomnia?

Tramadol is usually prescribed because of its less addictive potential than other opioid analgesics. While most analgesics are categorized under Schedule II under the Controlled Substance Act (CSA), Tramadol falls under the Schedule IV category.
Tramadol is abused for its euphoric effects, and people taking Tramadol usually feel happy and relaxed. Individuals with severe pain may take high doses of this drug, which puts them at greater risk of severe adverse effects, including respiratory depression and seizures.

Those who abuse or misuse Tramadol are at risk of developing an addiction. Individuals develop tolerance to this drug with its prolonged use, while sometimes, people become addicted even after following their doctor’s directions.

Along with tolerance/dependence, Tramadol users might experience withdrawal symptoms when they discontinue taking the drug. Tramadol withdrawal can cause depression, irritability, and flu-like symptoms. They may also show signs of Tramadol addiction and neurobiological disease with psychosocial, genetic, and environmental factors influencing how it develops. Other signs include relationship problems caused by drug use, frequent cravings, and uncontrolled use of Tramadol.

Possible Side Effects

Some people may experience side effects while taking Tramadol. These side effects can occur due to interactions with other medications or not taking the medicines according to prescription instructions. The most common side effects include:

  • Difficulty concentrating
  • Drowsiness
  • Irritability
  • Heartburn
  • Sleepiness
  • Dry mouth
  • Tiredness
  • Weakness
  • Constipation
  • Body ache

Generally, side effects occur when introducing the drug into the system. Many of these side effects might disappear as your body adjusts to the medicine. If side effects continue or become too bothersome, you should discuss your symptoms with your primary doctor.

Long-term side effects of Tramadol use, such as dependence, muscle spasms, difficulty sleeping, stomachaches, breathing problems, Seizures, adrenal insufficiency, and serotonin syndrome, can be challenging to manage. Long-term side effects of continued tramadol misuse can last for years without proper medical attention. 

In this case, speaking with your doctor about your tolerance and dependence on Tramadol may be helpful. Some people might need to seek a medical detox program to safely and comfortably withdraw from Tramadol without experiencing severe withdrawal effects.

What Are The Precautions Of Tramadol

Before starting with Tramadol, inform your medical practitioner of any medications you are taking, any medical conditions or allergies you have, whether you are pregnant or breastfeeding, or other significant facts about your health. The following factors might affect how you should take medication:

  • Alcohol or other medications that cause drowsiness: Do not combine Tramadol with alcohol or other medicines that cause drowsiness since additive drowsiness can occur and be dangerous and possibly even fatal.
    Accidental use: When an individual consumes Tramadol accidentally, the effects of this medication may be fatal. Store this medicine out of sight and reach of children.
  • Abdominal conditions: Tramadol slows down bowel movement. If you are suffering from an abdominal condition such as acute cholecystitis, inflammatory or obstructive bowel disease, or pancreatitis, discuss with your doctor how your medical condition will affect the effectiveness of this medication.
  • Dependence and withdrawal: This medication may be habit-forming if taken for prolonged periods. People with a history of drug Abuse problems may be at higher risk of developing addiction while taking this medicine. Do not discontinue taking this medication without consulting with your pharmacist or doctor.
  • Diabetes: Tramadol may reduce blood sugar levels and change glucose tolerance. People with diabetes should frequently monitor their blood sugar levels while using this medication.
  • Asthma and other respiratory conditions: Tramadol might cause increased breathing problems for people with an acute asthma attack, COPD, or other conditions that impact breathing. If you have asthma or related issue, discuss with your medical practitioner how this medication will affect your medical condition and whether any special monitoring is needed.
  • Kidney function: The kidneys partially remove Tramadol from the body. Reduced kidney function may cause Tramadol to build up in the body, causing side effects.
  • Heart rhythm: Tramadol can cause alterations in the heart's normal rhythm, including an irregular heartbeat called QT prolongation, which is a life-threatening condition.
  • Liver function: The liver partially removes Tramadol from the body. Reduced liver function may cause Tramadol to build up in the body, causing side effects.
  • Seizures: Tramadol may cause seizures, especially when taken in higher doses or with other medications that increase the risk of attacks.
  • Low blood pressure: After taking Tramadol, blood pressure drops too low. If decreased blood pressure causes you to faint, contact your doctor.
  • Surgery: Tramadol might interact with medications required during surgery. If you are scheduled for any surgery, inform your doctor that you are on this medication.
  • Breastfeeding: This medication passes into breast milk. If you are breastfeeding and are taking tramadol extended-release tablets, it may affect your baby.
  • Pregnancy: The Safety of this medication for mother and baby during pregnancy has not been determined. If you become pregnant while on this medication, contact your doctor immediately.
  • Head injury: People with increased pressure in the head or head injuries may have a greater risk of experiencing side effects or worsening their condition while taking this medication.

Tramadol Drug Interactions

There are several drug interactions among people who take Tramadol. Typical interactions include- Alcohol.

  • Antihistamines (e.g., cetirizine, doxylamine, loratadine, diphenhydramine)
  • Anti-Parkinson's medications (e.g., amantadine, levodopa, apomorphine)
  • Antipsychotics (e.g., haloperidol, chlorpromazine, clozapine, risperidone)
  • Antifungals (e.g., itraconazole, ketoconazole, fluconazole)
  • Barbiturates (e.g., butalbital, phenobarbital)
  • Diuretics (e.g., furosemide, hydrochlorothiazide, triamterene)
  • HIV protease inhibitors (e.g., ritonavir, darunavir, saquinavir)
  • HIV-NNRTIs (e.g., etravirine, efavirenz)
  • Lithium
  • Muscle relaxants (e.g., methocarbamol, baclofen, cyclobenzaprine, orphenadrine)
  • MAO Inhibitors (e.g., moclobemide, phenelzine, tranylcypromine)
  • Narcotic pain relievers (e.g., codeine, morphine, fentanyl)
  • St. John's wort
  • Tricyclic antidepressants (e.g., desipramine, amitriptyline)
  • Selective serotonin reuptake inhibitors (e.g., fluoxetine, citalopram, paroxetine)
  • Warfarin, cannabis

Contact your pharmacist or medical practitioner if you take any of these medications.

Bottom Line From Practical Anxiety Solutions

Tramadol is an opioid analgesic that is used to relieve moderate-to-severe pain. People might experience mild to severe side effects when taking this medication. It is also likely to cause insomnia. Its higher doses can produce euphoria and thus cause sleepless nights. Some drug interactions can also occur with Tramadol, and the effects can be severe. It is advised to take this drug with caution and contact your healthcare professional in case of any side effects.

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