Medical use of chronic opioids has recently increased in Switzerland. Even though their effect on daytime vigilance tends to disappear after some time, 70% of chronic opioid users will suffer from sleep disordered breathing. Most of them will show an ataxic breathing during sleep with mostly central apnea alternating with short breathing periods, but long hypopnea may also occur. Treatment with continuous positive airway pressure (CPAP) is usually ineffective. More sophisticated ventilatory modes such as bilevel ventilation with backup respiratory rate or adaptive servoventilation are often required. Older patients with concomitant COPD or obstructive sleep apnea are at higher risk of developing nocturnal breathing disorders.