Getting a good night’s rest is challenging for many people, especially if they’re experiencing an opioid use disorder (OUD). Long-term opioid use is frequently linked to insomnia, and opiate withdrawal only compounds sleep difficulties. Understanding the complex relationship between OUD and sleep health is crucial, since sleep is connected to so many aspects of overall health.
The importance of sleep
Sleep is more than just part of our routine—it’s a reset for the body and mind, letting the body process the day’s information. It helps promote proper cognitive functions, allowing us to learn, recall data, think clearly, and make better decisions.
Sleeping through the night also has important physical benefits:
- Gives muscles time to make repairs
- Allows hormones to rebalance
- Helps the cardiovascular system rest
- Promotes immune system recovery
On the other hand, a lack of sleep disrupts the mind and the body. Without enough rest, the brain has trouble focusing on tasks, making proper decisions, and regulating emotions. Sleep deprivation has also been linked to serious health issues, like heart disease, diabetes, high blood pressure, and a weakened immune response.
Given how delicate sleep patterns can be, it’s easy to see how much of an impact opioids and other substances that fundamentally alter brain and body function can have.
How does opioid use affect sleep health?
Worsens addiction
At first, opioid use can cause drowsiness and may seem beneficial for sleep, which is why so many people with chronic pain are prescribed opioids in the first place. But they’re only meant to be taken for a brief time because opioids interfere with the rapid eye movement (REM) stage. This is when dreaming occurs and the brain processes emotions and memories. As a result, roughly 75% of individuals with an OUD experience some form of sleep disruption.
Consistent opioid use can also fragment sleeping patterns, with people frequently waking up throughout the night. In other cases, they’ll cycle between light sedation and alertness without achieving the deep stages necessary for restorative sleep. It’s common for people with OUD to spend several hours unconscious but still wake up feeling exhausted; they’ve slept, but it wasn’t quality sleep.
Poor sleep can trigger a dangerous cycle of increasing opioid use to find relief from the exhaustion of not sleeping through the night. This is particularly risky because a lack of sleep already disrupts the brain’s reward system—and this can increase a person’s vulnerability to substance use. As a person seeks more opioids for sleep, their physical dependence and sleep problems worsen at the same time.
As a person’s opioid use continues and sleep disruptions become more common, they may struggle to maintain normal sleep patterns, even if they have a regular schedule of bed and wake times. Eventually, daytime fatigue and poor cognitive function become parts of everyday life.
Contributes to central sleep apnea
Opioids can cause serious respiratory issues during sleep, potentially causing central sleep apnea. In regular apnea, tissues block breathing while patients are asleep. With central sleep apnea, the brain temporarily stops sending signals to breathe. The higher the opioid dose, the more likely these respiratory problems become, affecting the brain’s ability to send wake signals when breathing problems occur.
How does opioid withdrawal impact sleep patterns?
Sleep deficiencies continue through the early stages of withdrawal. For many people, insomnia is the worst part of the process. By this time, the body has become accustomed to the sedating effect of opioids and will struggle to produce sleep hormones again.
Other physical symptoms of withdrawal—namely, nausea, sweating, and restless leg syndrome—can make it feel impossible to find a comfortable sleeping position. These symptoms tend to become more pronounced at night because there are fewer demands on a person’s attention, like work, school, or socializing. Focusing on the symptoms makes them feel more intense.
Even when sleep does come, it’s usually not very restful. Nightmares are common during withdrawal, likely because the brain is attempting to catch up on lost REM sleep. While this is usually limited to the acute stage of withdrawal, sleep disruptions may continue into post-acute withdrawal syndrome (PAWS). Patients will still experience unpredictable sleep patterns, alternating between nights of insomnia and excessive sleepiness. PAWS can be particularly frustrating as these disruptions may continue even after other withdrawal symptoms begin to subside.
Poor sleep at night can also lead to further mood and cognitive dysfunction during the day, which can end up having personal, professional, and academic consequences.
While these issues can be significant, sleep will gradually return to normal as the body adjusts to life without opioids.
How does Suboxone® impact sleep health?
Many clinicians prescribe Suboxone as a preferred medication for addiction treatment (MAT) because it doesn’t need to be taken in-office, helping patients maintain their daily routines (important safety information). While Suboxone has a significant positive impact, it does change a patient’s sleep patterns temporarily. Understanding these effects can help set realistic expectations for treatment and sleep quality.
Suboxone is a combination of buprenorphine and naloxone. Buprenorphine is a partial opioid agonist, which means it activates opioid receptors just enough to alleviate cravings and withdrawal symptoms. Meanwhile, naloxone is an opioid antagonist, which causes the body to reject opioids when consumed. As such, it’s most often used to rapidly reverse an overdose. People taking Suboxone benefit from buprenorphine’s withdrawal relief and craving prevention while the naloxone prevents the opioid high and discourages misuse if injected.
When first starting Suboxone treatments, some people may become drowsy due to the buprenorphine. Others may have the opposite experience and find it harder to fall asleep and stay asleep throughout the night.
These sleep changes occur because buprenorphine affects your brain’s sleep functions similarly to opioids themselves—you might spend less time in a deep, restorative sleep or wake frequently during the night. While these sleep disruptions can be frustrating, it’s important to remember that they’re temporary and less severe than the sleep problems caused by active addiction or withdrawal.
Managing sleep health during OUD treatment
If you’re experiencing sleep problems while taking Suboxone, clinicians can adjust your dosing schedule to minimize nighttime sleep disruptions. Maintaining a consistent bedtime routine and ensuring your environment has ideal light, temperature, and sound levels can also encourage more restful sleep. Even smaller changes, like avoiding screens a few hours before bed, can increase your melatonin levels, making it easier to wind down and fall asleep.
While Suboxone can impact sleep temporarily, it remains the gold standard for OUD treatment. It dramatically reduces cravings, prevents withdrawal symptoms, and helps restore normal brain function. The medication’s long-term benefits far outweigh the possible short-term side effects, which can often be managed with good sleep habits and support from your healthcare provider. That way, you’re in the best position possible to successfully recover and overcome an addiction that will cause far more severe and lasting damage to both your sleep and overall health if left untreated.
Opioid treatment that responds to your needs
Addiction treatment isn’t a one-size-fits-all process, so it’s important to work with a care team who understands you. Ophelia’s comprehensive care model puts your well-being first by incorporating comfort medications to relieve withdrawal symptoms and helping address behavioral health issues that may be related to OUD or affect treatment.
In addition to regularly scheduled virtual meetings with your care team, you’ll have access to triage nurses 7 days a week to get help with more urgent questions and concerns. If you’re experiencing poor sleep due to active OUD, withdrawal, or the early stages of buprenorphine treatment, we’re here to help.
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