Sleep problems are common in opioid use disorder. Some patients in Nashville arrive with sleep difficulties from causes beyond their opioids:
- Adult ADHD
- Aging-related changes in melatonin production
- Bedtime use of social media
- Depression
- Many real but less common causes
Opioids can disrupt normal sleep stages and breathing. Sleep may remain disturbed for weeks or months after opioid use stops. Persistent insomnia can affect mood, function, and recovery
William Conway, MD, FACP, FASAM
Internal Medicine, Diabetes and Metabolic Health, Longevity
Nashville, Tennessee
Sleep Problems Often Begin Before Opioid Recovery
When a new patient arrives in withdrawal, they are often suffering from poor sleep. The disordered sleep drifts into the background. The beating heart accelerates above 100, ranging from 100 to 120, occasionally higher. The patient reports feeling chills. Moistness of the face may accelerate, with sweat streaming down the face. Inner restlessness is reflected in shifting in the chair and an inability to sit for long. The pupils dilate as though the soul is searching. Diffuse mild joint pain may be reflected by the patient rubbing the joints and muscles. The nose runs. The eyes tear. The body is crying in discomfort; stomach cramps may turn into vomiting or diarrhea. The hands may shake simultaneously with yawning. The patient is emotionally upset, commonly expressed as anxiety.
Suboxone provides relief to the withdrawing, suffering patient. If all goes well, relief begins within the first few hours and continues quickly. On my telephone calls in the first 24 hours, I am pleased when the patient feels better.
Particularly with Kratom, not everything always goes so well. I have had one patient who went into precipitated withdrawal. In my limited experience, many have a much longer course of improvement
As we become better acquainted in the first month, with withdrawal fading into the background, we can explore sleep.
There are many reasons why patients who use opioids have poor sleep. Although not on the “bucket list” of questions asked, disordered sleep is more common than not in untreated adult ADHD. In our technical language, the physician states that disordered sleep is part of the syndrome of ADHD, although not formally listed in diagnostic criterion
Depression is more than constant sadness. Depression is a disease of the body. Sleep is commonly worsened. Falling asleep is troubled: waking up frequently during the night occurs: waking up too early.
Getting too much sleep can also be the body’s response to the disease of depression. Sleeping longer than usual is also the body’s response to depression
The laundry list for why patients do not sleep is long. Chronic pain is often a reason people turn to opioids. Obesity with obstructive sleep apnea is as American as apple pie. Too much caffeine or the nightly cocktail alters sleep. Scrolling on Facebook in bed at bedtime can affect sleep. Working night shifts affects sleep. Finally, less common but important causes of sleep disturbance fill sleep specialists’ offices.
It is my belief that the world is a better place for patients on suboxone if all of their significant conditions are addressed. Your life is more than Suboxone.
How Opioids Affect Sleep and Breathing
Opioids have a natural sedating quality. Sedation is not the same as deep, restorative sleep. Opioids affect the deep rhythm and pattern of restorative sleep. Opioids fragment sleep. Opioids can interfere with breathing during sleep. One problem is central sleep apnea, when the brain temporarily stops signaling the lungs to breathe.
You can be pleasantly sedated-and still wake up in the morning feeling exhausted.
Melatonin- the body’s natural signal of darkness- helps prepare the body for sleep. Being pleasantly sedated is not the same as deep restorative sleep.
Why Insomnia Continues after Opioid Withdrawal
Sleep commonly gets worse during withdrawal. If you are an active user of illicit opioids, poor sleep may be part of your daily life. During opioid intoxication, the drug produces sedation-but sedation is not true sleep. Between doses, and especially during withdrawal, opioid users commonly experience true insomnia:
- Difficulty falling asleep
- Frequent awakenings
- Restlessness
- Brief, fragmented sleep
Beswick et al. report that sleep disruption was greatest at the end of detoxification and in the period immediately afterward. Recovery time for sleep varies: some people improve within weeks while others have persistent sleep disorders. The sleep-wake system may take time to recover after prolonged opioid use and withdrawal.
Stopping opioids and restoring sleep are different. Persistent insomnia does not mean that suboxone is failing you. There are many causes of insomnia which need to be evaluated and treated.
Why Poor Sleep Matters During Opioid Recovery
Your Mom told you sleep matters. Mom was right. Restorative sleep-real sleep- matters. Many parts of your life are worse with poor sleep;
- Mood
- Memory
- Concentration
- Pain
- Energy
- Everyday functioning
Recent research links insomnia to return to opioid use and non-fatal overdose
Sleep studies suggest that lighter, more fragmented sleep may be associated with risk of relapsing to opioids.
Frequently Asked Questions About Opioids and Sleep
Is Difficult, interrupted sleep common in persons using opioids?
Deep interrupted sleep is not common in active opioid use. The active cycle of addiction impairs sleep
What is the natural sleep hormone?
Melatonin is the hormone of darkness. It is important in the mechanism of sleep
What happens to sleep during detoxification?
Detoxification affects sleep in many ways. Sleep takes time for opioid induced insomnia to reduce after detoxification
What are the associated reasons for difficult sleep in patients using suboxone?
There are many reasons for difficulty sleeping in patients on suboxone. Depression, adult ADHD, obesity, and other less common independent sleep disorders exist
Endnotes
. Hernandez E, Griggs S. Sleep health among adults in outpatient opioid use disorder treatment: a systematic review. Journal of Psychosocial Nursing and Mental Health Services. 2024;62(1):19–26. doi:10.3928/02793695-20230622-04.
- Dimsdale JE, Norman D, DeJardin D, Wallace MS. The effect of opioids on sleep architecture. Journal of Clinical Sleep Medicine. 2007;3(1):33–36. doi:10.5664/jcsm.26742.
- Mogri M, Desai H, Webster L, Grant BJB, Mador MJ. Hypoxemia in patients on chronic opiate therapy with and without sleep apnea. Sleep and Breathing. 2009;13(1):49–57. doi:10.1007/s11325-008-0208-4.
- Beswick T, Best D, Rees S, Bearn J, Gossop M, Strang J. Major disruptions of sleep during treatment of the opiate withdrawal syndrome: differences between methadone and lofexidine detoxification treatments. Addiction Biology. 2003;8(1):49–57. doi:10.1080/1355621031000069882.
- Hochheimer M, Ellis JD, Strickland JC, Rabinowitz JA, Hobelmann JG, Huhn AS. Insomnia symptoms are associated with return to use and non-fatal overdose following opioid use disorder treatment. Sleep. 2025;48(4):zsae284. doi:10.1093/sleep/zsae284.
- Rady A, Mekky J, Moulokheya T, Elsheshai A. Polysomnographic correlates for the risk of relapse in detoxified opiate-misuse patients. Neuropsychiatric Disease and Treatment. 2020;16:3187–3196. doi:10.2147/NDT.S284337.
