The cycle of opioid use followed by opioid withdrawal ruins sleep. The sedation produced by opioid use does not restore you- unlike restorative sleep. Withdrawal produces painful sleeplessness and suffering.

Suboxone-if taken reliably- eliminates your cravings while freeing you from the endless biological misery cycle of active opioid use. Your sleeplessness from opioid withdrawal is eliminated.

Your world is complicated; your body has many reasons you don’t sleep well. Suboxone does not relieve the sleeplessness produced by

  • Depression
  • Adult Attention Deficit Disorder
  • Obstructive Sleep Apnea
  • Aging-related melatonin Deficiency
  • Obstructive Sleep Apnea
  • The Numerous Causes of Insomnia treated by Sleep Specialists

Treatment with suboxone eliminates the insomnia characteristic of active opioid use. Suboxone is not the treatment for multiple, other- often serious- causes of your insomnia.

William Conway, MD, FACP

General Internal Medicine, Diabetes and Metabolic Health, Aging and Longevity

 Why Does Opioid Withdrawal Cause Insomnia?

My concierge patients in Nashville do not like discussing their suffering. The scientific literature describes the addiction cycle clearly and clinically. In withdrawal, you can feel restless, achy, anxious, and uncomfortable. Cravings can rob you of sleep as you spend hours in bed, waking up exhausted.

The science of withdrawal categorizes the symptoms

  • Difficulty falling asleep
  • Vivid dreams or unpleasant sleep experiences
  • Changes in deep and REM sleep can occur

Reading the autobiographical novels of active heroin users confirms the misery of this symptom list.

Can Suboxone Improve Sleep During Opioid Addiction

Yes, Suboxone can improve sleep when used to establish biological normalcy in recovery. No, Suboxone will not relieve the sleeplessness of depression, adult ADHD, or the myriad other causes of insomnia,

Patients in active recovery with suboxone will feel more comfortable.

Lukas et all reported improved sleep measures during chronic buprenorphine treatment. Zheng et found improved self-reported sleep during the first 90 days of buprenorphine treatment in small observational study.

These studies show sleep improvement during treatment, not that buprenorphine directly induces sleep independent of relief of withdrawal

Why Relief from Withdrawal, Not Sedation, May Improve Sleep

In technical language, buprenorphine is a long-acting opioid agonist. An effective maintenance dose suppresses withdrawal and cravings throughout the night. With withdrawal controlled, nighttime restlessness, body aches, anxiety, and cravings are reduced or eliminated,

The goal of dosing buprenorphine is to control withdrawal. An increase in dose for insomnia is not effective.

Is It Better to Take Suboxone in the Morning or at Night

Buprenorphine is a long-acting drug that lasts a long time; it has a long half-life. Traditional teaching is that once-a-day dosing is effective. Taking more often than once a day may be beneficial if you have chronic pain.

A review of the literature with SciSpace found no evidence to support taking buprenorphine preferentially in the morning or night. Many of my patients tell me that they sleep better when suboxone is taken before bed.

Why Some Patients Still Have Insomnia While Taking Suboxone

Insomnia has many causes. As we say in internal medicine, the differential diagnosis of insomnia has many causes. For many of these causes, there is a preferred treatment.

How Can You Treat Insomnia While Taking Suboxone

Cognitive Behavioral Therapy  for Insomnia (CBT-I)

Cognitive Behavioral Therapy (CBT) is the first-line treatment recommended for chronic insomnia by the American Academy of Sleep Medicine and the American College of Physicians. Cognitive Behavioral Therapy has been quite beneficial for my patients.

Consistent Sleep Habits and Circadian Rhythm

What Mom taught you is right. Go to bed at the same time. Get up at the same time. Be active during the day. Do not watch TV in your bedroom. Do not turn your bedroom into a kitchen. Do not scroll before bedtime

Treating Anxiety, Depression, Adult ADHD and Chronic Pain

All of these are serious. All have serious treatments. The treatments often take a while to work. The first treatment may not work. It may take several treatment changes to find something effective. Once you get an effective treatment, continue with it unless it stops working or makes you sick.

Screening for Sleep Apnea

Snoring, pauses in breathing, waking up gasping, or daytime sleepiness are all indications for a sleep study and specialist care

The Bottom Line: Treat Withdrawal, Then Address Persistent Insomnia

Suboxone reliably treats withdrawal. If insomnia persists, look for underlying treatable conditions.

For consultation at Nashville Concierge Medicines, call Heather at 615-708-0390.

Frequently Asked Questions About Suboxone and Sleep

Does Suboxone help you sleep better?

Yes, Suboxone (buprenorphine/naloxone) may improve sleep by controlling opioid withdrawal symptoms and cravings. Withdrawal often causes restlessness, anxiety, body aches, and insomnia. When these symptoms are controlled, patients may sleep more comfortably. However, Suboxone is not a sleeping medication and does not directly treat other causes of insomnia.

Can Suboxone cause insomnia or sleep problems?

Yes. Although Suboxone can improve sleep by relieving opioid withdrawal, some patients continue to experience insomnia or changes in sleep quality during treatment. Persistent sleep problems may be related to depression, anxiety, adult ADHD, chronic pain, sleep apnea, or medication effects. If insomnia continues despite stable treatment, a medical evaluation can help identify the underlying cause.

Is it better to take Suboxone in the morning or at night for sleep?

There is no strong scientific evidence that taking Suboxone in the morning or at night consistently improves sleep. Buprenorphine is a long-acting medication that typically controls withdrawal symptoms throughout the day and night. Some patients report sleeping better when they take it before bedtime, but responses vary. Discuss any changes in medication timing with your prescribing physician.

What should I do if I still cannot sleep while taking Suboxone?

If insomnia continues after opioid withdrawal is controlled, the next step is to investigate other possible causes rather than automatically increasing your Suboxone dose. Cognitive Behavioral Therapy for Insomnia (CBT-I) is a recommended first-line treatment for chronic insomnia. Maintaining a consistent sleep schedule, addressing depression or anxiety, managing chronic pain, and screening for obstructive sleep apnea may also improve sleep. Your physician can help determine the most appropriate treatment.

References

  1. 1. Lukas SE, et al. Buprenorphine and Sleep Architecture: Polysomnographic Study During Chronic Treatment. Psychol Addict Behav. 1996;4(4):413. DOI: 10.1037/1064-1297.4.4.413
  2. Zheng W, et al. Self-reported Sleep Improvement in Buprenorphine MAT Population. 2016;3(1). PMID: 28133635
  3. Laffont CM, et al. Buprenorphine exposure levels to optimize treatment outcomes in opioid use disorder. Front Pharmacol. 2022;13. DOI: 10.3389/fphar.2022.1052113
  4. Gauthier EA, et al. Buprenorphine Disrupts Sleep and Decreases Adenosine Concentrations in Sleep-regulating Brain Regions. Anesthesiology. 2011;115(4):743-753. DOI: 10.1097/ALN.0b013e31822e9f85
  5. Tripathi R, et al. Assessment of Subjective Sleep Problems in Men With Opioid Dependence Maintained on Buprenorphine. J Addict Med. 2020;14(2):132-138. DOI: 10.1097/ADM.0000000000000539
  6. Hallinan R, et al. Insomnia and excessive daytime sleepiness in women and men receiving methadone and buprenorphine maintenance treatment. Subst Use Misuse. 2019;54(10):1589-1598. DOI: 10.1080/10826084.2018.1552298
  7. Hernandez E, Griggs S. Sleep Health Among Adults in Outpatient Opioid Use Disorder Treatment: A Systematic Review. J Psychosoc Nurs Ment Health Serv. 2023. DOI: 10.3928/02793695-20230622-04