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How Does Suboxone Affect Sleep?

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Suboxone is a lifesaving medicine for people overcoming opioid use disorder. Buprenorphine, a partial opioid agonist and the main ingredient in Suboxone, can impact sleep and sleep disorders like insomnia and sleep apnea in the same way that full opioid agonists, like heroin, can.

Opioids can change your brain’s sleep architecture. s In general, medicines that bind to the opioid receptors in the brain can increase your risk of insomnia, and because it also binds to the opioid receptors, buprenorphine can also worsen sleep. Chronic opioid consumption is also linked to higher rates of sleep apnea. Although it is not well-studied, buprenorphine may worsen, or at least not improve, opioid-related sleep apnea.

Poor sleep quality increases the risk of relapse. Being poorly rested reduces impulse control and increases craving, irritability and poor mood, all of which increase the drive to use a substance like an opioid. It is important for treatment programs to screen incoming patients for sleep disorder signs and help them manage these issues as they appear during treatment.

Does Suboxone Affect Your Sleep Quality?

Although Suboxone is an important Medication for Addiction Treatment (MAT), there are potential side effects associated with taking this medicine, as there are with every medication. Typically, side effects ease over time.

Inform your physician of any uncomfortable effects from Suboxone. Follow their advice on managing these symptoms, including potentially adjusting your dose, waiting and further reporting, or taking other approaches.

These are potential Suboxone side effects:[1]

  • Constipation, stomach upset, and nausea
  • Headaches
  • Increased sweating
  • Physical pain 
  • Sleep disruptions or changes like insomnia

Though it’s rare, insomnia can be one of the toughest side effects. Losing sleep impacts the rest of your life, such as your ability to think clearly, manage pain, moderate emotions and stress, and perform tasks. If you think that Suboxone is impairing your ability to sleep, make sure to discuss this with your doctor.

Insomnia & Suboxone

Insomnia is a common sleep disorder that often affects people on a short-term basis due to life changes, stress, hormone fluctuations, illness, and other struggles.[2] Typically, insomnia will go away on its own, but some people need help managing the condition until they can return to a normal sleep pattern.

Opioid drugs are central nervous system depressants, so they cause sedation and sleepiness among other effects. A statement released by the American Academy of Sleep Medicine (AASM) reported that opioids are known to disrupt sleep architecture and cause sleep stage distribution, which can increase daytime fatigue, sleepiness, and disturbed sleep.[3]

In theory, Suboxone might be expected to either help or hurt sleep. When quitting opioids, sleeplessness and insomnia can be side effects, in part because withdrawal from opioids increases anxiety and agitation. Therefore, on the one hand, Suboxone might be theorized to ease some of these symptoms and improve sleep, since it reverses withdrawal. On the other hand, buprenorphine, the principal component of Suboxone, buprenorphine, has some opioid agonist effects, albeit weaker ones than full opioid agonist do. Through this mechanism, it might disrupt sleep patterns.

To address these questions, a study published in 2012 found that buprenorphine reduced rapid eye movement (REM) and non-rapid eye movement sleep cycles in rats.[4] This indicates that buprenorphine can indeed, reduce the quality of sleep, similarly to other opioids. Taking buprenorphine also increased sleep latency, or the amount of time it takes to fall asleep.

A more recent study reported that there were no significant differences in rates of reported sleep disturbances between people taking methadone as MAT compared to those taking Suboxone.[5] Recall that methadone is a full opioid agonist, which means that it strongly activates the opioid receptor, like heroin or oxycodone. While methadone’s associated sleep disruptions are well-documented (between 70 and 85 percent reporting poor sleep quality), buprenorphine’s sleep disturbances are less understood. Since sleep disturbance rates were similar between treatment groups, it is likely d that Suboxone can impact your ability to get good rest, like other opioids do, even though it is a partial agonist.

Sleep Apnea & Suboxone

Sleep apnea is another common sleep disorder in the United States, predominantly seen in older adults, people who are obese, and in those who abuse substances like alcohol and cigarettes.[6]

Obstructive sleep apnea is caused by upper airway blockage, which can slow or stop airflow. Central sleep apnea is a disturbance in the brain leading to disrupted, irregular, or labored breathing during sleep. Undiagnosed sleep apnea can increase the risk of diabetes, chronic pain, heart disease, glaucoma, some cancers, cognitive problems, and psychiatric conditions.

People who chronically take opioids for any reason are at higher risk of central and obstructive sleep apneas, hypopneas, ataxic breathing, and hypoxemia.[7]

Buprenorphine is likely no exception. For example, a 2013 study examined 70 participants who were taking buprenorphine/naloxone as their maintenance medicine for opioid use disorder treatment. Most participants were young, not obese, and female, but 63 percent of the participants had at least mild disordered breathing. Moderate and severe sleep apnea were present in 16 and 17 percent of participants, respectively. These rates are higher than in the general population.

Therefore, anyone taking Suboxone should be evaluated for potential sleep apnea and related breathing disorders. This is because buprenorphine can continue to disrupt sleep, and sleep apnea will increase the risk of poor sleep quality and insomnia.

Another study from 2015 examined two case reports involving sleep apnea and Suboxone.[8] One case benefitted from both a CPAP machine and a reduction in her Suboxone dose, while the other case did not tolerate Suboxone reduction and could only use a CPAP.

The case study further suggests the importance of screening for sleep disorders like insomnia and sleep apnea in people getting treatment for opioid use disorder. Chronic opioid use and abuse can make these conditions worse, and it is likely that buprenorphine can have the same adverse effects.

Managing Sleep Disorders During Treatment for Opioid Use Disorder

Treatment programs for opioid use disorder must consider the impact of insomnia or sleep disruption on the ability of the individual to remain in treatment.[9]

Feeling stressed, anxious, or having greater levels of physical pain due to poor sleep can increase the risk of relapse, so addressing potential insomnia risks before and during MAT is important. This includes assessing mental and physical health histories for anything like anxiety, depression, or sleep apnea that might lead to insomnia during treatment.

Although MAT is the preferred approach to treating opioid use disorder, nonpharmacological treatments are the preferred approach to managing insomnia or sleep disorders during addiction treatment. Cognitive behavioral therapy (CBT) for insomnia, for example, is an established evidence-based behavioral approach to improving sleep that is effective in reducing insomnia.

Sleep hygiene and education can also help. Try these tips:

  • Limit bedroom activities like checking your phone or computer right before bed.
  • Reduce stressful activities like paying bills right before bed.
  • Develop a pre-sleep routine like taking a warm bath, doing breathing exercises, stretching, or reading a book.

If sleep hygiene does not help to manage insomnia, a sleep medicine specialist can provide support. Over-the-counter medical treatments may also be beneficial, including valerian or melatonin supplements. Other non-addictive sleep medications may be of use, and can be explored with your provider. Avoiding addictive prescription medicines, like benzodiazepines, is important as these can interfere with Suboxone’s effectiveness and increase the dangerousness of Suboxone and other opioids in terms of overdose risk.

Suboxone greatly reduces the risk of relapse and improves treatment outcomes for people with opioid use disorder. , In the end, recovery from opioid use disorder will promote better sleep and rest, and have powerful overall effects on your mental well-being. Still, managing co-occurring conditions like sleep apnea and insomnia are important, as you progress in your opioid use disorder treatment.

SOURCES

  1. Buprenorphine (Oral/Sublingual). University of Michigan Health, Michigan Medicine. https://www.uofmhealth.org/health-library/d00840a1. Accessed February 2022. 
  2. Insomnia. National Heart, Lung, and Blood Institute (NHLBI). https://www.nhlbi.nih.gov/health-topics/insomnia. Accessed February 2022. 
  3. Chronic Opioid Therapy and Sleep: An American Academy of Sleep Medicine Position Statement. Journal of Clinical Sleep Medicine. https://jcsm.aasm.org/doi/10.5664/jcsm.8062. November 2019. Accessed February 2022. 
  4. Buprenorphine Disrupts Sleep and Decreases Adenosine Levels in Sleep-Regulating Brain Regions of Sprague Dawley Rat. Anesthesiology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3197808/. October 2012. Accessed February 2022. 
  5. Effects of Methadone, Buprenorphine on Sleep Quality in Opioid Use Disorder. Neurology Advisor. https://www.neurologyadvisor.com/topics/sleep-disorders/effects-of-methadone-buprenorphine-on-sleep-quality-in-opioid-use-disorder/. January 2020. Accessed February 2022. 
  6. Sleep Apnea. National Heart, Lung, and Blood Institute (NHLBI). https://www.nhlbi.nih.gov/health-topics/sleep-apnea. Accessed February 2022. 
  7. Sleep Disordered Breathing in Patients Receiving Therapy with Buprenorphine/Naloxone. European Respiratory Journal. https://pubmed.ncbi.nlm.nih.gov/23100497/. August 2013. Accessed February 2022. 
  8. Sleep-Disordered Breathing in Patients with Opioid Use Disorders in Long-Term Maintenance on Buprenorphine-Naloxone: A Case Series. Journal of Opioid Management. https://pubmed.ncbi.nlm.nih.gov/26312963/. July-August 2013. Accessed February 2022. 
  9. Treating Sleep Problems of People in Recovery from Substance Use Disorders. Substance Abuse and Mental Health Services Administration (SAMHSA). https://store.samhsa.gov/sites/default/files/d7/priv/sma14-4859.pdf. Fall 2014. Accessed February 2022. 

Medically Reviewed By Claire Wilcox, MD

Claire Wilcox, MD, is a general and addiction psychiatrist in private practice and an associate professor of translational neuroscience at the Mind Research Network in New Mexico; and has completed an addictions fellowship, psychiatry residency, and internal medicine residency. Having done extensive research in the area, she is an expert in the neuroscience of substance use disorders. Although she is interested in several topics in medicine and psychiatry, with a particular focus on substance use disorders, obesity, eating disorders, and chronic pain, her primary career goal is to help promote recovery and wellbeing for people with a range of mental health challenges.

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