How Does Suboxone Affect Sleep?

Although Suboxone is an important therapy for opioid use disorder (OUD), it has potential side effects. Some of those side effects involve your sleep. 

The buprenorphine inside Suboxone is a partial opioid agonist. Opioids can change your brain’s sleep architecture. 

In general, medicines that bind to the opioid receptors in the brain cause daytime sleepiness or somnolence, or conversely can affect the quality of sleep you get at night.

Breaking Down Sleep Disorders and Suboxone

It is hard to say exactly how Suboxone affects sleep in different individuals. Insomnia can be a side effect of simply discontinuing opioid use, and so sometimes it is hard to tell if insomnia is a side effect of Suboxone or simply a consequence of discontinuing other opioid use. 

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 many other factors. [1]

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 disrupt sleep architecture and cause sleep stage distribution, increasing daytime fatigue, sleepiness, and disturbed sleep.[2] Suboxone is only a partial opioid agonist, arguably a “weaker” opioid than other full opioids and therefore probably has even less effect on sleep than “full opioids”. However, everyone’s chemistry is different and therefore Suboxone may alter sleep architecture in certain individuals even if they are used to stronger opioids. 

Sleep Quality & Suboxone

A study published in 2012 suggested that buprenorphine reduced rapid eye movement (REM) and non-rapid eye movement sleep cycles in rats.[3] Taking buprenorphine also increased sleep latency, or the time it takes to fall asleep. The results indicate that buprenorphine can reduce the quality of sleep.

On the other hand, full opioids like oxycodone and heroin can also do this, potentially even more so. Therefore, switching from using full opioids to Suboxone may actually improve quality of sleep in some individuals. 

Sleep Apnea & Suboxone

Sleep apnea is another common sleep disorder in the United States, predominantly seen in older adults, people who are obese, and those who use substances like alcohol and cigarettes.[4]

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 the following:

• Diabetes
• Chronic pain
• Heart disease
• Glaucoma
• Some cancers
• Cognitive problems
• Psychiatric conditions

In a 2013 study, 63% of the participants taking buprenorphine/naloxone as their maintenance medicine for opioid use disorder treatment had at least mild disordered breathing.[5] It is therefore possible that, if you already have sleep apnea, being on Suboxone might make this condition worse. However, bear in mind that using full opioids like heroin or oxycodone will also make sleep apnea worse, probably even more so than a partial opioid like Suboxone. Discontinuing full opioids for Suboxone as a safer alternative might therefore decrease your sleep apnea symptoms in some individuals, particularly if they were using full opioids prior.

Tips to Help You Sleep Better While on Suboxone

Quality sleep is essential during the recovery process. Treatment programs for opioid use disorder should consider the impact of insomnia or sleep disruption on the ability of the individual to remain in treatment.[7]

Losing sleep impacts the rest of your life, such as the following:

• Ability to think clearly
• Willingness to manage pain
• Moderate emotions and stress
• Perform everyday tasks

It can also trigger relapse to opioids.

Follow these tips to get better sleep in general, but particularly when taking opioids or Suboxone:

Prepare for Sleep

Look for opportunities to calm your brain and body before you sleep. Take a warm bath, drink calming tea, and turn down the lights.

Avoid stressful or activating activities right before bed, including:

• Checking your email or writing text messages
• Reading the news
• Paying bills
• Arguing with a loved one
• watching TV 

Make Your Room a Sleep Haven

Think of your bedroom as a cozy nook for sleeping only. An ideal sleeping environment meets these criteria:

• Dark: Blackout curtains can help, as can closing doors and turning out the lights.
• Cool: Pile the blankets on your bed, but keep the room’s temperature low.
• Quiet: Try a noise machine if you have noisy neighbors or a busy neighborhood.

Talk to Your Doctor

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

Use Medications

Over-the-counter medical treatments may also be beneficial, including valerian or melatonin supplements. Other non-addictive sleep medications may be useful 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 overdose potential.

Sources

1. Insomnia. National Heart, Lung, and Blood Institute. https://www.nhlbi.nih.gov/health-topics/insomnia. Accessed February 2022.
2. 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.
3. 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.
4. Sleep Apnea. National Heart, Lung, and Blood Institute. https://www.nhlbi.nih.gov/health-topics/sleep-apnea. Accessed February 2022.
5. 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.
6. 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.
7. Treating Sleep Problems of People in Recovery from Substance Use Disorders. Substance Abuse and Mental Health Services Administration. https://store.samhsa.gov/sites/default/files/d7/priv/sma14-4859.pdf. Fall 2014. Accessed February 2022.