How to Overcome Insomnia During Opioid Withdrawal

Many people struggle with insomnia during opioid withdrawal. It's one of the most common complaints reported by from people undergoing withdrawal.[1]

Self-care steps can help quite a bit, as can medications. 

6 Insomnia Self-Care Tips to Try During Opioid Withdrawal

Expect sleep problems during opioid withdrawal, and prepare for them in advance. The plans you make now can help you rest comfortably and give you the energy to need to help your body adjust.

Because insomnia can last for months or even years after recovery, you might find yourself managing chronic insomnia after recovering from an opioid use disorder.[1]

Here are some suggestions to improve sleep disorders while undergoing recovery:

1. Stick to a Schedule 

When do you typically go to sleep? When do you need to awaken to get to work on time? Use these times as your sleep/wake schedule, and follow the same daily outline. 

2. Avoid Caffeine Before Bed

For many people in recovery, caffeine becomes a crutch. Unfortunately, caffeine can stay active for six to eight hours in the body, blocking your ability to sleep well particularly if you are consuming caffeinated beverage later in the afternoon.[2] If your insomnia is severe, try to minimize caffeine, or make sure you are taking it at a regular time in the morning and long before you are attempting to sleep at night. 

3. Clear Your Mind

Before you lay your head down on your pillow, take a moment to meditate. Slow your breathing, empty your mind, and focus on your body. Try to slow down your breath and your heart rate.

Techniques like this can help you prepare your mind for sleep. If you struggle to make this work on your own, there are therapists that specialize in relaxation techniques. There is even a therapeutic technique called “cognitive behavioral therapy for insomnia” (or CBTi) that can be learned to help with chronic insomnia. 

4. Keep Your Room Cool 

Most people sleep best when their rooms are about 65 degrees.[3] If you're struggling with withdrawal-related chills, sleeping in a comfortable temperature can really help. 

5. Block Out Excess Light 

Room-darkening curtains can block out excess light. If you don’t have blinds, try a face/eye mask. Make sure you turn off televisions or other light sources. 

6. Get Up If Needed 

It can be hard to slow a racing mind, especially during opioid withdrawal. If you've tossed and turned for 20 minutes with no relief, it's time to get up.[4] Find something soothing to do (such as reading, knitting, or petting your cat) until you feel ready to try again. 

What Medications Can I Use to Help With Sleep?

Insomnia is common, and grocery store shelves are filled with medications that claim to help. Some medications are safer and have a lot more efficacy than others.

Melatonin is commonly marketed as a safe and natural sleep aid, and it is quite safe to take, including for patients who are taking Suboxone, Methadone, or other medications for opioid withdrawal.[5]

Antihistamines like diphenhydramine or hydroxyzine also induce sleep,  but you can grow dependent on them if you take them for long periods.[6] Since you're in recovery from opioid use disorder, it's not wise to add another addictive element to the mix. In addition, they can have several other side effects such as dizziness, sedation, dry mouth, urinary retention, and constipation.

In addition, there are some other more potent sleep medications such Zolpidem (ambien) that can be offered in severe cases. However, Zolpidem can have some dangerous side effects including addiction/dependency and increased risk of respiratory suppression, especially then combined with other opioids or with MAT like Suboxone or Methadone. If you feel that ambien is necessary, it should be prescribed with close supervision by a medical professional. 

How Long Will Opioid Withdrawal Insomnia Last?

It really depends. Some individuals experience acute and short term insomnia while others may have insomnia that persists for months or years. In one of the earliest studies of opioid withdrawal insomnia, sleep problems peaked in the first two weeks. After a month, some were sleeping better, but others were not.[7] Every individual is different when it comes to their sleep needs. 

What Else Can I Try to Help With Sleep During Withdrawal?

MAT therapy is the first line treatment for withdrawal from opioid use, and for long term treatment of OUD. [8] Using MAT during the acute withdrawal period helps prevent and/or improve all the symptoms of withdrawal, including insomnia.

If you are going through withdrawal and concurrent insomnia, MAT therapy may be extremely helpful. Talk to your doctor about whether MAT might be right for you.

Sources

1. Insomnia in Patients with a Substance Use Disorder. UpToDate. https://www.uptodate.com/contents/insomnia-in-patients-with-a-substance-use-disorder. Accessed July 2022.
2. Caffeine Effects on Sleep Taken 0, 3, or 6 Hours Before Going to Bed. Journal of Clinical Sleep Medicine. https://jcsm.aasm.org/doi/10.5664/jcsm.3170. November 2013. Accessed July 2022.
3. The Best Temperature for Sleep. Sleep Foundation. https://www.sleepfoundation.org/bedroom-environment/best-temperature-for-sleep. March 2022. Accessed July 2022.
4. What To Do When You Can't Sleep. Sleep Foundation. https://www.sleepfoundation.org/insomnia/treatment/what-do-when-you-cant-sleep. March 2022. Accessed July 2022.
5. Melatonin and Sleep. Sleep Foundation. https://www.sleepfoundation.org/melatonin. April 2022. Accessed July 2022.
6. Diphenhydramine. National Health Service. https://www.nhs.uk/medicines/diphenhydramine/. October 2021. Accessed July 2022.
7. Insomnia Among Addicts During Supervised Withdrawal from Opiates: A Comparison of Oral Methadone and Electrostimulation. Drug and Alcohol Dependence. https://pubmed.ncbi.nlm.nih.gov/6609807/. March 1984. Accessed July 2022.
8. Opioid Use Disorder. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK553166/. January 2022. Accessed July 2022.