Sleep and Drug Use: Neuroimaging Evidence for a Multidimensional Brain Framework

Sleep plays a critical role in the initiation and maintenance of drug use, as well as recovery among individuals with substance use disorders. Sleep is a multidimensional construct, and a growing body of research has demonstrated the relative independence of various components. Specific sleep characteristics including insomnia (self-reported sleep disturbances), short sleep duration, late sleep timing and sleep irregularity have each been associated with increased risks of drug use. However, it remains unclear whether these sleep components contribute to substance use through shared neurobiological pathways. Conversely, drug use across different drug classes disrupts sleep. The extent to which drug-induced alterations in brain circuits account for shared and drug class-specific sleep disturbances remains poorly understood. In this review, we synthesize evidence from human neuroimaging studies to map sleep components predictive of drug use onto brain regions and large-scale brain networks. The anterior cingulate, insular and orbitofrontal cortices emerge as the brain regions most consistently implicated across sleep dimensions, and these regions play a key role in drug use initiation. We further discuss how chronic use of different drug classes also disrupts these brain regions and broader neural circuits involved in sleep regulation, thereby exacerbating initial sleep disturbances and potentially extending their effects to other sleep dimensions. This review underscores the importance of integrating multimodal sleep and neuroimaging assessments to advance the neurobiological understanding of the bidirectional relationship between sleep, drug use and addiction and highlights directions for future research.