Treatment interventions for co-occurring opioid use disorder, and sleep disturbances: a scoping review

Opioid use disorder (OUD) is part of the broader spectrum of substance use disorders often complicated by psychiatric symptoms such as depression, anxiety, PTSD (Post-Traumatic Stress Disorder), and sleep disturbances, with insomnia being particularly frequent. These psychiatric symptoms may act as precipitating factors and consequences of OUD, reinforcing a complex bidirectional relationship that complicates treatment and recovery. Despite the clinical importance of dual disorders, sleep impairments are particularly relevant yet understudied therapeutic targets and literature addressing sleep disturbances in the context of psychiatric symptoms or disorders in OUD remains limited. This scoping review examines pharmacological and non-pharmacological interventions of OUD and sleep disturbances in the presence of psychiatric disorders or symptoms, such as anxiety, depression, and PTSD.

This review follows the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews (PRISMA-ScR) guidelines using the following keywords: ("sleep" OR "insomnia") AND ("depression" OR "anxiety" OR "PTSD" OR "post-traumatic stress disorder" OR "posttraumatic stress disorder") AND ("opioid use disorder" OR "OUD" OR "opioid addiction. Sleep disordered breathing was excluded. Participants were adults (> 18 years old) with OUD or opioid dependence undergoing withdrawal or treatment. The study focused on quantitative and qualitative study designs.

Fifteen studies including 1,167 adults with OUD or opioid dependence were selected and categorized into pharmacological (targeting opioid or non-opioid receptors) and non-pharmacological interventions. Most interventions were adjunctive to opioid substitution or antagonist therapies. Naltrexone-induced insomnia was common but did not significantly affect mood and could be mitigated with lorazepam. Non-opioid pharmacotherapies yielded mixed results: guanfacine is suggested to increase insomnia risk but reduce stress and craving, while amitriptyline, prazepam, dronabinol, and neurotransmitter-precursor-supplements showed potential in improving sleep and withdrawal symptoms.

Improved characterization and management of impaired sleep in individuals with OUD and psychiatric symptoms may reduce relapse risk, enhance emotional regulation, and decrease self-medication. Clinicians should consider the complex interplay between OUD, psychiatric symptoms, and sleep as part of comprehensive care. Further research is needed to clarify these interactions and support the development of integrated, evidence-based strategies for treatment and prevention.

Not applicable.