Evie Summers
Sleep and opioids are closely linked. Opioids affect sleep through the orexin neurotransmitter system, which is responsible for wakefulness. If orexin is overactive, a person may have difficulty falling or staying asleep. As many as 80% of people with opioid use disorder (OUD) experience insomnia. While drugs such as benzodiazepines or zolpidem (Ambien) are sometimes prescribed to treat insomnia in people with OUD, they can increase the risk of opioid overdose. Suvorexant, an anti-wakefulness medication, has been studied as a possible treatment for insomnia in people with OUD, showing promising results in improving total sleep time and reducing opioid withdrawal and cravings. However, it's important to note that sleeping pills can have side effects and are not recommended for long-term use. Natural sleep aids like melatonin and valerian are also options, but it's always best to consult a healthcare provider before taking any sleep medication, especially when also taking opioids.
| Characteristics | Values |
|---|---|
| Safe sleeping pills to take with opioids | Suvorexant |
| Sleeping pills that are unsafe to take with opioids | Benzodiazepines, Zolpidem (Ambien) |
| Side effects of sleeping pills | Daytime drowsiness, muddled thinking, dizziness, balance problems, constipation or diarrhea, muscle weakness, digestive problems, worsened snoring and sleep apnea, confusion, memory problems, dry mouth, difficulty urinating |
| Natural sleep aids | Melatonin, valerian |
| Other non-drug therapies | Cognitive behavioral therapy (CBT) |
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What You'll Learn
- Zolpidem (Ambien) is a sleep aid that can be taken with opioids but may increase overdose risk
- Suvorexant is an anti-wakefulness medication that may help those with opioid use disorder
- Benzodiazepines can be used to treat insomnia but are dangerous when mixed with opioids
- Melatonin is a natural sleep aid that may help those on opioids
- Valerian is a natural herb that may aid relaxation and sleep for opioid users
Zolpidem (Ambien) is a sleep aid that can be taken with opioids but may increase overdose risk
Zolpidem, sold under the brand name Ambien, is a sedative-hypnotic medication commonly prescribed for the short-term treatment of insomnia. It is a controlled substance that can cause drowsiness, dizziness, and reduced control over movements. Zolpidem interacts with other medications and substances that have similar effects, including opioids, benzodiazepines, and alcohol.
While zolpidem can be taken with opioids, it is important to recognize the risks associated with this combination. Both medications affect the brain, and when used together, there is an increased risk of extreme sleepiness, slowed breathing, and unresponsiveness. These side effects can be dangerous and even life-threatening, potentially leading to difficulty breathing and, in severe cases, death.
The risk of experiencing adverse effects is higher when zolpidem is combined with opioids, particularly for women and adults over the age of 65. Additionally, the likelihood of a zolpidem overdose increases when the drug is taken with opioids or other central nervous system (CNS) depressants. Symptoms of a potential overdose include impaired consciousness, extreme sedation, and severe respiratory depression, characterized by slowed, shallow, or irregular breathing.
It is crucial to consult a healthcare provider before taking zolpidem, especially if you are also taking opioids. Healthcare professionals can assess the potential benefits and risks for each individual and provide guidance on managing drug interactions. They may recommend avoiding one or both medications or closely monitoring for signs of dangerous interactions.
While zolpidem can be an effective sleep aid, it should be used with caution, especially when combined with opioids. It is important to prioritize safety and follow the advice of healthcare professionals to minimize the risk of adverse effects and overdose.
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Suvorexant is an anti-wakefulness medication that may help those with opioid use disorder
Insomnia is a common issue for people with opioid use disorder (OUD), with as many as 80% of people affected. Opioids directly impact sleep through the orexin neurotransmitter system, which is responsible for wakefulness. If orexin is overactive, a person may struggle to fall asleep or stay asleep, and cravings for drugs or other substances may increase.
Suvorexant is an anti-wakefulness medication that blocks the action of orexin. It is not a classic sedative, but an orexin receptor antagonist. In a 2022 study, researchers administered suvorexant to 38 people with OUD during opioid withdrawal. The results showed improved sleep and REM time, reduced withdrawal symptom severity, and a heightened desire to quit opioid use.
Previous studies have also shown promising results for suvorexant in treating OUD. In a study by Huhn and colleagues, suvorexant improved total sleep time by 90 minutes in patients tapering off opioids and 60 minutes in the post-taper period. It also reduced participants' withdrawal symptoms and cravings.
An $18 million Phase 3 clinical trial of suvorexant for people in treatment for OUD is currently underway. The trial will enroll 300 participants with insomnia who have been on a stable dose of buprenorphine or methadone for opioid use disorder for at least two weeks. Participants will take 10 mg–20 mg of suvorexant or a placebo once a day for eight weeks and undergo sleep studies and mental health assessments.
Suvorexant has the potential to be a key treatment for adverse opioid withdrawal symptoms and may improve overall well-being and OUD treatment outcomes.
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Benzodiazepines can be used to treat insomnia but are dangerous when mixed with opioids
Benzodiazepines, also known as benzos, are a class of medications used to treat anxiety disorders, seizures, insomnia, and other health conditions. They work by targeting and binding to the gamma-aminobutyric acid (GABA) neurotransmitter in the brain, which leads to sedation, muscle relaxation, and reduced anxiety. While they can be effective for treating insomnia, they come with several risks and side effects, especially when mixed with other substances like opioids.
Benzodiazepines are associated with an increased risk of falls, fractures, overdose, misuse, and dependence, with these risks being greater for older adults, frail individuals, and people with a history of addiction. Mixing benzodiazepines with opioids can be particularly dangerous due to the depressant effects of both substances. The combination can lead to an increased risk of severe side effects, including respiratory depression and a fatal overdose.
Additionally, the concurrent use of benzodiazepines and opioids can increase the risk of opioid abuse and the likelihood of future chronic opioid use. People with insomnia are already at risk of substance use and dependence, and the use of benzodiazepines can further contribute to this risk. This is especially concerning given the ongoing opioid crisis, and efforts to address this crisis should include a focus on the use of benzodiazepines as a risk factor.
While benzodiazepines can be effective for treating insomnia in the short term, it is important to consider the potential risks and side effects, especially when mixed with opioids. It is recommended to discuss these risks with a healthcare provider and explore alternative treatments, such as cognitive behavioural therapy, before considering benzodiazepines.
In conclusion, while benzodiazepines can be used to treat insomnia, they should be approached with caution, especially when an individual is also taking opioids. The risks and side effects can be significant, and alternative treatments should be considered first to ensure the safest approach to managing insomnia.
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Melatonin is a natural sleep aid that may help those on opioids
Sleep difficulties and insomnia are common issues for those with opioid use disorder (OUD). While traditional sleep aids and drugs such as benzodiazepines or zolpidem (Ambien) can be prescribed, they may increase the risk of opioid overdose. As such, it is important to explore other options, and melatonin may be a suitable natural sleep aid.
Melatonin is a hormone that your body produces naturally. It does not induce sleep but prepares your body for it by creating a state of quiet wakefulness. Melatonin helps regulate your sleep cycle, and while it is not a long-term solution for insomnia, it can be useful for shifting your sleep schedule, such as when travelling across time zones.
If you are experiencing insomnia due to opioid use, melatonin supplements may be worth considering. They are available over the counter and can be taken with a glass of water before bed. It is recommended to take 1 to 3 milligrams two hours before bedtime. However, it is important to consult your healthcare provider before taking any new medication, especially if you are being treated for a mental or sleep issue, as melatonin may interfere with your treatment.
To optimise the effects of melatonin, you can take additional steps such as creating a relaxing environment before bed, keeping the lights low, and minimising exposure to blue and green light from electronic devices. Exposing yourself to natural daylight during the morning and afternoon can also help regulate your body's melatonin production.
While melatonin is a natural option that may assist with sleep, it is important to remember that it can cause side effects, and herbal supplements are not regulated like medications. Thus, it is always advisable to consult your healthcare provider for guidance on dosage, potential interactions, and the suitability of melatonin for your specific situation.
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Valerian is a natural herb that may aid relaxation and sleep for opioid users
Valerian, a herb native to Asia and Europe, has been used as a natural sleep aid since ancient times. It is often referred to as "nature's Valium" and can be consumed as a tea or supplement. Valerian root is believed to promote relaxation and improve sleep quality, making it a potential option for those struggling with insomnia or anxiety.
Several studies have supported the effectiveness of valerian in improving sleep. In a 2021 study, participants who took 530 mg of valerian root one hour before bedtime for a month reported higher-quality sleep compared to a placebo group. Another study from 2017 found that those who took an herbal supplement containing valerian fell asleep faster, slept longer, and experienced fewer nighttime awakenings.
For opioid users experiencing sleep disturbances, valerian may offer a natural alternative to traditional sleeping pills. Opioids can directly impact sleep through the orexin neurotransmitter system, which regulates wakefulness. As a result, individuals with opioid use disorder (OUD) often struggle with insomnia, and finding suitable treatments can be challenging. While drugs like benzodiazepines and zolpidem (Ambien) are sometimes prescribed for OUD patients with insomnia, they can interact with opioids and increase the risk of overdose.
Therefore, valerian, with its history of safe use and potential sleep-enhancing properties, could be a valuable option for opioid users seeking to improve their sleep. However, it is important to consult with a healthcare professional before taking valerian, especially if you are on medications or have existing health conditions. While natural supplements may be beneficial, they are not a cure-all, and addressing sleep issues may require a comprehensive approach that targets underlying causes.
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Frequently asked questions
It is not recommended to take sleeping pills with opioids due to the risk of overdose. However, if you are experiencing sleep issues while taking opioids, it is best to consult a doctor. They may suggest non-drug therapies such as CBT or natural sleep aids like melatonin or valerian.
Taking sleeping pills with opioids increases the risk of an opioid overdose. Stanford researchers found that nearly 30% of fatal opioid overdoses in the US involve benzodiazepines, a common sleeping pill.
Sleeping pills can cause a range of side effects, including constipation, muscle weakness, digestive problems, and worsened snoring and sleep apnea. They can also cause confusion and memory problems, especially in older adults, which could lead to accidents.
Yes, there are natural sleep aids such as melatonin and valerian supplements that can help induce sleep. However, it is always recommended to check with a healthcare provider before taking any sleep aids. Cognitive behavioral therapy (CBT) is also an effective alternative to improve sleep.
If you want to stop taking sleeping pills, it is important to slowly lower your dose over time to reduce the risk of rebound insomnia. Speak with your doctor about how to safely wean yourself off sleeping pills.
