Pharmacological and Nonpharmacological Interventions to Address Sleep Disturbance in Substance use Disorders

We examined literature from PubMed and Google Scholar to summarize the available evidence on pharmacological and nonpharmacological interventions to manage sleep disturbances in individuals with substance use disorders, with a focus on alcohol, opioids, cannabis, and nicotine use disorders. Overall, 82 studies were included in this review. For the studies included, the year of publication ranged from 1977 to 2023. Several pharmacological agents showed preliminary efficacy and tolerability in treating sleep disturbances in patients with substance use disorders, particularly in the context of alcohol and opioid use. Further well-powered studies with longer duration of follow-up are required. There was insufficient evidence to support the use of specific agents to treat sleep difficulties in cannabis and nicotine use disorders, although some medications showed initial promise. Nonpharmacological interventions such as cognitive behavioral therapy for insomnia (CBT-I) could serve as a valuable complement to pharmacotherapy in patients with substance use disorders; however, further research is needed in disorders other than alcohol dependence. Sleep disturbance was found to be a common, easily identifiable, and potentially modifiable risk factor in patients with substance use disorders. Recognition and treatment of sleep disturbance in this population can impact treatment participation, quality of life, and relapse risk. Evidence for pharmacological agents in this space is growing. Treatment options vary depending on the type of substance use disorders and clinicians need to balance potential risks and benefits in the individual patient.