Opiate/Opioid Withdrawal And Insomnia
Medically reviewed byJoseph Sitarik, DO
February 18, 2019
When individuals attempt to stop the use of opiates, they are exposed to several side-effects that stem from opiate withdrawal. While symptoms of withdrawal vary by person and the drug used, a common symptom that may result is insomnia.
What Is Withdrawal?
Opiate withdrawal or “dope sickness” results from prolonged use and physical dependence. This physical dependence can happen with both illicit and prescribed opiates. The withdrawals can occur not only after discontinuation but also after a significant reduction of use. These can be very unsettling and uncomfortable; the time it takes for the withdrawal symptoms to start is dependent on the drug. According to the NIH, “withdrawal from opiates is painful, but usually not life-threatening.”
Opiate withdrawal manifests itself in many ways. It ravages the body’s physical components, but it also wreaks havoc on a person’s mental state, going as far as to actually alter the chemistry of their brain and change the chemicals and processes that are elemental to our health and well-being, both in sleep and waking hours.
How Does Withdrawal Cause Insomnia?
Mayo Clinic defines insomnia as “a persistent disorder that can make it hard to fall asleep, hard to stay asleep or both, despite the opportunity for adequate sleep. With insomnia, you usually awaken feeling unrefreshed, which takes a toll on your ability to function during the day. Insomnia can sap not only your energy level and mood but also your health, work performance and quality of life.”
Insomnia is one of the most prevalent symptoms of opiate withdrawal and also one of the most challenging and frustrating to an individual striving towards recovery, as it affects nearly every other aspect or symptom of their withdrawal. This can make it seem all the more daunting, especially when the process can be mentally exhausting as well, as the person strives to cope with the cumulative effects of the withdrawal symptoms.
Due to the drug addiction, a person’s energy may be rapidly decreased. Despite this, sleep may continue to elude them, further exhausting them and magnifying the other aspects of their withdrawal. Unfortunately, a numerous amount of these affect a person’s sleep patterns and contribute to their inability to sleep, these include:
- Restless legs
- Aches and pains
- Nausea, vomiting, or diarrhea
- The chills
- Cold sweats
- Racing thoughts
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The Importance Of Sleep During Withdrawals And Recovery
Consistent and good quality sleep is crucial to your health and recovery. Sleep provides your body a venue by which to heal and revitalize itself; it helps to combat the physical, mental, and even emotional damage that an addiction imposes upon your body. The benefits of sleep during withdrawal are:
- Restores and strengthens your immune system, helping to protect and prevent against damage to the body, including that of the addiction
- Aids in heart health
- Helps to regulate cortisol levels; chronic lack of sleep can increase this steroid “stress-hormone.” High levels put your body at greater risk for disease and increased anxiety, both of which may already be increased by the addiction
- Helps maintain and elevate your mood
- Increases stamina and energy—withdrawal can be physically exhausting, so you need both to contend with its symptoms
Sleep deprivation can be very harmful to your health. According to Harvard’s Division of Sleep Medicine there is a “correlation between poor sleep and cardiovascular disease and stroke” and risk of “increased blood pressure, impaired control of blood glucose, and increased inflammation.” Why does this matter for someone that was addicted to opiates? Certain opioids if used excessively, including Heroin, can in the worst instances cause strokes and myocardial infarction. Some studies exhibit a correlation between opiate use and a negative impact on insulin and glucose levels.
Methods To Help Alleviate Insomnia
For a person entering into withdrawal, they are leaving behind a state of addiction while still contending with problems from the drug abuse, coupled with the symptoms of withdrawal. Sleep can be a solution to many of these issues, but as it eludes many during withdrawal, these systems of the body and mind continue to struggle during the rigors of withdrawal.
Today, there are many ways by which to treat this. As each individual person and the nature of their physiology and addiction are different, so can be the treatment. Again, it is for this reason—and the severity of withdrawal by itself—that a person seek medical help when attempting to regulate their sleep patterns.
Foremost, a person seeking to decrease or quit a drug may consider either intensive residential or outpatient treatment; this choice is best made under the guidance of someone trained within the addiction’s field. For those who don’t anticipate this choice, it is most beneficial to your health to promptly seek medical assistance as you begin to undergo withdrawal.
There are various over-the-counter (OTC), prescription, and non-medicated approaches that may be applicable in your circumstances.
Non-Medicated Approaches to Insomnia
There are a variety of methods that utilize behavioral health concepts, health and wellness practices, or interactive support. Australia’s National Drug Strategy (NDS) acknowledges this, “the non-pharmacological methods may not have an instant effect on sleep, but if continued for days to weeks such strategies will help establish normal sleep patterns.
Utilizing medications may really assist you, these approaches may supplement and aid in their efficacy.
- Take Time For Yourself: Reading a good book, listening to soothing music, or journaling may all help relax you and instill a greater sense of well-being.
- Light Exercise: Take it slow. As impossible as this may sound, light and low-impact exercise may actually help some people with withdrawal symptoms. Not only will it help tire your body out, but it helps create and release endorphins, which are one of your body’s feel-good chemicals that can fight depression. Do not do it right before bed, and check with a doctor to make sure this is a healthy option for you at this time.
- Laugh: Studies show that laughter can release endorphins and encourage your general state of well-being. Watch a funny movie or TV show.
- Get Outside: Getting sunlight, especially early bright sunlight, boosts your production of serotonin which in turn increases your sense of wellness; it also leads to early melatonin onset, a chemical that is responsible in helping you sleep. Sunlight also helps regulate and reset your circadian rhythms.
- Meditation: Though it may not be always realistic to practice yoga or other meditative practices, you can still seek to calm your mind and meditate in a quiet room.
- Professional Therapy: Drug addiction is often accompanied by a tumult of emotions: loneliness, shame, fear, blame, resentment, and even grief. These are also some of the things that may have driven a person to use drugs in the first place. Having a chance to speak about these and learning proper methods to handle them can be helpful in lessening your depression and/or anxiety and help calm your mind as you’re trying to sleep. Though you might not always be able to actively do this during withdrawal, if you anticipate quitting, or ceasing your drug use, you can prepare yourself by speaking to someone beforehand.
- Stay With Friends Or Family: Or vice-versa. This can help you to combat loneliness and fear, both of which may precede or accompany depression and/or anxiety. In addition, it will grant you a measure of comfort as you go through this difficult time.
- Preparing Your Body To Slow Down: Avoid bright lights before bed, and have as dark a room as possible when you’re trying to sleep. If you can tolerate it, a sleep mask may be helpful
- Avoid caffeine
- Drink lots of water. It is important to stay hydrated, however, try to avoid drinking anything an hour before you go to bed
- Take a hot bath before bed, or use a hot compress to help relieve your body pain
Over-The-Counter Options For Insomnia
Some of these options include: Melatonin, Benadryl, and various pain management medications that are paired with diphenhydramine HCl or citrate, among others. The latter two contain antihistamines, which may also treat some of the other symptoms, including: runny nose, nausea, vomiting and dizziness. However, for some people, these may cause an adverse effect, create symptoms of anxiety; some people may develop a physical dependence on some antihistamines.
Even though these medications or supplements are available without a prescription, it is still advisable that you speak to your doctor prior to beginning use, as certain brands or ingredients may be harmful to your condition.
Prescription Insomnia Treatments
- Sleeping Aids: Keep in mind that many of the prescription sleep aids can in fact be habit-forming, a serious side effect for someone that is striving to leave the world of addiction behind. These should only be used if administered by a physician that is familiar with the entirety of your health, including your addiction.
- Clonidine: Though it does not directly treat insomnia, it may be useful in helping a person struggling with insomnia. It treats other side effects of withdrawal, including cramping, muscle aches, anxiety, agitation, sweating, and a runny nose. As these symptoms may sometimes aggravate a person to the point of sleep impairment, reducing them may assist in a person being able to fall asleep more readily.
- Buprenorphine: A partial opioid agonist labeled as either Subutex when it stands alone, or as Suboxone when its paired with the opioid antagonist naloxone. These both help minimize symptoms by blocking opioid receptors, thus blocking and disabling the illicit opioid from exerting its effect. Helps curb withdrawal symptoms, many of which exacerbate insomnia. Has a “ceiling effect” to curb misuse. It is more apt to be misused when it stands alone.
- Methadone: A synthetic opioid, it is a full opioid agonist used to treat acute withdrawal syndrome (detoxification treatment); due to this it can be useful in decreasing the other trigger symptoms for insomnia. Can be highly addictive with significant risk of overdose.
- Benzodiazepines: Benzodiazepines are sedative-hypnotics that do curb anxiety, and are at times prescribed for temporary short-term relief of insomnia. There are certain considerations a recovering opiate user must take when using them under these circumstances; the combination of the two can be potentially harmful, and even deadly.For a person that runs the risk of relapse—which is common within recovery, the chance that they may use they drugs concurrently is a concern their physician should anticipate and monitor. In addition to this, certain treatment protocols for opiate addiction involve medications that are opiates themselves, such as Methadone—thus benzodiazepines may be out of the question because of the high risk factor.The NIH warns that “benzodiazepine use in the treatment of insomnia may cause benzodiazepine dependence, especially in opiate users.” These medications may actually be accompanied by their own withdrawal, and further sleep disturbances.Benzodiazepine’s may be prescribed when excessive sleep disturbance is an issue; however, a report published by the NDS cites “benzodiazepines should not be used routinely from the outset of the withdrawal episode. Where sleep is a problem, it is safer to increase the dose of buprenorphine than to prescribe benzodiazepines, with non-pharmacological approaches being encouraged (sleep hygiene strategies).” For this reason, researchers and medical professionals constantly seek to find alternative methods of treating this affliction.
Insomnia Treatments Currently Under Research
These methods are not widely used for withdrawal or addiction’s treatment, however, research has shown that they may hold great possibility in treating both.
Amitriptyline: A tricyclic antidepressant used most commonly to treat depression. If stopped suddenly, withdrawal symptoms may occur. Though it is not FDA approved for insomnia, it has been used to do so in certain applications. As is important with any medication, do not take it unless advised to do so by a doctor following a thorough medical evaluation.
One study, published in journal Acta Psychiatrica Scandinavica reported on a randomized double-blind trial that sought to compare the effects of amitriptyline verses lorazepam in treating opiate-withdrawal insomnia. In this study, 27 individuals contending with opiate withdrawal were given one or the other treatments. NIH reported on the findings, citing the results: “the scores of two sleep measures showed that all aspects of sleep, except for ease of awakening from sleep, in the two treatment groups were not significantly different.” Researchers concluded that “apart from the hangover effect, amitriptyline is as effective as lorazepam in the treatment of opiate-withdrawal insomnia.”
Cranial Electrostimulation (CES): Though there are varying opinions on the treatment, it has been widely studied within addictions research and numerous studies exhibit its promise as treatment for drug withdrawal. A study, published in the Practical Pain Management Journal (PPM) said “the role of CES in the treatment of chemical dependency is of great interest since anxiety and insomnia are frequently present in the early stages of recovery and these symptoms are a common precursor to relapse.”
The PPM spoke of CES as a treatment for opiate withdrawal specifically. In this study, all participants were allowed to use methadone as at they requested, under a supervised and observational setting. One group was paired with CES, whereas one had sham or inactive CES, and another had neither. The study took place over a period of ten days; one CES or sham CES treatment was administered per day for 30 minutes.
Not only did the majority of individual’s using methadone paired with CES cease using the medication completely after 6-8 treatments, and another after ten; but the majority experienced reduction in their anxiety and all those who received active CES reported “feeling restful and having a general feeling of well-being during the study, and their sleep was good and undisturbed after three treatments.”
This is in comparison to those who received the sham CES, they “were anxious and depressed, and complained of both difficulty sleeping and other somatic problems.” Additionally, their use of methadone did not see nearly the reduction within the same amount of time as those that received CES. The studies authors concluded that “CES is a safe, efficacious, cost-effective intervention for addictions. As such, CES should be added to all addiction treatment programs.”
Protect Your Health Today
Keep in mind, with any treatment, it is always best to seek the trained guidance of medical professionals before embarking on treatment. These methods are such that require specific and trained knowledge about their use within addiction’s treatment. It is always important to ask questions, do research, and be honest with your medical team as you approach any aspect of your recovery, whether it be withdrawal or the time after.
Withdrawal can be very difficult, as can making a decision about treatment options. If you or someone you love is contending with opiate addiction and you are worried about the possibility of withdrawal and the accompanying symptoms, please reach out to us today at RehabCenter.net so we can help you find the answers you need so you can make the best choice to seek treatment.