Sleep disturbances and substance use disorders: A bi-directional relationship

A complex bi-directional relationship exists between substance use and sleep that encompasses several sleep disturbances including insomnia, hypersomnia, obstructive sleep apnea, and excessive daytime sleepiness. Substances of abuse produce their effect by acting on various receptor and neurotransmitter systems, some of which are involved in normal sleep regulation. Disruption of these neurotransmitter systems can lead to changes in the normal sleep architecture, causing sleep disturbances. Sleep disturbances can persist even after abstinence, a fact that is often not well recognized by substance use disorder treatment programs, and can lead to relapses. Incorporating strategies to counter sleep disturbances can help in relapse prevention. Pharmacologic and nonpharmacologic strategies exist that can be used to treat sleep disturbances in substance use disorders. The potential scope of these strategies is large, but currently there are limited data regarding which pharmacologic options are effective in treating sleep disturbances in patients with substance use disorders. Further advancement in the development of pharmacologic agents could lead to new strategies to help in relapse prevention and successful completion of substance use disorder treatment programs. This review explores the complex bi-directional relationship between substance use and sleep disturbances.