Is sleeplessness one of the side effects of Suboxone?
Most people are concerned about Suboxone making them tired when they first start taking it. It is, after all, classified as an opioid. Yet, when they start taking it, they realize that they are able to function well throughout the day without the usual sleepiness and nodding off caused by other opioids.
Unfortunately, a small percentage of patients who are prescribed Suboxone, or similar buprenorphine-based medications, will discover that they have trouble sleeping. According to the FDA-approved literature on Suboxone, 14% of patients in a 4-week study experienced insomnia.
Another study concluded that buprenorphine causes a reduction in adenosine in certain parts of the brain, leading to poor sleep quality and greater difficulty in falling asleep. The sleep medication Lunesta, also known as eszopiclone, was used in the study to improve sleep quality.
Lunesta was able to counteract the effects of buprenorphine on adenosine levels in the basal forebrain and pontine reticular formation of the brain. The subjects were able to get to sleep normally with the combination of Lunesta and buprenorphine.
In the real world of patients being prescribed Suboxone, this does seem to be a real side effect. I have had some patients complain that they could not get to sleep after starting Suboxone.
On the other hand, we also have to consider the possibility that the transition off of potent opioids, such as oxycodone, heroin, or fentanyl may be a factor as well. Street opioids are powerful sedatives.
When a person quits these drugs, the brain goes through a difficult detox process. The experience is made much easier with Suboxone, but it is happening in the background during early recovery nonetheless.
Still, it does appear that Suboxone itself causes insomnia for some patients. This is because making changes to the Suboxone routine can improve the situation.
How much is too much Suboxone?
When a patient takes buprenorphine for the first time, it is called an induction. There are different methods to handle the overall induction process, but in nearly all cases, the patient takes a small test dose the first time to make sure that they don’t get sick with precipitated withdrawal.
After the patient is able to safely tolerate a low dose of buprenorphine, the doctor may decide to gradually increase it, a little at a time. Or, they may choose to start the patient at a relatively high dosage and then cut back if needed.
Both methods have their advantages. The reasoning behind getting a patient on a higher dosage in the beginning is to ensure that cravings are effectively blocked. Often, if a patient starts out taking too low of a dosage, they have cravings that might lead them to an opioid relapse.
On the other hand, the method of increasing slowly can be used to get the patient to a dosage that is effective, but not too high. How much Suboxone is too much?
Suboxone has a ceiling effect, so patients do not have to worry as much about being prescribed too much daily medication. The risk of overdose or being excessively medicated is relatively low. Also, most doctors have a prescribing limit of around 16 to 24 mg, which is below what is considered to be the maximum dosage of 32 mg.
Yet, the side effects from Suboxone may be an issue within the usual dosage range. A person who has trouble falling asleep while taking 16 mg daily may be able to sleep better at 12 mg or 14 mg.
If the doctor starts the patient at a higher dosage of Suboxone as a precaution to help keep them safe from dangerous cravings and relapse, they may then have to start reducing the dosage gradually to address side effects, such as insomnia.
Does the timing of when a patient takes their medication affect Suboxone insomnia?
The timing of taking medication is important. Taking Suboxone too close to bedtime may keep you awake. While this may seem like an obvious fix, there does have to be a balance of not taking it too early or too late.
This also brings up the issue of how often to take Suboxone during the day. According to the product information and addiction experts, taking Suboxone in divided doses may encourage an addictive pattern of thinking.
The experts would like for patients to focus on the act of taking medication as little as possible. In fact, many experts are strongly in favor of newer injectable and implantable forms of addiction treatment medications. An injection can last as long as a month and an implant as long as six months.
Unfortunately, these newer forms of treatment medications that are either injected or implanted come with their own issues, such as pain at the injection site, infection, scarring at the implant site, or even possibly nerve damage. Of course, with newer, safer products coming out and the increasing experience of doctors performing these procedures, the risks are getting lower over time.
So, for the time being, if you are taking Suboxone sublingual films or tablets, they recommend once daily dosing. Unfortunately, in the real world, this rarely works out to be ideal. Even though Suboxone has a long half-life of about 36 hours, the medication levels peak for a much shorter period of time.
Patients often complain that when they must take their entire daily dosage of Suboxone all at once, that it seems too strong in the beginning and wears off too much later in the day. To increase around-the-clock efficacy, many doctors recommend that patients divide their dosage and take half in the morning and half in the evening.
Twice daily dosing usually works out very well. I have not noticed any issue of addictive behavior made worse by having to focus on taking medication twice daily.
Patients don’t mind taking Suboxone twice daily so they do not have to feel over-medicated or under-medicated at any time of the day. They still do not have the overwhelming obsession with opioids that they had before starting Suboxone.
During active addiction, you are unable to think of anything other than when and where you will get your next dose of opioid. And, when you are able to take the next one, you are already obsessing over the next and feeling the compulsion to take more.
This endless cycle of obsession and compulsion goes away with Suboxone treatment, even if it is taken twice daily. The timing of twice daily Suboxone use should be about eight to twelve hours between doses.
Of course, the question is, when do you take the second dose in the evening? Does taking it too late at night lead to insomnia?
Especially for patients who are new to treatment, they may want to take the evening dose closer to the time when they might have otherwise been out taking heroin or fentanyl. This provides good peak coverage to help prevent those stronger cravings triggered by cues that evening is approaching.
Yet, taking the evening dose too late may lead to insomnia. Early in treatment, there must be a balance of not taking Suboxone too late or too early. If you are wondering about the best times to take your Suboxone, speak to your doctor and work out a schedule that is ideal for you.
As you can imagine, moving up your evening dose by an hour or two may help with your Suboxone insomnia. Another option may be to take a larger amount earlier and smaller amount in the evening.
Ask your doctor if it might be possible to take two-thirds in the morning and one-third later. There are also other ways to divide the daily doses of Suboxone that can help to reduce side effects, including insomnia.
What about just taking less Suboxone to help with insomnia?
As we noted earlier, Suboxone side effects may be related to taking too much Suboxone. The solution to getting to sleep easier may be reducing your daily dosage by a specific amount.
However, the process of changing your Suboxone dosage must be done in coordination with your doctor. You should not make changes to your medication regimen without speaking first to your doctor.
If reducing your Suboxone is the solution, you may not need to make a very large change. A small reduction may be all it takes to feel better with respect to side effects such as insomnia.
Of course, you must be aware that reducing your Suboxone dosage may result in breakthrough cravings or Suboxone withdrawal symptoms. Reducing Suboxone is usually more of a problem early in treatment.
As you progress in Suboxone therapy during the first year of treatment, your doctor will help you to reduce it gradually when you are ready. Reductions early on must be done carefully, because you are more at risk for having opioid cravings if you are not taking enough Suboxone.
Can sleeping medications help to overcome buprenorphine insomnia?
As you can imagine, for someone who is working to overcome a dangerous opioid addiction, it is a good idea to avoid taking sedating sleeping medications if possible. However, sometimes nothing else works and sleeping medication may be a suitable short-term solution.
Before starting sleeping meds, you should first try everything possible within the realm of sleep hygiene. Are you engaging in activities or habits that work against your falling asleep?
With your newly found alertness and clarity of thought, you may discover that you have many interests that you have neglected for far too long. You suddenly remember books you want to read and topics you enjoy following online. And, now you are able to fully enjoy watching engaging television programming.
The problem with rediscovering your real self who enjoys engaging with life and experiencing the world is that you still need sleep to rest your brain and body. If you have too much stimulation around bedtime, including binge-watching Netflix and reading social media or ebooks, you will have more trouble sleeping.
In addition to putting the smartphone aside and turning off the bedroom television, you may find that meditative sound tracks can help you to get better sleep. There are binaural beats recordings as well as guided meditations that can help you to transition into sleep and stay asleep. Even if you awaken in the night, you can use these relaxing recordings to get back to sleep again.
Listening to meditative sound programs is harmless. It is much safer to listen to sounds that make you sleepy rather than taking another pill to try to put you to sleep.
However, if you must take something to sleep, you could start with some of the available over-the-counter sleep aids. For example, in the natural supplement section, they have various melatonin preparations that can help make you sleepy.
Melatonin is a natural supplement that has less risk of side effects or drug interactions compared to pharmaceutical products. It is a relatively safe supplement to take for sleep. You should still check with your doctor before starting on any supplement to make sure that it will not interfere with your medical treatment.
You may also want to consider a snack before bedtime, such as warm milk or hot chocolate made with milk. A turkey sandwich can also be helpful.
Do these foods really have tryptophan that can make you sleepy? While the tryptophan claim may be a myth, these foods might still help to promote sleepiness.
When nothing else is working, ask your doctor about over-the-counter medications for sleep. Unisom is a brand of diphenhydramine, similar to Benadryl. While it may not help to promote high quality sleep, some people do swear by its effectiveness. Again, you must check with your doctor before starting any medication, even over-the-counter meds.
What about prescription medications to help with sleep?
You will find that Suboxone doctors are wary of prescribing sleep medications when you are already taking Suboxone. Many prescription sleep drugs are controlled substances with abuse potential.
Your doctor will be concerned about you becoming dependent on or addicted to the sleeping medication. The sleeping medication may also negatively affect your mental functioning, taking away from the advantages you have just gained from starting Suboxone to get off of opioids.
Another concern is the potential interaction between a prescription sleeping medication and Suboxone. It is generally not a good idea to combine sedating drugs with Suboxone. The ceiling effect of Suboxone that protects you from overdose may go away when sedating medications are taken at the same time.
While taking a prescription sleep aid at the same time as Suboxone will not automatically put you at risk for overdose, the concern is that people with a history of addiction may overdo any medication and take too much.
Yet, this is not an assumption that should be made in all cases. If a doctor is concerned about their patient taking too much sleeping medication, they should consider prescribing only a very small amount at a time to reduce that risk.
Prescription sleep aids that are FDA approved for insomnia include Ambien, Sonata, Restoril, Halcion, and others. These medications are all controlled substances with a moderate risk of abuse.
Another option is to use certain prescription medications that are not FDA approved for insomnia but are known to help patients get to sleep. This is known as off-label prescribing, when a medication is used for a purpose for which it was never given approval.
Trazodone is a popular prescription medication that is prescribed by doctors to help patients with sleep. Trazodone was originally intended to be used for depression and anxiety. Many doctors now prescribe it for sleep.
Suboxone insomnia is often successfully treated with a prescription for trazodone. However, doctors must be careful to check for drug interactions before prescribing it. It is particularly important to check to see if the patient already takes other antidepressants.
What should not be done for Suboxone insomnia?
There is a drug that many people around the world use on a regular basis to help them get to sleep. It is widely available and easy to purchase at almost any store that sells food and drink. Unfortunately, it is also one of the most deadly and harmful drugs in the world.
As you may have guessed, this drug is alcohol. I cannot emphasize enough that you must not use alcohol as a sleep aid, especially if you take Suboxone.
While other drugs can increase the risk of overdose when combined with Suboxone, alcohol is particularly dangerous in this regard. If you drink alcohol regularly with Suboxone, you are putting yourself in danger.
If you already drink, let your doctor know so they can recommend ways to help you to cut back and quit. You may even find that taking Suboxone makes it easier to stop drinking alcohol. It is important that your doctor is aware of your drinking, because there may be additional treatments required to protect you from the effects of heavy alcohol use.
Whatever you do, It is very important that you do not have even one drink, or even a sip, to help you sleep. Alcohol is definitely not the solution to treating Suboxone insomnia.
What else should I do if I cannot sleep because of Suboxone?
Your doctor may also want to do some tests to see why you cannot fall asleep easily. It is possible that you have a sleeping disorder that went undiagnosed while you were using street opioids. It is possible, for example, that you have sleep apnea, but you were not aware of it because of the effects of the opioids you were taking.
Your doctor may send you to a sleep study center to have a formal sleep study. These tests are often evaluated by a sleep expert or pulmonologist. They may recommend sleep habit changes or even a cpap machine if you test positive for sleep apnea. When sleep apnea is treated, you get much better, restful sleep.
Otherwise, your doctor will likely investigate other possibilities of conditions that can affect sleep. Some people have an overactive thyroid which can have an effect on your ability to get to sleep. Or, you may have an underlying issue related to anxiety. Many health conditions are masked by opioid use and then revealed when your opioid addiction is successfully treated.
The most important thing that you can do when you start Suboxone treatment is to communicate with your doctor and let them know if you have any side effects. Just because you have side effects from treatment does not mean that you must live with them.
Side effects, such as sweating, constipation, headaches, ankle swelling, or insomnia can be addressed and treated. Side effects may also point to other issues that must be addressed. If you are concerned about Suboxone induced insomnia, speak to your doctor today so they can get started on helping you to resolve the problem.