Effects of Methadone, Buprenorphine on Sleep Quality in Opioid Use Disorder

Patients with opioid use disorder who receive treatment with either methadone or combined buprenorphine and naloxone (Suboxone^®) do not have significant differences in monitored sleep disturbances, according to study results published in Drug and Alcohol Dependence.¹

Sleep disturbances are a frequent complaint of patients on methadone, with 70% to 85% reporting poor sleep quality.^2,3 However, less is known about the effects of newer opioid use disorder treatments on sleep, noted the researchers, led by Patrick H. Finan, PhD, associate professor of psychiatry and behavioral science at Johns Hopkins University School of Medicine in Baltimore, Maryland.

To determine objective and subjective ambulatory measures of sleep, the investigators compared the 2 primary medications (methadone and buprenorphine) in 55 adults and used ambulatory monitoring to measure sleep continuity. A daily sleep diary was used for up to 17 weeks (mean, 54.1 days) and a Sleep Profiler^™ home sleep electroencephalography (EEG) monitor was issued, which patients were asked to wear for 7 consecutive nights  (mean, 5.76 days) during active treatment.

When controlling for gender and pain severity, no significant difference in sleep continuity was found in patients in either treatment group. “The results suggest that individuals on buprenorphine and methadone treatments did not substantively differ in any sleep parameter,” the researchers noted. However, “EEG-based estimates of sleep continuity showed more disturbed sleep than the patients’ own diary-based estimates.”

While EEG-derived total sleep time was longer in women than in men, no statistical significance was observed between treatment groups. Patients taking buprenorphine had less slow wave sleep and more shallow stage sleep compared with patients taking methadone. Men had greater shallow stage sleep and less slow wave sleep than women.

“Because our sample was predominantly male [75%], and the buprenorphine group had more men than the methadone group [87% vs 62%], it is possible that these underlying sex differences in sleep continuity and architecture may have obscured medication-related differences in sleep that would have otherwise been observed with a larger, more balanced sample,” the researchers noted.

Investigators also found differences between self-reported sleep results and EEG-derived estimates. EEG results for wake after sleep onset were greater than sleep diary results and total sleep time and sleep efficiency were lower according to EEG results than to sleep diary results.

“Home-based multimodal measures of sleep were either not different or only modestly and inconsistently different between patients treated with buprenorphine/naloxone [vs] methadone. With either medication, patients evidenced a positive misperception of sleep quality,” the study investigators noted.

They concluded that, “The findings, if replicated, may help guide recommendations for managing sleeping in patients with [opioid use disorder].”

References

1. Finan PH, Mun CJ, Epstein DH, et al. Multimodal assessment of sleep in men and women during treatment for opioid use disorder. Drug Alcohol Depend. 2019;207:107698.

2. Hsu WY, Chiu NY, Liu JT, et al. Sleep quality in heroin addicts under methadone maintenance treatment. Acta Neuropsychiatr. 2012;24(6):356-360.

3. Hartwell EE, Pfeifer JG, McCauley JL, Moran-Santa Maria M, Back SE. Sleep disturbances and pain among individuals with prescription opioid dependence. Addict Behav. 2014;39(10):1537-1542.