Insomnia in Patients With Substance Use Disorders: Assessment and Management

Insomnia, characterized by difficulty initiating or maintaining sleep, or poor sleep quality, is highly prevalent among individuals with substance use disorders (SUDs). The relationship between the 2 conditions is often bidirectional. We reviewed the impact of various substances (alcohol, stimulants, opioids, and cannabis) on sleep architecture and their potential to contribute to insomnia. The role of insomnia as a risk factor for different SUDs is also explored. Assessment strategies for co-occurring insomnia and SUDs are discussed, emphasizing the importance of reassessment throughout various phases of substance use treatment. Evidence-based nonpharmacologic and pharmacologic interventions for managing insomnia in SUD patients are presented, highlighting the importance of tailoring treatment approaches to individual needs and substance-specific considerations. Assessment and management of comorbid insomnia and SUDs is crucial but can be difficult; however, studies have shown some benefits using nonpharmacologic and pharmacologic approaches.