Perspectives and experiences with sleep and recovery among women receiving buprenorphine for opioid use disorder

Sleep issues are prevalent among women receiving medication for opioid use disorder (OUD). However, there is limited data about subjective sleep experiences and how they relate to OUD trajectories. This mixed-methods study explored the intersection of sleep and OUD recovery from the patient perspective among a sample of women receiving medication for OUD. This study enrolled non-pregnant women aged 18-65 who were stabilized on buprenorphine from an outpatient OUD program. Participants were recruited during their routine treatment visits, and enrollment occurred from February 2022 through September 2023. Study participants who endorsed clinically elevated insomnia symptoms on the Insomnia Severity Index (ISI) (≥11 score) (n=50) were included in current study analyses. A sub-sample (n=11) who met the ISI threshold participated in semi-structured interviews. Survey responses were analyzed using descriptive statistics, and interviews were analyzed using applied thematic analysis. The average length of time on buprenorphine for the overall sample was 30 months (range: 2 months - 245 months). Participants reported engagement in healthy sleep behaviors, grouped into four domains: positive sleep related cognitions, sleep environment, sleep restriction, and reducing stimulating activities. Respondents characterized the multidimensional relationship between sleep and health. Women also described how sleep evolves through addiction into recovery, and how good sleep reduces risk of return to substance use. Finally, women discussed the impacts that medication for OUD have on sleep, specifically how they might time their buprenorphine to align with sleep and how it might impact their energy levels. We found that sleep is a dynamic process among this sample of women receiving medication for OUD. Findings are intended to inform future investigations of the mechanisms underlying the sleep-OUD intersection. In addition, this study reflects the importance of incorporating patient perspectives into the development of therapeutics targeting this patient population.