Key takeaway
SAMHSA says sleep problems are common with substance use disorders, can last months or years into recovery, and are tied to relapse. The pattern depends on the substance. Non-drug approaches come first because many sleep medicines can be misused. Tell the prescriber before you stop methadone, buprenorphine, or a benzodiazepine.
Last updated: Mon Oct 05 2026 00:00:00 GMT+0000 (Coordinated Universal Time)
You are doing what treatment asked, and the night still will not end. That exhaustion is common. It is not proof that stopping was the wrong idea, and it is not a reason to drink or take a leftover pill so you can get through work tomorrow.
The National Heart, Lung, and Blood Institute describes sleep deprivation as not getting enough sleep, and sleep deficiency as a wider problem: too little sleep, sleep at the wrong time of day, sleep that is not sound, sleep that skips the kinds of rest the body needs, or a disorder that blocks rest. SAMHSA's brief on sleep in recovery says substance use can worsen those difficulties, and that the difficulties are themselves a risk factor for substance use or for relapse. The pattern is not the same for every drug.
If someone will not wake, is having a seizure, or cannot breathe, call 911. For a mental health crisis, call or text 988. Stopping a benzodiazepine on your own can bring withdrawal that includes seizures. Do not try to wait that out in a dark room.
What shows up, by substance
Sleep problems can include insomnia, a long time to fall asleep, broken sleep, or sleeping too much during the day. The manual SAMHSA cites recognizes a substance- or medication-induced sleep disorder. A bad week and that diagnosis are not the same thing. A clinician sorts them.
For alcohol, insomnia and other sleep disturbances are common in alcohol dependence. Many people have insomnia before they enter treatment. Reported rates of sleep problems among people with alcohol use disorder in treatment range from 25 to 72 percent. Some people in recovery still have insomnia, or sleep-disordered breathing such as sleep apnea, for weeks, months, or sometimes years after they stop drinking. The medical danger in the first days is laid out in how alcohol withdrawal unfolds. Sleep trouble can outlast that danger. It does not replace it.
Other substances have their own pattern. People stopping marijuana can have sleep problems in the first days of withdrawal, and those problems can last for weeks. People in opioid detoxification often report insomnia. In one study of people who used cocaine chronically, measured sleep quality got worse during abstinence even while they thought it was improving. Another cocaine-withdrawal study found poor sleep quality in three-quarters of the group. College students who reported nonmedical psychostimulant use reported worse sleep than students who had not. Those findings are not a rate for every person who has used one of those drugs.
Recovery does not switch sleep back on
Sleep loss can hurt physical, mental, and emotional well-being, and it can interfere with treatment. Persistent sleep complaints after withdrawal are associated with relapse to alcohol. Poor sleep quality before a quit attempt from cannabis is a risk factor for lapsing back into use within two days. Exhaustion in week three can be a known problem, not a personal failure.
Medication for opioid use disorder does not automatically spare sleep. Disrupted sleep, including central sleep apnea and related daytime sleepiness, is prevalent in people on methadone maintenance. Methadone dose and the length of opioid use before treatment correlate with sleep problems. The brief attributes that both to methadone, a full opioid agonist, and to other common factors: mental disorders, benzodiazepine misuse, and chronic pain. Buprenorphine, at routine therapeutic doses, has also been found to change breathing during sleep. If you snore, gasp, or fight sleep in the daytime on either medicine, tell the prescriber. A solo taper is a different question from the job of those medicines. Read the medication overview before you change a dose. A sleep complaint is a reason for a clinical conversation, including a sleep study if breathing is the worry.
Ask how long you have been in recovery, which medicines you take, whether you snore or move too much at night, and whether stress, a crisis, or a side effect could explain the nights. Nicotine belongs on that list. People also tend to overestimate how well and how long they slept. A sleep log helps the clinician. It is not a diagnosis you assign yourself.
Why non-drug care comes first
SAMHSA prefers non-drug treatments because many medicines for insomnia can be misused and can interfere with recovery. Research on cognitive-behavioral therapy for insomnia has shown positive results in general and in people who are alcohol dependent. Other approaches a clinician might use include stimulus control, sleep restriction, relaxation, mindfulness, exercise, and bright light. Combining approaches may work better than one. Some people need a sleep medicine specialist. A breathing machine for obstructive sleep apnea is medical equipment, not a gadget to buy because a paragraph mentioned snoring.
A regular sleep time, less caffeine and nicotine near bed, and using the bed for sleep are education points. They are not a withdrawal plan. If you are shaking, confused, or unable to stop drinking safely, those habits do not replace care.
Many over-the-counter sleep aids contain sedating antihistamines. They are not recommended long term. They can worsen the sleep cycle and leave you groggy and less alert, and evidence that they work long term is insufficient. Valerian is not supported for this use and could damage the liver. Melatonin has limited evidence for chronic insomnia in some people. Limited evidence is not a reason to start a supplement during withdrawal.
Benzodiazepines should be avoided by people with substance use disorder histories. They can be addicting. They can cause daytime sedation, thinking problems, poor coordination, and rebound insomnia. Stopping them after long use can bring withdrawal that includes seizures. A prescribed benzodiazepine stays with the prescriber, for the reasons in benzodiazepine withdrawal. Do not stop it because you want a better night this week.
Zaleplon, eszopiclone, and zolpidem still have abuse potential. They are Schedule IV. At high doses they may share benzodiazepine side effects. SAMHSA says they should be used only for short-term treatment of insomnia in people with a substance use history, and only after a careful evaluation.
The first step in the brief is the recovery itself. You should be in substance use treatment that fits, and other medical or mental health problems that disturb sleep should be addressed. When depression, anxiety, or trauma is part of the nights, the frame is co-occurring care. Physicians have tried other medicines. None of that is an instruction to chase a particular pill.
Ask who screens for sleep, whether opioid medicines are reviewed for breathing during sleep, and whether cognitive-behavioral therapy for insomnia is available or can be referred. Ask what they refuse to prescribe. A benzodiazepine as the default sleep plan for people with a substance use disorder is not what this brief recommends.
Call or text (800) 653-9376 if you need a program that will talk about sleep and substance use in the same assessment.
Additional Resources
Sources cited on this page:
- SAMHSA In Brief: Treating Sleep Problems of People in Recovery From Substance Use Disorders (SMA14-4859)
- NIH National Heart, Lung, and Blood Institute: Sleep deprivation and deficiency
- 988 Suicide & Crisis Lifeline
Common Questions
If I cannot sleep in early recovery, does that mean treatment is failing?
Not by itself. SAMHSA's 2014 brief says insomnia and other sleep problems are common in alcohol dependence, including before treatment, and that some people still have insomnia or sleep-disordered breathing for weeks, months, or sometimes years after they stop. Persistent sleep complaints after withdrawal are associated with relapse to alcohol. Tell the program. Do not restart the substance to sleep.
Can I take a benzodiazepine or a sleeping pill I already have?
Do not start or restart one because a night went badly. SAMHSA says benzodiazepines should be avoided by people with a substance use disorder history because they can be addicting, and that stopping them can bring withdrawal symptoms that include seizures. Zaleplon, eszopiclone, and zolpidem have abuse potential and should be used only short term, if a clinician uses them at all. Call 911 for a seizure, trouble breathing, or a person who will not wake.
Does methadone or buprenorphine cause the sleep problem?
It can contribute. SAMHSA says disrupted sleep, including central sleep apnea and daytime sleepiness, is prevalent in people on methadone maintenance, and that buprenorphine at routine therapeutic doses has also been found to change breathing during sleep. Tell the prescriber. Stopping either medicine on your own is a clinical decision, not a sleep hack.
Are over-the-counter sleep aids a safe workaround?
SAMHSA says many of them contain antihistamines and are not recommended as a long-term insomnia treatment. They can disrupt the sleep cycle and cause morning grogginess, daytime sleepiness, and impaired alertness and judgment. Evidence for long-term effectiveness is insufficient. Valerian does not have enough evidence to support use and could damage the liver. Ask a clinician before you add a supplement.
What should the program be doing about sleep?
The brief tells clinicians to screen for insomnia, ask about sleep in the history, rule out stress and medication side effects, teach sleep habits, and refer to a sleep specialist when needed. Non-drug treatments are preferred, including cognitive-behavioral therapy for insomnia, which has shown positive results in people who are alcohol dependent. A mattress slogan is not that therapy. Ask who assesses sleep, and whether a sleep study is available if breathing at night is a concern.