Sleep disturbances are prevalent among individuals with opioid use disorder (OUD). Although estimates vary, many studies have found that over half of people with OUD experience significant sleep difficulty (Hernandez and Griggs, 2024, Wilkerson and McRae-Clark, 2021). These problems may be especially prevalent during early stages of recovery, when the risk of relapse is high (Reid-Varley et al., 2020, Tripathi et al., 2020, Wang and Teichtahl, 2007). The relationship between opioids and sleep appears to be bidirectional, with evidence for deleterious effects of opioids on sleep (Angarita et al., 2016, Tripathi et al., 2020), as well as evidence suggesting that sleep disturbance increases risk for opioid misuse among the general population (Groenewald et al., 2021, Tang et al., 2016). However, little is known about the influence of sleep on risk factors for relapse during early OUD recovery.

One mechanism by which sleep may increase risk for substance use is through affective and self-regulatory processes implicated in substance misuse. For example, sleep disturbance is associated with increases in negative affect and decreases in executive functioning and self-regulation (Fairholme and Manber, 2015, Lim and Dinges, 2010), both risk factors for substance misuse and relapse (Witkiewitz & Marlatt, 2004). Additionally, among people receiving treatment for OUD, poor sleep is linked to increased prescription opioid craving (Lydon-Staley et al., 2017), a factor associated with an increased likelihood of relapse (McHugh et al., 2014). Finally, in healthy adults, poor sleep is associated with heightened stress reactivity (van Dalfsen & Markus, 2018), a risk factor for relapse among those in early recovery from substance use disorders (Sinha et al., 2011, Sinha et al., 2006).

This study aimed to characterize the association between sleep disturbances and stress-related risk for relapse in adults with OUD receiving inpatient detoxification and stabilization treatment. We sought to (1) quantify the relationship between indicators of sleep disturbance and self-reported craving and negative affect, and (2) determine whether sleep duration and insomnia severity were associated with stress reactivity (affective and craving response to acute stress). Better understanding the potential impact of sleep disturbance during this high-risk time in recovery from OUD may help identify risk factors for relapse and treatment targets during detoxification that may improve outcomes for people with OUD.