Sleep Disturbance in Opioid Use Disorder: Systematic Review of Insomnia Prevalence and Sedative-Hypnotic Utilization

BACKGROUND: Opioid use disorder (OUD) is a chronic condition affecting approximately 60 million individuals worldwide. Sleep disturbances, particularly insomnia, are highly prevalent in OUD and may worsen psychiatric symptoms, reduce treatment adherence, and increase relapse risk. However, insomnia remains underrecognized and the pharmacological treatment options for insomnia may not be optimal in OUD population. METHODS: through February 23, 2026 for observational studies, clinical trials, and conference abstracts reporting insomnia prevalence and outcomes related to sedative-hypnotic use in OUD. RESULTS: Thirty-seven studies (2010-2026) were included, predominantly from the US. The prevalence of insomnia or poor sleep quality ranged from 20.8% to 87.0%, with wide variation by population, opioid treatment, and assessment method. Studies using the Pittsburgh Sleep Quality Index (PSQI) consistently found poor sleep quality in over 70% of patients. Seven studies reported treatment patterns, most often benzodiazepines, antidepressants, anticonvulsants, and z-drugs. Ten studies examined outcomes and found benzodiazepine and hypnotic use associated with higher overdose risk, worse depressive and anxiety symptoms, suicidal ideation, and affective dysregulation, without sustained sleep benefit. CONCLUSIONS: While insomnia measurement varies across studies, insomnia consistently remains a common and underrecognized condition in OUD. There is a need for better insomnia screening and safer sleep interventions for patients with OUD.