The Association Between Sleep Disturbances and Perceived Stress in Substance Use Disorder Treatment

Martin Hochheimer, PhD ; Brion Maher, PhD ; Brion Maher, PhD ; Justin C. Strickland, PhD ; Jill A. Rabinowitz, PhD ; David Wolinsky, MD ; Andrew S. Huhn, PhD

J Clin Psychiatry 2024;85(3):23m15220

Abstract

Introduction: Sleep disturbances and elevated stress levels are commonly reported among individuals seeking treatment for substance use disorders (SUDs). However, it remains unclear whether the relationship between sleep and stress differs based on the primary substance of use or if there are commonalities across different substances. This study aimed to investigate the association between sleep disturbances and perceived stress among individuals in SUD treatment and examine whether primary substance influences this relationship.

Method: A sample of 4,201 individuals from 59 SUD treatment programs completed assessments including the Insomnia Severity Index and Perceived Stress Scale in 2021. Cross-sectional and longitudinal analyses were conducted to evaluate the relationship between sleep and stress across different primary substances during treatment.

Results: The results demonstrated that higher stress was associated with more severe insomnia, and vice versa, both at treatment intake and over the course of treatment, regardless of primary substance. Persons using heroin/ fentanyl evidenced a stronger association of sleep on stress, and persons using cocaine evidenced a stronger relationship of stress on sleep.

Discussion: The findings suggest that sleep/stress associations are ubiquitous across different classes of drugs, although sleep might have more influence on stress in persons primarily using heroin/ fentanyl, and stress might have more influence on sleep in persons primarily using cocaine, relative to other substances. Interventions targeting either sleep or stress could have positive effects on SUD outcomes, but further research is needed to investigate the underlying neurobiological mechanisms and inform the development of effective interventions for sleep and stress in SUD populations.

J Clin Psychiatry 2024;85(3):23m15220

Author affiliations are listed at the end of this article.

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