Buprenorphine and insomnia

[Rls29]

I started Buprenorphine just over a week ago at a dose of 0.4mg. For the last 3 nights I haven't been able to sleep at all, finally dropping off in the morning, after about 5am, I think. During the daytime I am very sleepy and low energy. I read last night that insomnia is one of the unfortunate side effects and I'm wondering how long this is likely to last and/or if anyone has had to take additional medication for the insomnia? Thank you for reading and for any replies.

[SueJohnson]

See healthunlocked.com/rlsuk/po... and also the link in it.

[Joolsg]

That is a real shame.Insomnia is a side effect of many opioids.

Opioids have an 'alerting' effect. For me it was panic attacks/anxiety.

But as it stopped ALL RLS I was determined to find a solution. For me it was a small dose of pregabalin which is a sedating med.

You could try a small dose of pregabalin or medical cannabis at night.

[amrob123]

Look into palmitoylethanolamide (PEA) supplement. It really helps with sleep. It can take several weeks to feel the full benefit of it.

[ID158]

I had insomnia for a few weeks at that dose and it eventually went away. Hopefully the same will happen to you.

[Simkin]

I have been on low dose buprenorphine for over a year & I am awake a lot in the night & feel very lively & consequently lack energy during the day but to me the insomnia is worth putting up with when I now have no RLS.

[Marlayna67]

because of insomnia I can’t take buprenorphine every night. I take it every third night and use oxycodone on the other night. That loss of sleep was so detrimental to me. I couldn’t deal with it.

[restlessstoz]

Hi, I use the buprenorphine patches and I too am one of those people who are alert when using opioids. After two years of very little sound sleep and getting desperate, I read somewhere on here that taking gabapentin would decrease the alertness and over time have settled on a dose of 600mg. I now sleep soundly, and even dream- or as soundly as one does with trips to the loo and a very good thriller to read finish!

[intermk]

I have been on Buprenorphine (Bupr) for almost 7 years and I currently take 6 mg per day. I had terrible insomnia until about two months ago when I learned that this was a common side effect of Bupr. So, what I do now is take the Bupr during the day, around the noon hour. It's reported to have a variable half life and in me that seems to be about 12 hours. I'm now able to get to sleep between 0100-0300 but not sleeping soundly until around 0600 and then I sleep until 1100 that day. Fortunately I am retired now so I can do that. I'm trying it earlier and earlier every week until I find the best time to take it for me. I don't use any sleep meds. Note: the dry mouth issue people mention can be mostly eliminated if you swallow the pills rather than dissolve them sublingually. It still works well for me but I need a least 2 mg more for it to work as well as sublingual. Best to take on an empty stomach.

[Typicallygaslit in reply to intermk]

I think the reason you’re not supposed to swallow is that the stomach acid destroys it. Some of it is probably absorbed on the way down but could be why you need more, guessing you mean 0.2 mcg not 2 mg. You can also use mouth sprays at night to counteract the dryness. I use Salivix as it doesn’t have sorbitol.

Not entirely sure why you’re taking it at noon since it should work through the night?

[intermk in reply to Typicallygaslit]

No, I mean 2 mg tabs. I take three of them every day for 6 mg total. You are correct, the stomach acid interferes with absorption or action of Bupr. But it still works. I did the swallowing method for three months and told my doctor it worked well and he had a fit. Suggested he might cancel my Rx if I didn't do the sublingual method. Although he has no way of knowing how I do it, I still do it as instructed because I respect him and his opinion and don't want to make a mistake in an office visit and mention that I still swallow the tabs. If he supported me in that method I'd still be doing it that way. If you swallow them on an empty stomach you don't have much stomach acid to interfere until they are already dissolved. Taking them with or soon after meals will not get you much benefit. Also, I take them in the morning or no later than noon because I have bad insomnia from Bupr. Taking them in the evening keeps me up all night. They work better than three cups of coffee. Taking them in the morning keeps me alert throughout the day but allows me to get to sleep between 0130-0300 at this time. I'm working on dosing three times per day by taking 2 mg at 0900, 2 mg at 1130 then the last 2mg at 1400. Not sure how well this will work yet but I should know in a week or two. Working with a drug that has a variable half life is difficult.

[Typicallygaslit in reply to intermk]

But 6 mg sublingual is a gigantic amount, no wonder it keeps you awake.

[intermk in reply to Typicallygaslit]

Yes, most certainly it's high compared to what so many others take. But that's how much is necessary to stop the symptoms. I've tried time and again to move down to 4 mg or even 5 mg but that dose simply does not work. Even with 6 mg dissolved sublingually I get breakthrough symptoms around 0400 hours. The doc would go up another 1-2 mg but because of the incessant insomnia, I don't want to do more.

[LotteM in reply to intermk]

The absorption of buprenorphine sublingual tablets is extremely low WHEN you swallow them. No wonder you need such a high dose.

Have you tried taking just half or even a quarter of a sublingual tablet to see whether that works for the RLS without giving you insomnia? Let it dissolve under your tongue. And after 5-10 min rinse your mouth thoroughly if you are worried about or sensitive to tooth decay.

[intermk in reply to LotteM]

Not for me. I only need 1 mg more to get the same effect swallowing the tablets vice dissolving them sublingually. I have 7 yrs of experience with this medicine and have dialed in the exact dose through a fair amount of trial and error. I know what works for me and how best to use it at any given time. I usually dissolve sublingually. But since I take Bupr during the day, sometimes my dosing schedule happens right in the middle of a meeting. That's when I swallow the pills.

[Typicallygaslit]

Yes, me too, there’s quite a lot about that on here so you might like to browse. I use both Zopiclone and Diazepam, for starters.