Joint Trajectories of Insomnia Severity and Quality of Life Among Adults in Opioid Use Disorder Treatment: A Longitudinal Study With Parallel Process Latent Growth Curve Modelling
Published in: Journal of Sleep Research
Accepted: July 16, 2025
Ariel Hoadley¹ | Anju Felix¹| Salome Hailu¹ | Jennifer D. Ellis¹ | Justin C. Strickland¹ | Jill A. Rabinowitz² | David Wolinsky¹ | Martin Hochheimer¹ | J. Gregory Hobelmann³ | Andrew S. Huhn¹,³
¹Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA | ²Department of Psychiatry, Robert Wood Johnson Medical School, Rutgers University, Piscataway, New Jersey, USA | ³Ashley Addiction Treatment, Havre de Grace, Maryland, USA
ABSTRACT
Sleep health is related to quality of life (QOL) in the general population, yet less is known about the trajectories of sleep and QOL during opioid use disorder (OUD) treatment. This study examined the joint trajectories of insomnia severity and QOL during the first 4 weeks of OUD treatment and tested predictors of the growth trajectories. Adults (N = 1607) in supervised withdrawal or residential OUD treatment completed surveys weekly for 4 weeks. Kruskal–Wallis tests and correlations examined differences in insomnia and QOL at intake by sociodemographic and clinical characteristics. An unconditional parallel process growth model examined the joint trajectories of sleep and QOL, and time-invariant covariates were added to a conditional growth model. In the unconditional growth model, insomnia and QOL were inversely related at intake (p < 0.001). Greater insomnia at intake was associated with more pronounced increases in QOL (p = 0.020), but QOL at intake did not predict changes in insomnia. Increases in insomnia severity were associated with worsening of QOL (p < 0.001). Patients who were younger (p = 0.020) and unemployed (p = 0.048) had greater improvements in insomnia, and patients who were younger (p = 0.001) and started treatment in a supervised withdrawal setting (p = 0.002) had greater improvements in QOL. Sleep quality and QOL are modifiable, so understanding their joint trajectories during OUD treatment can help improve quality of care and recovery. Targeting sleep disturbances early in treatment may support overall well-being and improve recovery outcomes.
1 | Introduction
Insomnia and other sleep issues are especially prevalent in individuals with opioid use disorder (OUD), with over 75% of patients presenting to treatment with poor sleep quality (Chen et al. 2017; Langstengel and Yaggi 2022). Sleep quality usually refers to subjective perceptions of how well one sleeps, including indicators like perceived ease of falling asleep, frequency of waking throughout the night, and restfulness (Åkerstedt et al. 1994). Insomnia, by contrast, is a clinical syndrome characterised by persistent difficulties with falling or staying asleep that are accompanied by significant daytime impairment and unattributable to environmental factors (Sateia et al. 2017).
