From the Guidelines
Naltrexone is not typically recommended as a first-line treatment for sleep disorders. While low-dose naltrexone (LDN, typically 1-4.5 mg) has been explored for various conditions, there is limited scientific evidence supporting its use specifically for insomnia or sleep disturbances 1. Naltrexone is primarily FDA-approved as an opioid antagonist for treating opioid and alcohol dependence. Some patients with certain pain conditions or autoimmune disorders who take LDN have reported improved sleep as a secondary benefit, but this is not its primary indication.
If you're struggling with sleep issues, better options include:
- Practicing good sleep hygiene
- Cognitive behavioral therapy for insomnia (CBT-I) 1
- Discussing with your healthcare provider about appropriate sleep medications like melatonin, doxepin, or other approved sleep aids 1
The mechanism by which naltrexone might affect sleep is not well understood, though it may involve modulation of endorphin levels and immune system function. If you're interested in naltrexone for sleep, consult with a healthcare provider who can evaluate your specific situation and recommend appropriate treatment options.
From the FDA Drug Label
Among opioid free individuals, naltrexone hydrochloride administration at the recommended dose has not been associated with a predictable profile of serious adverse or untoward events In an open label safety study with approximately 570 individuals with alcoholism receiving naltrexone hydrochloride, the following new-onset adverse reactions occurred in 2% or more of the patients: ... insomnia (3%), The following adverse reactions have been reported both at baseline and during the naltrexone hydrochloride clinical trials in opioid addiction at an incidence rate of more than 10%: Difficulty sleeping, Postmarketing ExperienceData collected from postmarketing use of naltrexone hydrochloride show that most events usually occur early in the course of drug therapy and are transient... Events that have been reported include ... insomnia, Naltrexone may cause insomnia or difficulty sleeping in some patients 2.
From the Research
Naltrexone for Sleep
- There is limited research directly addressing the use of naltrexone for sleep.
- However, a study published in JAMA psychiatry 3 found that extended-release naltrexone (XR-NTX) had a significant effect on reducing insomnia symptoms compared to buprenorphine-naloxone in patients with opioid dependence.
- The study measured insomnia symptoms using the Insomnia Severity Index and found that the XR-NTX group had a lower insomnia score than the buprenorphine-naloxone group.
- Another study published in eNeuro 4 investigated the effects of low-dose naltrexone (LDN) on the endogenous opioid system and found that LDN had slight effects on proopiomelanocortin neurons, but these effects did not translate to changes in intrinsic excitability or baseline electrical activity.
- The use of naltrexone for sleep disorders is not a primary indication, and more research is needed to fully understand its effects on sleep.
- Naltrexone is primarily used for the treatment of opioid and alcohol dependence, and its efficacy in these areas has been demonstrated in several studies 5, 6, 7.