Table 2.

Qualitative themes, codes and quotes.

Theme	Sub-theme	Quotation
Prior experiences with sleep treatments	Medications that have negatively and/or positively impacted sleep	“In recovery, the hydroxyzine does help with the anxiety and does help get me to sleep. I am not so anxious when I do try to go to sleep. But that's about it for now during recovery, I try to stay away from anything.”—(Study ID 57)
	Medication and behavioral sleep treatments are typically siloed	“I feel like I never have taken the time to really focus on [sleep]. I've just fixed it with a pill. And I'm not blaming the doctors, and I'm not saying they're just throwing medication at it. But when they're seeing 5,000 patients a week, what more do they have to offer when they see you once a every 6 months to a year. I feel like if you took therapy and sleep therapy and medication together, it would probably really work.”—(Study ID 34)
Preferences for medications to improve sleep while in OUD recovery	Ability to improve sleep quality and quantity	“[I would take a medication for sleep because] I would love to know what it feels like to sleep for like six hours straight or even four. I would take it if I knew I could stay asleep more than three to four hours straight.”—(Study ID 47)
	Beneficial to mood	“I would know a medication for sleep is working because I would notice waking up, you know, rested and feel better.”—(Study ID 45)
	Minimal sedation effects	“I would be willing to try [a sleep medication] because I would definitely like to be sleeping better. It also depends on what it is, because I still have to be able to wake up if my daughter is crying or if something happens.”—(Study ID 21)
	No risk of developing dependence on the medication	“[I would be interested in a sleep medication] as long as it's not a narcotic or a benzo or any of those. I just don't want to feel like that ever again. Because I feel like, if I were to get something that were to give me that feeling again. I hate to say it even though it has been this long. I'm so scared that I'lI just take right to it. And I don't want to take something from my doctors that gives me that feeling and then I take it to the street and end up relapsing over it. I think that's my biggest fear.”—(Study ID 34)
Challenges to employing non-pharmacologic strategies for sleep while in OUD recovery	Abstaining from substances that interfere with sleep is challenging	“Nicotine would be hard to stop, because I smoke cigarettes, and also the tea because I like tea. I'm trying to switch to decaf now and I drink coffee in the morning. But I don't know, when I first stopped using and drinking, it was a lot of coffee all the time, so it was like a pleasure so now I'm just in the habit of coffee or tea now.”—(Study ID 22)
	Mental health symptoms can interfere with implementation of behavioral strategies for sleep	“If I can't get to sleep and then I'm tossing and turning and then looking at the clock. I know you're not supposed to be looking at the clock. And then I'll go and be like I'm not looking at the clock, I'm not, I'm not, and then next thing I'm looking at it and then I only have so many hours left to sleep and all this and tomorrow's going to be a shitty day. Woo-hoo that's me!”—(Study ID 14)
	Current physical environment renders behavioral strategies hard to implement	“[Reducing time spent awake in bed] Just because my room is the only place that I've got that is, like, quiet and away from everybody else. Because there's twelve people in the house, like eight kids and four adults.”—(Study ID 41)
Preferences for non-pharmacologic sleep treatment delivery method for individuals in OUD treatment	Convenience of telehealth options due to ongoing social determinants as barriers to in-person sessions	“Getting to in-person sessions would be hard because my car messes up a lot. Like, just always need stuff done with it.”—(Study ID 71)
	Need for flexibility in session durations and formats to accommodate competing schedules and responsibilities	“Like you know if it's more convenient for me to be at home to do it versus me doing the commute. I do live at home with my parents and my grandma has a mother-in-law suite here too, after I do this today, I have to do something for her so it's kind of convenient if we've got more than one thing going on during the day. Because that commute, that's like an hour and a half out of the day that something else could have been done.”—(Study ID 14)
	In-person options promote treatment accountability	“[In-person therapy] holds yourself accountable to be 100% honest and open on what's really going on. There is a lot you can tell from a person… I speak with my hands, my facial expression, how I'm carrying myself. So, going in person would probably make me feel a lot more believable to the process, than just being told over the phone or over video “hey do this, and tell me how it goes.”—(Study ID 34)