Among adults who use cannabis regularly for insomnia, cognitive behavioral therapy (CBT) via telemedicine was more effective for improving sleep and reducing cannabis use compared with a matched behavioral placebo control, according to research presented at the 2022 Annual Meeting of the American Academy of Sleep Medicine and the Sleep Research Society, held from June 4 to 8, 2022, in Charlotte, North Carolina.
The pilot randomized controlled trial compared telemedicine-delivered CBT for insomnia in regular users of cannabis for sleep (CBT-CB-TM) with sleep hygiene education (SHE-TM) for improving sleep and daytime functioning and reducing cannabis use.
A total of 57 participants (mean age, 37.6±12.8 years; 43 women) with chronic insomnia who reported using cannabis for sleep ≥3 times weekly were included and screened for sleep, medical, and mental health disorders. The patients were randomized to 6 sessions of CBT-CB-TM (n=30) or SHE-TM (n=27). All participants self-reported measures of insomnia (Insomnia Severity Index [ISI], primary outcome), daytime functioning (sleep beliefs, depression, and overall functioning), and cannabis use before and after treatment and at 8 weeks.
Participants’ scores improved more on the ISI (β=-2.83, se=0.62; P <.001) and Dysfunctional Beliefs and Attitudes about Sleep scale (β=-0.73, se=0.25; P <.006) in the CBT-CB-TM group compared with the SHE-TM group, according to mixed model analysis.
Small pretreatment to posttreatment decreases in the daily frequency of cannabis use were observed in those who received CBT-CB-TM vs SHE-TM (pre-post change: 0.60±0.94 vs -0.04±0.35, P <.007).
Depression symptoms (Patient Health Questionnaire [PHQ]-8: CBT-CB-TM 8.5±0.7 to 6.8±1.0 vs SHE-TM 9.1±0.7 to 7.0±0.9, P <.004) and overall functioning (SF-12 MCS: CBT-CB-TM 43.3±1.9 to 50.8±2.9 vs SHE-TM 39.8±2.0 to 51.6± 2.5, P <.0005) improved in both conditions from baseline through follow-up.
“Telemedicine-delivered CBT for insomnia improved sleep and reduced cannabis use more than a matched behavioral placebo control in this pilot trial of adults using cannabis regularly for insomnia,” stated the researchers. “These preliminary findings support the need for adequately powered randomized controlled trials with longer follow-up periods to evaluate the efficacy of targeting insomnia to reduce problematic cannabis use.”
Arnedt JT, Conroy D, Stewart H, Bohnert K, Ilgen M. Cognitive behavioral therapy for insomnia to reduce cannabis use: results from a pilot randomized controlled trial. Presented at SLEEP 2022; June 4-8; Charlotte, North Carolina. Abstract 686.