Cannabis use as a moderator of cognitive behavioral therapy for insomnia

Mary Beth Miller; Ryan W Carpenter; Lindsey K Freeman; Ashley F Curtis; Ali M Yurasek; Christina S McCrae

doi:10.5664/jcsm.9796

Cannabis use as a moderator of cognitive behavioral therapy for insomnia

J Clin Sleep Med. 2022 Apr 1;18(4):1047-1054. doi: 10.5664/jcsm.9796.

Authors

Mary Beth Miller¹, Ryan W Carpenter², Lindsey K Freeman^{1

3}, Ashley F Curtis^{1

3}, Ali M Yurasek⁴, Christina S McCrae¹

Affiliations

¹ Department of Psychiatry, University of Missouri School of Medicine, Columbia, Missouri.
² Department of Psychological Sciences, University of Missouri-St. Louis, St. Louis, Missouri.
³ Department of Psychological Sciences, University of Missouri, Columbia, Missouri.
⁴ Health Education and Behavior Department, College of Health and Human Performance, University of Florida, Gainesville, Florida.

Abstract

Study objectives: Cannabis use is common among young adults and has been proposed as a potential treatment for insomnia. However, controlled studies examining the impact of cannabis use on insomnia symptoms are rare. This secondary analysis of published trial data tested cannabis use during cognitive behavioral treatment for insomnia (CBT-I) as a moderator of treatment efficacy.

Methods: Young adults (ages 18-30 years) who reported past-month binge drinking (4/5+ drinks for women/men) and met diagnostic criteria for insomnia disorder were randomized to CBT-I (n = 28) or sleep hygiene (n = 28) groups. Interaction effects were tested using multilevel models. Outcomes included insomnia severity, actigraphy-assessed sleep efficiency, diary-assessed sleep quality, drinking quantity, and alcohol-related consequences.

Results: Twenty-six participants (46%; 12 in the sleep hygiene group and 14 in the CBT-I group) reported using cannabis during the treatment phase of the study, on an average of 23% of treatment days (range, 3%-100%). Relative to those who did not use cannabis, participants who used cannabis during treatment reported heavier drinking and more frequent cigarette use. Approximately 1 in 4 cannabis users (27%) reported using cannabis to help with sleep; however, cannabis users and nonusers did not differ in the use of alcohol as a sleep aid. Controlling for sex, race, drinking quantity, cigarette use, symptoms of depression, and symptoms of anxiety, use of cannabis during treatment did not moderate CBT-I effects on insomnia severity (b, -.002; p = .99) or other outcomes (all p > .20).

Conclusions: CBT-I is effective in reducing insomnia symptoms among young adult drinkers with insomnia, regardless of cannabis use.

Clinical trial registration: Registry: ClinicalTrials.gov; Name: The Insomnia Treatment and Problems (iTAP) Study; URL: https://clinicaltrials.gov/ct2/show/NCT03627832; Identifier: NCT03627832.

Citation: Miller MB, Carpenter RW, Freeman LK, Curtis AF, Yurasek AM, McCrae CS. Cannabis use as a moderator of cognitive behavioral therapy for insomnia. J Clin Sleep Med. 2022;18(4):1047-1054.

Keywords: alcohol; cannabis; insomnia; sleep; treatment.

Publication types

Randomized Controlled Trial
Research Support, U.S. Gov't, Non-P.H.S.
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Actigraphy
Adolescent
Adult
Cannabis*
Cognitive Behavioral Therapy*
Female
Humans
Male
Sleep
Sleep Initiation and Maintenance Disorders* / therapy
Treatment Outcome
Young Adult

Associated data

ClinicalTrials.gov/NCT03627832

Abstract

Publication types

MeSH terms

Associated data

Grants and funding