CBTi Effective for Treating Insomnia in Patients Who Use Cannabis Regularly

In individuals who use cannabis on a regular basis, cognitive behavioral therapy for insomnia (CBTi) can be an effective way to treat insomnia, according findings of a pilot study published in the journal Sleep Medicine.

Recognizing that sleep disorders are common among individuals who use cannabis, with poor sleep quality being the most common complaint, researchers sought to evaluate the impact of CBTi in people with cannabis use disorder and insomnia. Additionally, they aimed to explore the effect of CBTi on levels of serum inflammatory biomarkers relative to symptoms of insomnia.

Insomnia has been linked to higher levels of adrenocortitropic hormone and cortisol, with the severity of the disorder directly proportional to cortisol levels and elevations in C reactive protein (CRP).

Participants with cannabis use disorder and insomnia symptoms were recruited from the outpatient clinic at the Psychiatry Clinic of the American University of Beirut, located in Beirut, Lebanon. All participants were recruited over an 18-month period. The researchers collected data on demographics, self-reported sleep parameters, and cannabis use. Blood samples were obtained from all participants to measure interleukin-2 (IL-2), IL-6, CRP, and cortisol levels.

All participants completed the Insomnia Severity Index (ISI) questionnaire and the Patient Health Questionnire-4 (PHQ-4). Study enrollees were provided with an actigraphy (wrist) device for 1 week prior to CBTi and the week following the completion of 4 CBTi sessions.

A total of 19 individuals participated in the study. Overall, 84.2% of the participants were young adult men, more than half were aged 30 years or older, and 79% presented with insomnia as their chief complaint. Mean ISI score decreased from that indicative of moderately severe insomnia at baseline to no clinically significant insomnia following CBTi, with sustained reductions at 3-month and 6-month follow-ups.

Based on actigraphy, a significant decrease was observed in sleep onset latency  following CBTi (28.6 minutes prior to CBTi vs 22.0 minutes post-CBTi; P =.023). At 3 months after CBTi, 80% of the participants actually reported a decrease in their use of cannabis. Further, a significant, sustained decrease in mean PHQ-4 scores was reported after CBTi (P <.05). The levels of 3 of the 4 inflammatory biomarkers evaluated (ie, IL-2, IL-6, and CRP) were reduced following CBTi, although these results only trended toward significance.

Several limitations of the current study should be noted. To begin, because this is a pilot study with a small sample size, this presents a limit on the level of evidence and decreases the power of the statistical analysis. Further, the PCQ-4 used in the study poses another limitation, since it is a screening tool, rather than a diagnostic tool.

According to the researchers, “CBTi is effective as a short- and long-term treatment of insomnia and comorbid anxiety/depression in individuals who regularly use cannabis. A potential added benefit is a reduction in cannabis consumption and inflammatory serum biomarkers.”