Cognitive behavioral therapy for insomnia improved sleep, mood, and reduced cannabis use | Research

The takeaway

A pilot study found that CBT for insomnia reduced insomnia severity from "moderately severe" to "not clinically significant" in cannabis users, with 80% reporting decreased cannabis use at 3 months.

Cannabis users with sleep problems, addiction counselors, and sleep medicine clinicians.

80% of participants reduced cannabis use 3 months after CBT for insomnia

What the researchers found

After four CBT for insomnia sessions, mean ISI scores dropped from moderately severe to not clinically significant, sustained at 3 and 6 months. Actigraphy confirmed decreased sleep onset latency. PHQ-4 anxiety/depression scores also decreased significantly. At 3 months, 80% reported decreased cannabis use. Three of four inflammatory biomarkers (IL-2, IL-6, CRP) trended downward at 6 months.

Why it matters

Many cannabis users report using cannabis for sleep, creating a cycle where insomnia drives cannabis use. Treating insomnia directly with CBT may reduce the perceived need for cannabis.

The numbers in context

19 participants. ISI dropped from moderately severe to not significant. Actigraphy showed significant decrease in sleep onset latency. 80% reduced cannabis use at 3 months. Significant PHQ-4 score decrease.

How the study worked

Pilot study of 19 participants with cannabis use disorder and insomnia. Four CBT-i sessions with objective (actigraphy) and subjective sleep measures, validated questionnaires (ISI, PHQ-4), and serum inflammatory markers measured at baseline, post-CBT, 3 months, and 6 months.

What this study cannot tell us

Very small sample (19 participants). No control group. Cannot separate CBT effects from natural recovery or placebo. Inflammatory biomarker changes only trended toward significance.

How to read the evidence

Small pilot study with no control group. Promising but needs replication in a controlled trial.

When this study was published

Published in 2022.

The bigger picture

The reduction in cannabis use after treating insomnia supports the theory that some cannabis use is functionally driven by sleep problems, and addressing the underlying issue may reduce the substance use.

Questions still open

Would these results hold in a larger controlled trial? Is CBT-i as effective as or better than cannabis for managing insomnia?

Common questions

Did treating insomnia reduce cannabis use?

Yes. 80% of participants reported decreased cannabis use 3 months after completing just four CBT for insomnia sessions, suggesting that treating the sleep problem reduced the perceived need for cannabis.

How long did the improvements last?

Insomnia improvement was sustained at 3 and 6 months. Anxiety and depression improvements were also sustained. Cannabis use reduction was reported at 3 months.

Read the original research

Assessing cognitive behavioral therapy for insomnia in individuals with cannabis use disorder utilizing actigraphy and serum biomarkers: A pilot study.

Sleep medicine, 100, 434-441

View on PubMed ↗Publisher’s paper ↗

Citation

Geagea, Luna; Ghanimé, Pia Maria; El Hayek, Samer; Kobeissy, Firas; Tamim, Hani; Elbejjani, Martine; Talih, Farid. (2022). Assessing cognitive behavioral therapy for insomnia in individuals with cannabis use disorder utilizing actigraphy and serum biomarkers: A pilot study.. Sleep medicine, 100, 434-441. https://doi.org/10.1016/j.sleep.2022.09.017