Cannabis Use Did Not Interfere with Cognitive Behavioral Therapy for Insomnia | Research

The takeaway

Among young adults with insomnia who also binge drink, cannabis use during treatment did not reduce the effectiveness of cognitive behavioral therapy for insomnia.

Sleep medicine clinicians, people using cannabis for sleep who also want therapy

Cannabis moderation effect: b = -0.002 (P = 0.99)

What the researchers found

Among 56 young adult binge drinkers with insomnia, 46% used cannabis during the treatment phase. Cannabis use did not moderate CBT-I effects on insomnia severity (b=-0.002, P=0.99) or any other outcomes. Cannabis users reported heavier drinking and more cigarette use but CBT-I remained effective regardless.

Why it matters

Clinicians may worry that cannabis use undermines insomnia therapy. This study suggests CBT-I works whether or not patients use cannabis concurrently, which is reassuring for clinical practice.

The numbers in context

56 participants; 46% used cannabis during treatment; 27% of cannabis users used it for sleep; cannabis moderation effect b=-0.002 (P=0.99); 23% of treatment days involved cannabis use

How the study worked

Secondary analysis of a published RCT. Young adults (18-30) with binge drinking and insomnia disorder were randomized to CBT-I (n=28) or sleep hygiene (n=28). Cannabis use was assessed during the treatment phase and tested as a moderator using multilevel models.

What this study cannot tell us

Secondary analysis not powered to detect cannabis effects. Small sample. Cannabis use was naturalistic and self-reported. Only young adult binge drinkers, limiting generalizability.

How to read the evidence

Secondary analysis of an RCT with small sample. Provides reassuring but preliminary evidence.

When this study was published

Published in 2022

The bigger picture

Many people with insomnia use cannabis for sleep. Rather than requiring cannabis cessation before starting CBT-I, this study suggests the therapy can proceed effectively alongside concurrent cannabis use.

Questions still open

Would heavier cannabis use interfere with CBT-I? Does cannabis use decline naturally once insomnia improves through therapy?

Common questions

Does cannabis use interfere with insomnia therapy?

This study found cannabis use had virtually zero effect on CBT-I outcomes (b=-0.002, P=0.99). The therapy was equally effective for cannabis users and non-users.

How many insomnia patients used cannabis for sleep?

Among the 46% who used cannabis during treatment, about 27% reported using it specifically for sleep. However, cannabis users and non-users did not differ in using alcohol as a sleep aid.

Read the original research

Cannabis use as a moderator of cognitive behavioral therapy for insomnia.

Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 18(4), 1047-1054

View on PubMed ↗Publisher’s paper ↗

Citation

Miller, Mary Beth; Carpenter, Ryan W; Freeman, Lindsey K; Curtis, Ashley F; Yurasek, Ali M; McCrae, Christina S. (2022). Cannabis use as a moderator of cognitive behavioral therapy for insomnia.. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 18(4), 1047-1054. https://doi.org/10.5664/jcsm.9796