Study register · detailRCT · Sleep Disorders · 2023
Cognitive behavioral therapy for insomnia to reduce cannabis use: Results from a pilot randomized controlled trial.
Todd Arnedt et al.·Drug and alcohol dependenceImpact 0.8
Clear benefitGRADEModerate18 citations
Samplen = 57 Pat.
Durationpre-treatment, post-treatment…
ControlSleep hygiene education via telemedicine
EndpointISI
Blindingeinfachblind
DesignRCT
”Key finding
CBTi-CB-TM showed significantly stronger improvement in insomnia severity scores and higher remission rates than the control group; it also reduced cannabis use shortly before bedtime.
Summary
n=57 pilot RCT (43 women, age 37,6±12,8 years) with chronic insomnia and cannabis use for sleep ≥3×/week; telemedicine CBT-i for cannabis users (CBTi-CB-TM, n=30) vs. sleep hygiene education (SHE-TM, n=27). ISI scores improved significantly more in CBTi-CB-TM (β=-2,83; SE=0,84; p=0.004; d=0.81); at 8-week follow-up: 60% CBTi-CB-TM vs. 14,8% SHE-TM in insomnia remission (χ²=12,8; p=0.0003). Both groups showed a small reduction in cannabis use (β=-0,10; SE=0,05; p=0.026); CBTi-CB-TM showed a greater reduction in cannabis use within 2 h before bedtime (-29,1±7,9% vs. +2,6±8,0%; p=0.008).
P
PopulationAdults with chronic insomnia and regular cannabis use for sleep promotion (≥3×/week), n=57, mean age 37,6 years
I
InterventionTelemedicine-based cognitive behavioral therapy for insomnia, adapted for cannabis users (CBTi-CB-TM)
C
ControlSleep hygiene education via telemedicine (SHE-TM, n=27)
O
OutcomeISI scores improved significantly more under CBTi-CB-TM vs. SHE-TM (β=−2,83, p=0,004, d=0,81); insomnia remission after 8 weeks: 60,0% vs. 14,8% (p=0,0003); greater reduction in cannabis use within 2h before bedtime post-treatment (−29,1% vs. +2,6%, p=0,008)
Confidence in the evidence
Very lowLowModerateHigh
Moderate
The third of four GRADE levels, the effect estimate is probably reliable.
Downgraded for
Imprecision
Quality profile
Sample size★★★★★
BlindingSingle-blind
Effect sizeClear benefit
Citations / year★★★★★
Authors
Todd Arnedt J, Conroy DA, Stewart H, Yeagley E, Bowyer G, Bohnert KM, Ilgen MA
Background: Individuals with regular cannabis use demonstrate adverse health outcomes, yet infrequently seek treatment. Insomnia, a common co-occurring complaint, could be targeted to reduce cannabis use and improve functioning in these individuals. In an intervention development study, we refined and tested the preliminary efficacy of a telemedicine-delivered CBT for insomnia tailored to individuals with regular cannabis use for sleep (CBTi-CB-TM).
Methods: In this single-blind randomized trial, fifty-seven adults (43 women, mean age 37.6 +/- 12.8 years) with chronic insomnia and cannabis use for sleep >/=3 times/week received CBTi-CB-TM (n = 30) or sleep hygiene education (SHE-TM, n = 27). Participants completed self-reported assessments of insomnia (Insomnia Severity Index [ISI]) and cannabis use (Timeline Followback [TLFB] and daily diary data) at pre-treatment, post-treatment, and 8-week follow-up.
Results: ISI scores improved significantly more in the CBTi-CB-TM compared to SHE-TM condition (beta = -2.83, se=0.84, P = 0.004, d=0.81). At 8-week follow-up, 18/30 (60.0 %) CBTi-CB-TM compared to 4/27 (14.8 %) SHE-TM participants were in remission from insomnia (X(2) =12.8, P = 0.0003). The TLFB showed a small reduction in past 30-day cannabis use for both conditions (beta = -0.10, se=0.05, P = 0.026); CBTi-CB-TM participants demonstrated greater post-treatment reductions in the % of days cannabis was used within 2 h of bedtime (-29.1 +/- 7.9 % fewer days vs. 2.6 +/- 8.0 % more days, P = 0.008).
Conclusions: CBTi-CB-TM is feasible, acceptable, and demonstrated preliminary efficacy for improving sleep and cannabis-related outcomes among non-treatment-seeking individuals with regular cannabis use for sleep. Although sample characteristics limit generalizability, these findings support the need for adequately powered randomized controlled trials with longer follow-up periods.