Study register · detailRCT · Sleep Disorders · 2022
Cannabis use as a moderator of cognitive behavioral therapy for insomnia.
Miller et al.·Journal of clinical sleep medicineImpact 2.7
Clear benefitGRADEModerate3 citations
Samplen = 56 Pat.
DurationTreatment phase of the study
ControlSleep hygiene intervention
EndpointInsomnia Severity Index
Blindingunklar
DesignRCT
”Key finding
CBT-I effectively reduced insomnia symptoms in young adults with alcohol use and insomnia, independent of cannabis use during treatment.
Summary
Secondary analysis of an RCT on CBT-I in young adults with insomnia (n=56); 46% used cannabis during treatment (Ø 23% of treatment days). Cannabis use did NOT moderate CBT-I efficacy on insomnia severity (b=-0.002, p=0.99). CBT-I was effective independent of cannabis use.
P
PopulationYoung adults (18–30 years) with insomnia disorder and binge drinking in the past month, n=56
I
InterventionCognitive behavioral therapy for insomnia (CBT-I)
C
ControlSleep hygiene intervention
O
OutcomeCannabis use did not significantly moderate the effects of CBT-I on insomnia severity (b=−0,002; p=0,99); all further outcomes also not moderated (all p>0,20)
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★★★★★
Blinding—
Effect sizeClear benefit
Citations / year★★★★★
Authors
Miller MB, Carpenter RW, Freeman LK, Curtis AF, Yurasek AM, McCrae CS
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.