From the Guidelines
For insomnia treatment, neither cannabis nor sleeping pills should be considered first-line options, and instead, cognitive behavioral therapy for insomnia (CBT-I) and good sleep hygiene practices should be started first. If medication is needed, short-term use of prescription sleep aids like zolpidem (Ambien) 5-10mg, eszopiclone (Lunesta) 1-3mg, or temazepam (Restoril) 7.5-30mg may be appropriate under medical supervision, typically for 2-4 weeks 1. Cannabis has limited clinical evidence for insomnia treatment and carries risks including dependence, cognitive effects, and respiratory issues if smoked, with its effects on sleep architecture potentially disrupting normal sleep cycles and reducing REM sleep 1. Cannabis products vary widely in composition, making dosing unpredictable, and if considering either option, it is crucial to consult a healthcare provider who can assess the specific situation, medical history, and potential drug interactions 1. Long-term solutions should focus on addressing underlying causes of insomnia rather than relying on any sleep aid indefinitely. Key points to consider include:
- CBT-I as the initial treatment for chronic insomnia disorder, given its effectiveness in treating the general population of adults as well as older adults with chronic insomnia disorder 1
- The potential benefits and harms of pharmacologic treatments, including eszopiclone, zolpidem, and suvorexant, which may improve short-term global and sleep outcomes but have risks for cognitive and behavioral changes and other adverse effects 1
- The importance of good sleep hygiene practices and addressing underlying causes of insomnia for long-term solutions 1
From the Research
Comparison of Cannabis and Sleeping Pills for Insomnia
- There are no direct studies comparing cannabis and sleeping pills for insomnia in the provided evidence.
- However, studies suggest that non-pharmacologic approaches, such as cognitive behavioral therapy for insomnia (CBT-I), should be preferred over pharmacologic treatments due to potential adverse effects 2.
- CBT-I has been shown to be effective in reducing insomnia severity and improving mental health in patients with comorbid mental disorders, with moderate to large effect sizes 3.
- Cannabis use has been proposed as a potential treatment for insomnia, but controlled studies examining its impact are rare 4.
- One study found that cannabis use did not moderate the effects of CBT-I on insomnia severity, suggesting that CBT-I is effective regardless of cannabis use 4.
- Digital CBT-I (dCBT-I) has also been shown to be effective in reducing insomnia severity and preventing pain interference, a common comorbidity with insomnia 5.
- A meta-analysis of long-term effects of CBT-I found that it produces clinically significant effects that last up to a year after therapy, with moderate to large effect sizes 6.