The effects of lithium carbonate supplemented with nitrazepam on sleep disturbance during cannabis abstinence

David J. Allsop*, Delwyn J. Bartlett, Jennifer Johnston, David Helliwell, Adam Winstock, Iain S. McGregor, Nicholas Lintzeris

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

19 Citations (Scopus)


Study Objectives: Sleep disturbance is a hallmark feature of cannabis withdrawal. In this study we explored the effects of lithium treatment supplemented with nitrazepam on objective and subjective measures of sleep quality during inpatient cannabis withdrawal. Methods: Treatment-seeking cannabis-dependent adults (n = 38) were admitted for 8 days to an inpatient withdrawal unit and randomized to either oral lithium (500 mg) or placebo, twice daily in a double-blind RCT. Restricted nitrazepam (10 mg) was available on demand (in response to poor sleep) on any 3 of the 7 nights. Dependent outcome measures for analysis included repeated daily objective actigraphy and subjective sleep measures throughout the 8 day detox, subjective cannabis withdrawal ratings, and detoxifi cation completion rates. Results: Based on actigraphy, lithium resulted in less fragmented sleep compared to placebo (p = 0.04), but no other objective measures were improved by lithium. Of the subjective measures, only nightmares were suppressed by lithium (p = 0.04). Lithium did not have a signifi cant impact on the use of nitrazepam. Sleep bout length (p < 0.0001), sleep effi ciency ( p < 0 .0001), a nd s leep f ragmentation ( p = 0 .05) were improved on nights in which nitrazepam was used. In contrast, only night sweats improved with nitrazepam from the subjective measures (p = 0.04). A Cox regression with daily repeated measures of sleep effi ciency averaged across all people in the study a predictor suggests that a one-unit increase in sleep effi ciency (the ratio of total sleep time to the total time in bed expressed as a percentage) resulted in a 14.6% increase in retention in treatment (p = 0.008, Exp(B) = 0.854, 95% CI = 0.759-0.960). None of the other sleep measures, nor use of lithium or nitrazepam were signifi cantly associated with retention in treatment. Conclusions: Lithium seems to have only limited effi cacy on sleep disturbance in cannabis withdrawal. However the nitrazepam improved several actigraphy measures of sleep disturbance, warranting further investigation. Discord between objective and subjective sleep indices suggest caution in evaluating treatment interventions with self-report sleep data only.

Original languageEnglish
Pages (from-to)1153-1162
Number of pages10
JournalJournal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine
Issue number10
Publication statusPublished - 2015


  • Actigraphy
  • Cannabis withdrawal
  • Cannabis withdrawal scale
  • Lithium
  • Nitrazepam
  • Pharmacotherapy
  • Sleep disturbance


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