Insomnia, a chronic condition already afflicting nearly 16% of the general population in France, emerges with alarming frequency among individuals battling psychiatric disorders. Its ramifications extend beyond mere sleeplessness, deeply influencing clinical outcomes, responsiveness to psychiatric treatments, daily functional capacity, and overall quality of life. Despite its evident burden, until now, no study had precisely quantified insomnia’s footprint within outpatient public psychiatric care—a primary access point for patients in France’s mental health system.

The PAPPI study employed a rigorous, monocentric, descriptive, cross-sectional design, leveraging a pseudo-random sampling method and patient-completed questionnaires to gauge insomnia prevalence and related factors. Conducted in January 2024 at the Guillaume Régnier Psychiatric Hospital-affiliated centers in Rennes, the research encompassed three key outpatient settings: Community Mental Health Centers, Community-Based Rehabilitation Centers, and Psychiatric Day Hospitals.

Among 624 eligible adult patients scheduled for care appointments, an impressive 82% participation rate resulted in data from 511 respondents. Using the validated Insomnia Severity Index (ISI), with a clinical insomnia threshold at a score of 15 or above, researchers identified a startling 34.8% prevalence rate of clinical insomnia. This frequency is more than double that observed in the broader population, signaling a significant convergence of sleep disturbances and psychiatric conditions in outpatient contexts.

Delving deeper, the study’s multivariate analysis revealed a nuanced web of factors that either heightened or mitigated insomnia risk. Higher educational attainment, specifically at the A-Level and beyond, was linked with more than double the odds of reporting clinical insomnia. This counterintuitive association invites further exploration into socio-educational stressors or heightened awareness of sleep problems among more educated patients.

Moreover, depressive disorders emerged as a substantial clinical correlate, doubling the likelihood of insomnia, consistent with well-documented bidirectional relationships between mood disturbances and disrupted sleep architecture. Environmental and behavioral elements played pivotal roles as well; nighttime exposure to disruptive light and noise increased insomnia odds by 82%, while screen use before bedtime inflated risk by 90%. These findings reaffirm established sleep hygiene principles, emphasizing the need for environmental control to preserve restorative sleep.

Conversely, markers of financial stability provided a protective buffer, with patients reporting financial ease exhibiting about 60% lower odds of insomnia compared to their financially insecure counterparts. Additionally, adherence to regular sleep schedules correlated with a remarkable 75% reduction in insomnia risk, underscoring the therapeutic value of circadian rhythm consistency in this vulnerable group.

Equally striking was the treatment landscape uncovered by the study. Pharmacological management dominated clinical responses; 61.2% of patients with insomnia reported using sleep medications, significantly overshadowing the 45.3% medication use among those without insomnia. In contrast, evidence-based non-pharmacological interventions—particularly cognitive behavioral therapy for insomnia (CBT-I)—were alarmingly underutilized, accessed by only 4.5% of those with insomnia. Similarly, participation in sleep hygiene education groups remained minimal, at 3.7%.

This heavy reliance on pharmacotherapy raises critical concerns regarding iatrogenic risks and the potential for medication dependence, tolerance, and side effects. The evident underuse of CBT-I, widely regarded as the gold standard non-drug treatment for chronic insomnia, highlights a systemic gap between best-practice guidelines and actual mental health service delivery.

The PAPPI study’s revelations carry profound implications. They not only quantify the silent epidemic of insomnia within outpatient psychiatric populations but also spotlight modifiable environmental and behavioral contributors ripe for intervention. Importantly, this research paves the way toward reshaping insomnia care paradigms by advocating for scalable, accessible non-pharmacological therapies tailored to psychiatric patients’ unique needs.

There is an urgent call to action for healthcare policymakers, clinicians, and researchers to bridge the disconnect between current medication-heavy practices and the robust evidence supporting CBT-I and sleep hygiene education. Developing treatment pathways integrating these modalities could markedly improve patient outcomes, reduce adverse effects, and contribute to holistic mental health recovery.

Furthermore, the study’s findings underscore the necessity to implement routine insomnia screening in outpatient psychiatric settings, enabling early identification and personalized intervention. This, combined with environmental modifications aimed at minimizing nocturnal light and noise pollution and promoting healthy screen habits, could yield tangible clinical benefits.

As insomnia continues to cast a long shadow over psychiatric wellbeing, the PAPPI cross-sectional study shines a piercing light on its prevalence and management deficiencies in outpatient public psychiatric care. Its evidence-based insights offer a roadmap to enhance sleep health and, by extension, psychiatric recovery through multidimensional, patient-centered strategies.

The landscape of psychiatric sleep medicine is poised for transformation, spurred by this landmark research. By acknowledging the intertwined nature of mental health and sleep and prioritizing integrative, non-pharmacological interventions, the healthcare community can take significant strides toward alleviating one of psychiatry’s pervasive, yet often neglected, comorbidities.

Subject of Research: The study focuses on the prevalence, associated factors, and care management of clinical insomnia among adults receiving outpatient psychiatric services in France.

Article Title: The PAPPI cross-sectional study: prevalence, associated factors and care management for insomnia in outpatient public psychiatric services

Article References:
Daucé-Fleuret, L., Gary-Bobo, P. & Reilhac, A. The PAPPI cross-sectional study: prevalence, associated factors and care management for insomnia in outpatient public psychiatric services. BMC Psychiatry 25, 1100 (2025). https://doi.org/10.1186/s12888-025-07562-0

Image Credits: AI Generated

DOI: 10.1186/s12888-025-07562-0 (Published 18 November 2025)

Keywords: insomnia, psychiatric outpatients, prevalence, sleep management, Insomnia Severity Index, cognitive behavioral therapy for insomnia, sleep hygiene, pharmacotherapy, mental health care, sleep disturbance, France

Insomnia and sleep disturbances affect roughly one-third of the global population at some point in their lives, with approximately 10 percent meeting the clinical criteria for insomnia disorder—a condition characterized by chronic difficulty in initiating or maintaining sleep that significantly impairs daytime functioning. Conventional pharmacological treatments, such as benzodiazepines or non-benzodiazepine hypnotics, often pose risks including tolerance, dependence, and adverse side effects, leaving a critical need for safer and more effective therapies.

Exploring cannabis-based medicinal products as an alternative treatment, the researchers analyzed patient-reported outcomes, focusing on subjective sleep quality, levels of anxiety and depression, and overall quality of life. These metrics provide a comprehensive understanding of how insomnia and associated symptoms respond to cannabis-based interventions over a substantial timeframe. The observational design of the study offers real-world evidence while acknowledging the necessity for future randomized controlled trials to confirm causality and further validate efficacy.

Patients enrolled in the study demonstrated significant, sustained improvements in self-reported sleep quality throughout the duration of the study. Notably, these benefits persisted for up to 18 months, suggesting that cannabis-based products may mitigate the issues of tolerance and diminishing effects observed with many traditional hypnotics. This sustained improvement points to a promising role for cannabinoids in sleep regulation pathways, potentially involving interactions with the endocannabinoid system, which is known to influence circadian rhythms and sleep architecture.

In addition to enhancements in sleep, the study participants showed marked reductions in anxiety and depression symptoms, conditions frequently comorbid with insomnia that exacerbate sleep difficulties. Such improvements are particularly relevant because psychoactive cannabinoids like THC and non-intoxicating compounds such as CBD have demonstrated anxiolytic and mood-stabilizing properties in other clinical contexts, implying a multifaceted therapeutic profile for medical cannabis in neuropsychiatric symptom management.

Pain—a notable contributor to sleep disruption—also lessened significantly among the study cohort. Chronic pain conditions often interfere with the onset and maintenance of restful sleep, and cannabinoids have been widely studied for their analgesic properties. The dual action on pain and sleep disturbances might explain the observed comprehensive improvements and highlight the potential for cannabis formulations tailored to complex symptom clusters.

Side effects associated with cannabis-based medicinal treatment were reported by approximately nine percent of patients, including fatigue, insomnia paradoxically, and dry mouth. Importantly, none were life-threatening or severe enough to warrant discontinuation in most cases. These findings underscore that while not without risk, the safety profile of cannabis-based products may compare favorably to that of conventional hypnotics, which often carry risks of dependence, cognitive impairment, and other adverse outcomes.

Dr. Simon Erridge, Research Director at Curaleaf Clinic and co-author of the study, underscored the significance of these findings in the clinical management of insomnia. He emphasized the importance of monitoring potential tolerance development over time and tailoring treatments on an individual basis to maximize efficacy while mitigating risks. The practical implications for clinicians include the possibility of integrating cannabis-based products as adjunctive or second-line therapy, particularly in patients unresponsive to or intolerant of standard pharmacological options.

The observational nature of this research is both a strength and a limitation. While allowing a realistic picture of patient experiences over an extended period, it inherently cannot establish cause-effect relationships. Confounding variables such as lifestyle changes, placebo effects, and the variability in product formulations and dosages require careful consideration. Nevertheless, the study’s real-world evidence broadens our understanding of medical cannabis’s therapeutic potential, encouraging further rigorously controlled investigations.

From a neurobiological perspective, it has been hypothesized that cannabinoids modulate sleep through their action on CB1 receptors in the central nervous system. These receptors influence neurotransmitters implicated in sleep cycles, such as GABA and glutamate. Moreover, the balance of THC and CBD in medicinal formulations could account for differential effects on sleep latency and maintenance, where THC’s sedative properties complement CBD’s anxiolytic and anti-inflammatory effects, possibly improving sleep architecture and subjective restfulness.

The complex interplay between insomnia, mental health, and pain highlights the multifactorial nature of chronic sleep disorders. Cannabis-based treatments potentially target these overlapping symptoms simultaneously, addressing the limitations of mono-target pharmacotherapeutics. Additionally, favorable patient-reported outcomes may promote adherence, an essential factor often overlooked in clinical trials but critical for real-world success.

As the legal and regulatory landscapes evolve, so too does the urgency to clarify the clinical role of cannabis-based medicinal products. The study’s findings contribute to a growing body of literature advocating for the thoughtful incorporation of these treatments into personalized medicine strategies. However, regulatory agencies and healthcare professionals must weigh these benefits against potential risks, emphasizing careful screening, dosing protocols, and longitudinal follow-up.

In conclusion, this pioneering investigation offers encouraging evidence that cannabis-based medical products can provide meaningful and sustained improvements in sleep quality and associated symptoms over an extended period. While not a panacea, these findings illuminate a promising avenue for patients grappling with the often intractable challenge of insomnia. The research paves the way for future randomized trials that will be critical in defining standardized treatment guidelines and integrating cannabinoid therapies into mainstream clinical practice.

For full access to the study and detailed data, the article appears freely available in PLOS Mental Health, reinforcing the commitment to open science and the dissemination of knowledge that may benefit insomnia patients worldwide.

Subject of Research: People

Article Title: UK Medical Cannabis Registry: A clinical outcomes analysis for insomnia

News Publication Date: 27-Aug-2025

Web References: https://doi.org/10.1371/journal.pmen.0000390

References:
Aggarwal A, Erridge S, Cowley I, Evans L, Varadpande M, Clarke E, et al. (2025) UK Medical Cannabis Registry: A clinical outcomes analysis for insomnia. PLOS Ment Health 2(8): e0000390. https://doi.org/10.1371/journal.pmen.0000390

Image Credits: Photo by Jeff W on Unsplash (free to use under the Unsplash License)