Updated: Nov 8, 2020
Cannabis is a viable option for those who suffer from insomnia. Insomnia is a debilitating sleep disorder that can affect the ability of a person to function normally. The inability to get proper sleep can create changes in the brains and trigger a cascading series of physical, emotional and mental health issues.
Insomnia is one of the most common sleep disorders in the world. Around 10-30% of the general population suffers from insomnia and the figures climb as high as 50-to-60 per cent for older adults and people with medical or mental ill-health.
People with insomnia find it difficult to fall and remain asleep, often to the point where it affects their ability to function in day-to-day life. Its daytime consequences can include fatigue, impaired concentration, memory problems, social dysfunction, and mood disturbances. Insomnia has also been associated with several other chronic health problems, such as heart disease, endocrine dysfunction, and hypertension.
In a recent survey of 1,000 recreational cannabis customers in Colorado, 84 per cent of respondents said that they found cannabis to be "very or extremely helpful" and a significant portion chose to reduce their use of other sleep aids in favour of the drug.
A 2018 study concluded that medical cannabis consumption “is associated with significant improvements in perceived insomnia with differential effectiveness and side effect profiles, depending on the product characteristics.” The study used data submitted by 409 people with insomnia via an app, which recorded real-time ratings of perceived insomnia severity prior to and following cannabis consumption. The study found that, on average, users reported an average of a 4.5 point reduction on a 0-10 scale of symptom severity after using cannabis, and that vaporizer use and higher cannabidiol (CBD) contents were associated with greater symptom relief.
Before you select this option
The research overwhelming support the use of cannabis for insomnia but before you consider this option, you need to understand more about cannabis. Different strains produce a different effect on the person who takes it. Many recreational users have discovered that smoking weed keeps them awake rather than help them sleep. Thus, not all weed is similar and those with insomnia will need to talk to a specialist to get the right dose from the right strain of marijuana in order for it to work. Sativa strain for example should not be taken if sleep is your goal.
Tetrahydrocannabinol (THC), the major intoxicating compound present in cannabis, has also been linked to general improvements in sleep quality. A 2008 study found that both smoked cannabis and orally administered THC reduces the amount of REM sleep each night while increasing the proportion of time spent in stage 4 sleep, the deepest level of sleep. Additionally, the researchers found that acute administration of cannabis also appeared to facilitate falling asleep at night. However, it should be noted that getting too little REM sleep can also be problematic, and can lead to memory problems and mood disorders in some people. So again, we emphasize the need to get the dosage and the strain right.
MARIJUANA HELPS COMORBID INSOMNIA?
Comorbid insomnia or “secondary” insomnia, is insomnia that arises alongside another medical condition. Not all insomnia disorders are comorbid, but many are. Insomnia frequently arises with other health conditions, and as a side effect of medication and other treatments for health problems. There’s a growing body of research indicating that cannabis can be useful in treating comorbid insomnia. For example:
Physical pain is a major source of insomnia. A robust body of research demonstrates that cannabis can alleviate physical pain. Pain management is another prime reason why people use cannabis in the first place. Recent research shows cannabis can improve pain and insomnia symptoms. This 2014 study found a group of people using cannabis therapeutically had an average of 64% reduction in their pain severity, and about half of them experience significant relief to their insomnia.
Anxiety is another condition that causes significant problems for sleep, and a big driver of insomnia and its symptoms. It’s also another major reason why people use cannabis and cannabis-derived products such as CBD oil. A 2019 study found people using cannabis for insomnia and comorbid conditions, including anxiety, depression and physical pain, reported significant improvements to all their co-occurring conditions. It’s worth pointing out that three-quarters of participants in this study had 2 or more conditions simultaneously. It’s common for insomnia to exist in a cluster of other health conditions, both physical and psychological, and to have these factors all interact with one another in complex, escalating ways.
PTSD is another condition that improves with cannabis treatment. Studies are starting to show that cannabis may help alleviate insomnia symptoms that occur with PTSD, or post-traumatic stress disorder. Sleep disorders, including insomnia and REM sleep behaviour disorder, as well as intense nightmares, are frequently present with PTSD. With its ability to help improve sleep onset (i.e., to make falling asleep easier), and to reduce nightmares and suppress some amounts of REM sleep (when most active, intense dreaming occurs), cannabis appears to be promising as a therapy for PTSD-related insomnia. This is an exciting and important area of research that deserves critical attention.
CANCER patient using cannabis often find that it helps relieve them of cancer symptoms and the side effects of cancer treatment. Cannabis has a well-documented ability to relieve pain, reduce nausea, and alleviate anxiety. That makes this complex plant well suited to address symptoms faced by people living with cancer and undergoing treatment. Insomnia often occurs with cancer and as a result of therapies such as radiation and treatment. Research, including this 2019 review of studies, shows cannabis may improve insomnia that is comorbid with cancer.
These are just a few of the comorbid insomnia conditions that cannabis has shown promise in treating. In future discussions, we’ll look at some of these conditions and their relationship to sleep and cannabis therapy in greater depth—and we’ll also continue to go where the research takes us, as cannabis is investigated in relation to other comorbid insomnia conditions.
HOW DO THE COMPOUNDS IN CANNABIS AFFECT SLEEP ARCHITECTURE?
Sleep architecture refers to the nightly structure of sleep as it moves through repeated cycles and individual stages. Every full cycle of sleep (a typical,7-to-8-hour night’s sleep includes 4-5 complete cycles) contains two main types of sleep: non-REM (or NREM) and REM sleep. Within NREM, there are four different sleep stages, moving from light sleep to deep sleep. REM sleep is a distinct stage from the 4 stages of Non-REM. All the stages of sleep appear to be affected by cannabis, to a degree.
Light sleep: Stages 1 and 2
These light non-REM sleep stages tend to be increased by the use of cannabis. Within the body, activation of the endocannabinoid system has been shown to lengthen non-REM sleep phases. The sedative properties of cannabis, most closely associated with the cannabinoid THC as well as with several different terpenes found in cannabis, help shorten sleep latency—meaning, it helps you fall asleep more quickly and perhaps lengthens the early phases of these lighter stages of non-REM sleep.
Light sleep might sound like a throwaway sleep—inconsequential, or lacking in substance. It’s not. Throughout a night of sleep, light sleep paves the way for the cyclical stages of deep sleep and REM sleep, with changes to brain waves, nervous system activity, and hormones. Dreaming can occur during light sleep, and important elements of cognitive processing—including the emergence of sleep spindles in Stage 2, which help the brain transfer memories and newly acquired information, and also elevate the soundness (aka quality) of sleep—take place during these sleep stages. Sleep architecture is a finely-calibrated balance of stages, each serving important purposes. That’s true for light sleep as it is for slow-wave sleep and REM.
Deep Sleep: Stages 3 and 4
While the full spectrum of research to date is somewhat mixed, with some individual studies showing no changes to slow-wave sleep or decreases to slow-wave sleep via cannabis, a persuasive body of research has demonstrated that cannabis is likely to increases deep, non-REM, slow-wave sleep. This sleep phase, composed of Stages 3 and 4, is when the body engages in its most powerfully restorative work to the body, repairing cells and tissue, strengthening immune function, and makes important contributions to memory processing. One open question about the effects of cannabis on slow-wave sleep is, for how long might these deep-sleep boosting effects last? Some research indicates that the increase in slow-wave sleep from using cannabis may not be a long-term, durable phenomenon. We don’t know enough yet to have a clear answer to that question.
There’s been a fair amount of attention paid to the effects of cannabis on REM sleep. Cannabis, especially THC-rich strains, are likely to reduce levels of REM sleep. This is the stage of sleep when we do our most active dreaming, and when the brain does a lot of memory processing and consolidation of acquired information, as well as the processing of emotional experiences. REM sleep can be thought of as a kind of wiping the slate clean in the brain each night, helping prepare the brain for all the activity, including cognitive and emotional activity, that it powers during every moment of waking life.
Too much suppression of REM sleep is not healthy—that’s true for all sleep stages. But it’s also possible to experience too much REM sleep. Cannabis is now increasingly recognized as a promising therapeutic tool for sleep disorders associated with abnormal REM sleep and disruptive dreaming, including REM Sleep Behavior Disorder and PTSD.
As I’ve said, the impact of cannabis on sleep architecture is likely to be influenced by a number of factors, including the composition of any given cannabis strain. Different strains are made up of different amounts of the cannabinoids THC, CBD, CBN and others, as well as other biochemical compounds such as terpenes. Let’s take a brief look at what we know about how the two best-known, most used cannabinoids may affect sleep cycles and stages.
THC appears to be the cannabinoid that plays the most active role in altering sleep architecture, and time spent in specific stages of sleep. Over the decades of research on cannabis and sleep, many studies have focused on THC and THC-rich strains of cannabis, and it’s this cannabinoid that is most closely linked to reductions in REM sleep and increases to deep, slow-wave sleep and the lighter stages of non-REM sleep. THC has clear sedative effects. Strains of cannabis that are higher in THC will generally be more sleep-inducing. But take note: a too-heavy concentration of THC can lead to next-day grogginess.
It’s less clear what specific effects CBD has specifically on the cycles and stages of sleep—in part because so much of the research that focuses on cannabis and sleep include strains with plenty of THC, making it difficult to isolate the effects of CBD apart from this other cannabinoid. Some research has demonstrated that CBD delivers little to no effect on sleep architecture, but it’s important we see more research before drawing any firm conclusion. CBD has been shown as a promising therapy for REM behaviour disorder. At different doses, CBD can be either stimulating or sedating. Low doses of CBD tend to provide stimulation, while higher doses deliver sedative or sleep-inducing effects. Right now, it appears that CBD’s most potent role in facilitating sleep comes through relief from its ability to relieve anxiety and pain.
Article contributors: Dr Micheal Breus, https://thesleepdoctor.com/
Alexander Beadle, https://www.analyticalcannabis.com/editor/alexander-beadle
Dr Lennie Soo, https://www.lenniesoo.com/