Insomnia

Medical Cannabis and Insomnia

Insomnia is a sleep disorder and one of the most common reasons many people use cannabis. Alongside eating well and exercising, getting a good night’s sleep is one of the most important things you can do to keep healthy. Medical cannabis – and cannabinoids and terpenes like THC, CBN, and myrcene in particular – is well-noted for its sedative properties and can aid a person’s sleep.

Sleeplessness is a common side effect of many conditions. Around 30% of the U.S. population suffers from sleep disturbance, and 10% of the U.S. population could be said to have insomnia or insomnia-like symptoms. Those who regularly lack quality sleep (i.e., only being able to sleep a few hours a day) could also be insomniacs. Insomnia has a little-researched but close link to chronic pain.

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What is Insomnia?

Insomnia affects day-to-day functioning significantly and weakens the immune system, increasing the chances of infection. Insomnia or rebound insomnia can be caused by and be the result of anxiety, depression, and migraines and can magnify their symptoms.

A night or two of sleeplessness is not enough to be considered insomnia. If sleeplessness goes on for an extended period, and/or there are a few nights of sleeplessness every week, it is insomnia. Insomnia also includes difficulty getting to sleep, staying asleep, or waking up earlier than expected. Erratic sleep, or irregular sleep-wakefulness, is also a feature of insomnia.

There are two main types of insomnia: primary and secondary. Primary insomnia is insomnia that stands alone and is not related to any other health problem. Secondary insomnia occurs due to the side effects of other conditions. Some types and classes of medications, such as ADHD medication or short-lasting benzodiazepines, may cause insomnia or rebound insomnia. Alcohol, opioid, and/or sedative withdrawal can cause insomnia, as can antidepressant use and high doses of caffeine.

Irregular heart rhythms, post-surgery recovery, and hyperthyroidism can cause insomnia. Highly active people may get exercise-induced insomnia, and chronic pain can make sleeping difficult. Insomnia can also result from sleep apnea, where cessation of breathing while asleep forces the body awake.

Those who suffer from persistent sleep disturbances and insomnia have elevated cortisol levels and adrenocorticotropic hormones, suggesting an elevated level of stress and anxiety at night and a hyperactive HPA axis. This flight-or-fight response may have been helpful for our ancestors when you needed to be more alert to danger, but it is less useful in modern life. Those with insomnia are also likely to have drastic shifts in the levels of cytokines (proteins that help send signals to other immune and blood cells) in their bodies.

Brief Summary of Current Treatments

Having fixed sleeping patterns, regular exercise, reduced consumption of refined sugar and caffeine, reduced alcohol use (which can improve sleep quality), having a healthier diet, and using herbal remedies such as chamomile, lemon balm, and lavender are the most common treatments for insomnia. Melatonin supplements are also sometimes recommended, especially for delayed sleep phase syndrome.

Sedative-hypnotic drugs, often benzodiazepine-based ones like zolpidem (Ambien) or temazepam (Restoril), may be prescribed in extreme cases of insomnia. Still, these are addictive and can make insomnia worse if withdrawn. Antidepressants may be prescribed to alleviate anxiety and/or depression, which may help reduce insomnia.

How Might Medical Cannabis Help?

There are several good reasons why medical cannabis can help manage insomnia. These include:

• As an alternative to sedatives, which can be highly addictive.
• Endocannabinoids play a significant role in regulating the sleep-wake cycle – phytocannabinoids like THC, CBD, and CBN may help restore a disturbed sleep-wake cycle in insomniacs.
• Cannabis contains several terpenes that help aid sleep, including linalool, myrcene, and ocimene.
• Cannabis may reduce the amount of time it takes for a person to get to sleep.
• CBN has sedative properties that can equal that of benzodiazepines but with far less addiction potential.

Cannabinoids

THC and CBN have sedative effects, as could some CBD when used in combination with THC and CBN. However, CBD alone may keep some awake when used in low doses.

If you use CBD with little-to-no THC, you may require high doses of CBD to achieve a sedative effect.

Cannabinoid Ratios

A THC:CBD ratio of 1:1 may be helpful for some. Some may require more THC, so a THC:CBD ratio of 2:1 may also help.

Terpenes and Terpenoids

• Myrcene
• Linalool
• Humulene
• Ocimene
• Nerolidol
• Pinene
• Beta-caryophyllene

Flavonoids

There is little research into specific flavonoids for treating or managing insomnia. Peanut stem and leaf extract may improve sleep quality “via a mechanism of action that decreases neuronal excitability.” Reducing sodium and potassium flow in neuronal cells can have sedating effects. 7-di-O-methyl naringenin (BMN) and 2′-O-methyl isoliquiritigenin (MIL) are the main active flavonoids that help induce sleep. Cannabis contains some similar flavonoids in naringin and naringenin.

Effective Ways of Taking Medical Cannabis for Insomnia

Routes of Administration

• Inhalation
• Sublingual
• Ingestion

Special Formulations

Cannabis flower and products that contain THC, CBN, myrcene, linalool, and humulene may be helpful. Pinene and beta-caryophyllene may also help aid relaxation. CBN is a byproduct of THC as it ages, so cannabis flower harvested later and with plenty of amber trichomes could be more sedative compared to cannabis flower harvested earlier in its flowering period. THCV can be uplifting in lower doses but may combine with and enhance THC’s sedative effects in higher doses.

Inhaling marijuana for its immediate effects can help one get to sleep, and an edible or tincture can help one stay asleep.

Dosing Methods

• Vaporizing
• Inhaler
• Tincture
• Edible
• Drinkable

What are the Pros and Cons of Taking Medical Cannabis for Insomnia?

Potential Pros

• Medical cannabis is a much safer alternative to hypnotic sedatives, with fewer adverse side effects.
• Cannabis use can help one get to sleep faster.
• A tincture or edible can help a patient stay asleep.
• Medical cannabis can help manage other insomnia-related issues, like chronic pain and anxiety.
• Frequent and light cannabis users tend to engage in more physical activity than non-users, and exercise helps regulate sleep patterns.
• Restricted sleep enhances circulating levels of the endocannabinoid 2-arachidonoylglycerol (2-AG) in the body. Phytocannabinoids can help regulate and reduce 2-AG production as required.

Potential Cons

• There is much debate around CBD. Low to medium doses may promote wakefulness in some, and this is because CBD is a cannabinoid receptor 1 antagonist. The anxiolytic effects of CBD may help sleep, but higher doses (300 mg or more) may be needed for sleep-inducing effects at nighttime. High doses of CBD may help some get to sleep as it can calm the mind and body.
• Too much THC may also induce anxiety in some people, leading to restlessness.
• Cultivars (often referred to as “strains”) that contain a combination of high amounts of pinene, beta-caryophyllene, and limonene tend to have more energizing or focused effects that are not necessarily conducive to sleep. Interestingly, these terpenes can also have relaxing effects that aid sleep when used separately and/or in lower doses.
• Low doses of THCV may also promote wakefulness (higher doses of THCV may enhance THC’s effects as well, however).
• Cannabis can reduce the time spent in REM sleep, which can be critical for those suffering from conditions like bipolar disorder.
• Some studies suggest that the beneficial effects of cannabis for insomnia and sleep apnea are short-lived.
• Cannabis withdrawal can cause rebound insomnia.

Useful Anecdotal Information

Spears, Emma, “Mental health, pain, and insomnia are top reasons U.S. patients use medical cannabis: study” The Growth Op

“Australian Insomniacs Test Cannabis Drug,” Woolcock, Thursday, April 23, 2020

Scientific Data Overview and Studies

Data Overview

• Total Studies = 65
• Positive Studies = 54
• Inconclusive Studies = 8
• Negative Studies = 3
• 42 Meta-Analyses (32 positive, 7 inconclusive, 3 negative); 11 Animal Studies (all positive); 8 Double-Blind Human Trials (all positive); 4 Human Trials (3 positive, 1 inconclusive)
• 23 studies include CBD (19 positive, 2 inconclusive, 2 negative); 16 studies include THC (14 positive, 2 inconclusive); 1 study includes CBN (positive)
• No. of Leafwell Patients (2022) = 5,837
• Possible Overall Efficacy: High

Quotes from Studies

“Nabilone [synthetic THC] is effective in improving sleep in patients with FM and is well tolerated. Low-dose nabilone given once daily at bedtime may be considered as an alternative to amitriptyline. Longer trials are needed to determine the duration of effect and to characterize long-term safety.” Ware MA, Fitzcharles MA, Joseph L, Shir Y. ‘The effects of nabilone on sleep in fibromyalgia: results of a randomized controlled trial.’ Anesth Analg. 2010 Feb 1;110(2):604-10. doi: 10.1213/ANE.0b013e3181c76f70. Epub 2009 Dec 10. PMID: 20007734.

“Two weeks of nightly sublingual administration of a cannabinoid extract (ZTL-101) is well tolerated and improves insomnia symptoms and sleep quality in individuals with chronic insomnia symptoms.” Walsh JH, Maddison KJ, Rankin T, Murray K, McArdle N, Ree MJ, Hillman DR, Eastwood PR. ‘Treating insomnia symptoms with medicinal cannabis: a randomized, crossover trial of the efficacy of a cannabinoid medicine compared with placebo.’ Sleep. 2021 Nov 12;44(11):zsab149. doi: 10.1093/sleep/zsab149. PMID: 34115851; PMCID: PMC8598183.

Conclusion

There is a significant amount of evidence to support the idea that medical cannabis can aid sleep and manage insomnia, with appropriate doses of THC and CBD helping many patients get to and stay asleep.

Related Articles

How Can Cannabis Treat Insomnia?

Anxiety, Insomnia and Chronic Pain: How Medical Cannabis & Telehealth Helped People During the Pandemic

Webinar: Why Cannabis is Effective for Chronic Pain and Insomnia

Note that the information in this article does not constitute medical advice.

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