Cannabis and Insomnia
Insomnia is the inability to fall asleep or maintain sleep.
Sleep disorders attend many medical conditions, especially pain syndromes.
Cannabis and it’s extracts have been successfully used to treat a range of
sleep disorders, including insomnia, sleep disruption, and sleep apnea. A
primary reason for this is that cannabis medicines can be mildly sedative.
Recently, endocannabinoid signaling was found to modulate
sleep. Studies have shown that successful treatment of sleep disorders with
cannabis medicines is likely to be dose- and delivery-method dependent.
Historic Uses
The Indian Ayurvedic medical tradition recognizes the
sleep-inducing qualities of cannabis, in which it is characterized as
nidrajanan (sleep-inducing). This ancient tradition if reflected in a 1991
survey of Indian cannabis users in the city of Varanasi, where 90% of the
participants found cannabis effective for sleep. Historically, cannabis has
been used to help with sleep because of it’s ability to reduce pain and
discomfort. William O’Shaughnessy, an Irish physician working in colonial India
in the 19th century, noted the effectiveness of cannabis as a
sedative for the treatment of pain and rheumatism. In 1964, early studies
showed that it reduced the time required for patients to fall asleep and
suppressed deep sleep.
Effects
In theory, medical cannabis, especially when used as a
tincture or oral form, should be superior to other pharmacologic or
non-pharmacologic interventions. Insomnia is always one of the top reasons
cited by medical cannabis patients for its use.
The Endocannabinoid system is of central importance in
modulating the induction and the quality of sleep. THC produces residual
sedation, while CBD tends to be wake-promoting. However, CBD is effective for
reducing anxiety, which can make it easier to fall asleep. Some cannabis
cultivars may be highly stimulating. Indicas tend to help you relax and sleep,
Sativas tend to help you stay alert and awake. This may not be true for
everyone, so it is important to find the perfect medicine for yourself that
helps induce sleep.
Insomnia and sleep disorders are conditions for which the
cannabinoid profile of the medicine, along with the timing and size of the
dose, are critical to a successful outcome. Nearly all recreational users of
cannabis note the residual sedative properties of cannabis that occur 90
minutes after dosing, as the drug’s initial stimulation gives way to
sleepiness.
THC appears to be initially stimulating, while its metabolites
are more sedative, which means that patients should smoke or vaporize cannabis
about an hour before bedtime to let the sedative THC metabolites accumulate.
However, overmedicating with cannabis can produce intense psychoactivity, which
makes falling asleep difficult and can interfere with normal sleep cycles.
Patients tend to have improved sleep when using cannabis, while excessive THC
use may reduce restful, normal sleeping patterns.
Edible cannabis has a 2 to 5 hour duration of action, with
little or no residual effect the next morning, given that the dose is
reasonable and you are properly hydrated.
The safety profile of medical cannabis is superior to the
benzodiazepine and nonbenzodiazepine GABA-agonists, and there is much less
potential for dependence or withdrawal symptoms. Cannabis does not cause
rebound insomnia or anxiety when discontinued, and there is no risk of fatal
intentional or accidental overdose.
When medical cannabis was used by patients with a medical
condition known to disturb sleep, there was “some consistency across studies
that showed improved sleep with reduced nighttime disturbances.” Studies that
used THC/CBD combinations tended to show more consistently positive results.
CBD plays a role as a modulator of the therapeutic effects
of THC. Observational accounts indicate that CBD can help an excessively fatigued
patient sleep, but well-rested patients will find CBD too stimulating.
For patients with significant insomnia problems, it is
unrealistic to assume that everything will be solved with medical cannabis,
regardless of the delivery method or dose. Attention to sleep hygiene and
non-pharmacologic treatments is still important. Consider using high CBD
non-psychoactive tincture during the day to reduce your background level of
stress. Do not use CBD after 5pm, as it may be wake-promoting.
If a patient is waking in the middle of the night, oral
cannabis – with its longer-lasting effects – may be more appropriate. Care must
be taken not to overmedicate, since stimulating and psychoactive effects of high
doses of cannabis may awaken the patient and make sleep impossible.
Dosing with Cannabis
Oral cannabis preparations are quite effective for
increasing the quality of rest and sleep, and provide longer-lasting analgesia
for pain patients. Taking swallowed cannabis medications typically take 45
minutes to 1 hour to be felt. In contrast, inhaled forms are felt immediately
and sublingual (under the tongue) takes about 20 minutes to be felt.
If insomnia is due to pain, depression, or PTSD, please research
on those specific concerns. Insomnia is one of the most frequent adverse side effects
of antidepressants. Depressed patients, or those with PTSD, who may be doing
well with their antidepressants but have sleep issues that are not relieved,
may want to investigate whether their antidepressants are causing them
insomnia. Do not change dose or use of any medication without the supervision
of your physician.
Anxiety or rumination (repetitive thoughts about problems,
negative self-judgments, or worrying without resolution) can interfere with
restful sleep. THC is effective for anxiety or rumination at 1-5mg when taken
sublingually.
CBD may make a sleep-deprived patient sleepy, but becomes
wake-promoting once the patient has caught up on rest or if CBD is taken after
5pm.
THC taken orally is recommended for sleep: 5-7mg THC,
swallowed one hour before bed or when bed rest is needed. Swallowing THC
increases its soporific and analgesic effects and extends the period of action.
Vaporized or smoked cannabis is quite effective for insomnia
when taken one hour before bed or waking during the night.
High Mycrene (a terpene found in cannabis) “Purple”
varieties that also produce linalool are consistently noted to have
effectiveness for sleep disorders, possibly because these terpenes are calming
and lightly sedative. Strains like Grape Ape and Purps, and Kush varieties such
as Hindu Kush and Bubba Kush are examples that contain linalool and myrcene.
Information on Cannabis and Insomnia was found in the book:
Cannabis Pharmacy –
The Practical Guide to Medical Marijuana
By Michael Backes, fwd by Andrew Weil, M.D., and Jack D.
McCue, M.D., Medical Editor
Scientific Research
Cannabis and Insomnia - Patients commonly report that use
of cannabis reduces the time it takes them to fall asleep —whether or not
insomnia was the complaint with which they presented. By Rolando Tringale,
MD and Claudia Jensen, MD
“The intake data of 166 patients were assessed for
eligibility and 147 were included (See tables 1 and 2). The two cohorts were well matched except for
their ingestion of cannabis orally (p=0.0494).
Those patients who report Those
patients who reported sleep difficulties appeared to ingest more cannabis. As
for the secondary-outcome measure of self-reported sleep latency time, 104 of
116 patients reporting difficulty with sleep, and 21 of 31 reporting no
difficulty with sleep were included. We
noted a significant decrease in reported time to sleep after the use of
cannabis in both those groups. with
(median -1.25 hours, p=0.000) and those without.”
Cannabis and Sleep - Many people are using cannabis as a
sleeping medication but does it really work?
“These drug effects are caused by the action of chemicals
known as cannabinoids that activate cannabinoid receptors in the central
nervous system. The primary cannabinoids responsible for the characteristic
psychological effects of marijuana are THC (tetrahydocannabinol) and CBD
(cannabidiol). THC is the only cannabinoid found in marijuana that has direct
psychological effects but its effects may be modified by the action of
cannabidiol and perhaps other cannabinoids as well. In small doses THC tends to
be a sedative, in moderate doses to be a stimulant, in large doses it is
psychedelic, and in very large doses may cause psychotic-like symptoms.”
Cannabis and Sleep Disturbances
“How we fall asleep, stay asleep, wake up, and remain awake
is part of an internal biological process regulated by our circadian rhythms
and our endocannabinoid system. Circadian rhythms govern a diverse array of
actions in the body, including hormone production, heart rate, metabolism, and
when to go to sleep and wake up.
It’s as if we have an internal biochemical timer or clock
that keeps track of our need for sleep, guides the body to sleep and then
influences the intensity of sleep. This biological mechanism is affected by
external forces such as travel, medication, food, drink, environment, stress
and more.”
Survey: Cannabis Better Than Big Pharma Meds for PTSD - A
recent Care by Design survey of 300 patients suggests that cannabis is better
than Big Pharma meds for PTSD issues.
“Respondents reported that
cannabis was the most likely to improve PTSD symptoms and the least likely to
make symptoms worse.
Veterans reported being prescribed
more pharmaceutical medications than civilians. They were also more likely to
be prescribed medications that generally worsened their symptoms, including
anti-psychotics, narcotic pain meds, and so-called mood stabilizers.
The most common medication
prescribed for the treatment of PTSD among survey respondents was anti-depressants.
Yet, few report these were effective. Only 18% of respondents said their
depression got better on anti-depressants. Half reported that their depression
got worse on anti-depressants.
Roughly half of respondents
reported they had been prescribed narcotics for PTSD, and a majority of them
reported that their anger and irritability, depression, and sleep problems got
worse while they were on narcotics.
Half of the respondents reported
using CBD-rich cannabis to treat their PTSD symptoms.
80% of respondents reported that
they consume less alcohol when using cannabis.”
