Does cannabis help with sleep?

Cannabis Sativa is a commonly used plant which contains over 100 different phytocannabinoids.  The two most pharmacologically active cannabinoids are:

Tetrahydrocannabinol (THC): this is a primary psychoactive ingredient of cannabis that causes many of the feelings of being high.

Cannabidiol (CBD): this is a non-psychoactive compound, meaning that it does not induce the highs associated with cannabis.

Cannabidiol oil (CBD) is legally available as an over the counter supplement in the UK with a restricted maximum THC content of 0.2%. CBD oil should be distinguished from high-CBD strains of medical marijuana, which contains larger percentages of THC. CBD is not a licenced  medicine and therefore only can be sold as long as claims are not made about its medical benefits.

However, CBD is marketed by the producers for a variety of medical and psychological conditions, including insomnia. Cannabis has long been used recreationally to aid sleep. It is frequently presented as a “healthier and more natural” alternative to prescription medication. It is also  advertised as “having fewer side effects”.

With the legislation around cannabis use changing rapidly, cannabidiol oil (CBD) is becoming an in­creasingly popular over-the-counter pharmacological treatment of sleep issues. The question of whether it can help with sleep is becoming ever more critical.

What do the studies say?

Research on the impact of cannabis on sleep started in the 1970s and but high-quality studies are lacking because of the drug’s legal status. Absolute majority of clinical research on the effect of cannabinoids on sleep  involved the whole cannabis plant, THC components and synthetic THC.

These studies produced mixed results. Some papers reported faster sleep initiation (Cousens and DiMascio, 1973) or reduced time of awakening in the middle of the night (Pivik et al., 1972). However, other studies did not observed the same effect ((Feinberg et al., 1975, Feinberg et al., 1976, Barratt et al., 1974). It would be worth noting that these studies are old. They were conducted such a long time ago, when robust methodology expected in modern scientific research was not followed.

Some newer studies, which reported positive finding, were conducted with financial support a pharmaceutical company producing medical cannabis (Nicholson et al., 2004, Russo et al., 2007). Such studies, therefore, might be biased.

Few studies, which reported sleep improvement following cannabis administration, were done in very special populations groups, such as patients with chronic pain, fibromyalgia or multiple sclerosis (Wade et al., 2003, Wade et al., 2006, Notcutt et al., 2004, Rog et al., 2005). It is possible, that in these patients sleep improvement was related to the reduction of pain intensity. The results therefore can not be generalised to the population with primary sleep problems, such as insomnia.

Clinical research investigating the effect of CBD in insomnia is very limited. A series of experiments with CBD were performed in Brazil comparing different doses of CBD to placebo and old-fashioned hypnotic  nitrazepam in 15 people with insomnia (Carlini and Cunha, 1981). Low doses of CBD had no significant effect on sleep. People receiving the highest CBD dose (160 mg)  subjectively reported having slept longer than those receiving placebo. There were objective measures taken in this research.

In 2017 a review of the scientific research into cannabis use for sleep and sleep disorders concluded that the overall picture is far from clear, that “research on cannabis and sleep if in its infancy” and better designed studies are needed (Babson et al., 2017).

Should I take cannabis for sleep?

Chronic sleep difficulties can have a significant negative impact on mental and physical wellbeing. People with insomnia can be so distressed, that they are willing to experiment with any alternative sleep therapies including cannabis (Tringale and Jensen, 2011, Belendiuk et al., 2015).

But using cannabis-based products requires significant caution for several reasons. Firstly, it is still unclear whether the cannabis has proven benefits for sleep. It is not established what kind of cannabinoids (if any) might aid sleep and how safe these substances are.  It is also possible for cannabis use to become addictive and to develop into

cannabis-use disorder. Cannabis with high content of THC is associated with greater risk of cannabis use disorder. Higher THC concentration can also have significant negative effect on mental wellbeing, particular in people with genetic vulnerabilities to mental health disorders. People sometimes smoke cannabis with tobacco, which is a known carcinogen.

Taking cannabis to induce sleep is not a natural method of sleep initiation, and it can lead to a dependency on the drug. In fact, taking sleep-inducing medications for chronic sleep problems is not effective strategy and not recommended. Use of medication does not address unhelpful behaviours and sleep related worries which act as perpetuating factors maintaining chronic sleep difficulties.  Self-medication for chronic sleep problems is usually not effective and just can make problems worse in a long run.

For long-term solutions to problems of chronic insomnia Cognitive Behavioural Therapy for Insomnia (CBT-I) is identified as a standard first-line treatment (Sateia et al., 2017).

In May 2016, the American College of Physicians published clinical practice guideline for the management of chronic insomnia. This guideline recommends that all patients with chronic insomnia receive CBT-I as the initial treatment intervention (Qaseem et al., 2016).

If you are experiencing chronic sleep difficulties you should consult a specialist to determine a cause of sleep problems. To get advice on whether you need any further investigation and on the best suited therapeutic options please get in touch with ROC to speak to our sleep specialist Dr Olga Runcie.

References:

BABSON, K. A., SOTTILE, J. & MORABITO, D. 2017. Cannabis, Cannabinoids, and Sleep: a Review of the Literature. Current Psychiatry Reports, 19, 23.

BARRATT, E. S., BEAVER, W. & WHITE, R. 1974. The effects of marijuana on human sleep patterns. Biol Psychiatry, 8, 47-54.

BELENDIUK, K. A., BABSON, K. A., VANDREY, R. & BONN-MILLER, M. O. 2015. Cannabis species and cannabinoid concentration preference among sleep-disturbed medicinal cannabis users. Addictive Behaviors, 50, 178-181.

CARLINI, E. A. & CUNHA, J. M. 1981. Hypnotic and antiepileptic effects of cannabidiol. J Clin Pharmacol, 21, 417s-427s.

COUSENS, K. & DIMASCIO, A. 1973. (-) Delta 9 THC as an hypnotic. An experimental study of three dose levels. Psychopharmacologia, 33, 355-64.

FEINBERG, I., JONES, R., WALKER, J., CAVNESS, C. & FLOYD, T. 1976. Effects of marijuana extract and tetrahydrocannabinol on electroencephalographic sleep patterns. Clin Pharmacol Ther, 19, 782-94.

FEINBERG, I., JONES, R., WALKER, J. M., CAVNESS, C. & MARCH, J. 1975. Effects of high dosage delta-9-tetrahydrocannabinol on sleep patterns in man. Clin Pharmacol Ther, 17, 458-66.

NICHOLSON, A. N., TURNER, C., STONE, B. M. & ROBSON, P. J. 2004. Effect of Delta-9-tetrahydrocannabinol and cannabidiol on nocturnal sleep and early-morning behavior in young adults. J Clin Psychopharmacol, 24, 305-13.

NOTCUTT, W., PRICE, M., MILLER, R., NEWPORT, S., PHILLIPS, C., SIMMONS, S. & SANSOM, C. 2004. Initial experiences with medicinal extracts of cannabis for chronic pain: results from 34 ‘N of 1’ studies. Anaesthesia, 59, 440-52.

PIVIK, R. T., ZARCONE, V., DEMENT, W. C. & HOLLISTER, L. E. 1972. Delta-9-tetrahydrocannabinol and synhexl: Effects on human sleep patterns. Clinical Pharmacology & Therapeutics, 13, 426-435.

QASEEM, A., KANSAGARA, D., FORCIEA, M., COOKE, M., DENBERG, T. D. & FOR THE CLINICAL GUIDELINES COMMITTEE OF THE AMERICAN COLLEGE OF, P. 2016. Management of chronic insomnia disorder in adults: A clinical practice guideline from the american college of physicians. Annals of Internal Medicine, 165, 125-133.

ROG, D. J., NURMIKKO, T. J., FRIEDE, T. & YOUNG, C. A. 2005. Randomized, controlled trial of cannabis-based medicine in central pain in multiple sclerosis. Neurology, 65, 812-9.

RUSSO, E. B., GUY, G. W. & ROBSON, P. J. 2007. Cannabis, Pain, and Sleep: Lessons from Therapeutic Clinical Trials of Sativex®, a Cannabis-Based Medicine. Chemistry & Biodiversity, 4, 1729-1743.

SATEIA, M. J., BUYSSE, D. J., KRYSTAL, A. D., NEUBAUER, D. N. & HEALD, J. L. 2017. Clinical Practice Guideline for the Pharmacologic Treatment of Chronic Insomnia in Adults: An American Academy of Sleep Medicine Clinical Practice Guideline. J Clin Sleep Med, 13, 307-349.

TRINGALE, R. & JENSEN, C. 2011. Cannabis and insomnia. Depression, 4, 0-68.

WADE, D. T., MAKELA, P. M., HOUSE, H., BATEMAN, C. & ROBSON, P. 2006. Long-term use of a cannabis-based medicine in the treatment of spasticity and other symptoms in multiple sclerosis. Mult Scler, 12, 639-45.

WADE, D. T., ROBSON, P., HOUSE, H., MAKELA, P. & ARAM, J. 2003. A preliminary controlled study to determine whether whole-plant cannabis extracts can improve intractable neurogenic symptoms. Clin Rehabil, 17, 21-9.