Insomnia and Medical Cannabis
Definition
A single night or two (or even three) of sleeplessness is not enough on its own to be considered insomnia. However, if sleeplessness goes on for a long period of time, and/or there’s a few nights of sleeplessness every week quite regularly, then it is very likely 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.
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Potential Efficacy / Quality of Evidence (Low, Average, High) of Medical Marijuana for Insomnia
High
Cannabinoids, Terpenes/Terpenoids, Strains and Ratios that May Help
THC and CBN could be of particular use, as could some CBD (although it may keep some awake when used in low doses and without any THC/CBN).
Myrcene, humulene, ocimene and linalool could be very helpful for aiding sleep.
CBD:THC 1:1; THC in particular may help.
Medical Cannabis Pros
Sedatives can be highly addictive, and cannabis can be a much better alternative.
Endocannabinoids play a significant role in the regulation of the sleep-wake cycle – phytocannabinoids may help restore a disturbed sleep-wake cycle in insomniacs.
Cannabis contains cannabinoids and terpenes that help aid sleep, including THC, linalool, myrcene and ocimene.
Cannabis may reduce the amount of time it takes for a person to get to sleep.
Medical Cannabis Cons
There is much debate around CBD. Low to medium doses may actually promote wakefulness in some. This is because CBD is a cannabinoid receptor 1 antagonist. The anxiolytic effects of CBD may help sleep, but higher doses 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 cause anxiety in some people.
Strains that to have a high amount of beta-caryophyllene and limonene (and sometimes pinene) seem to have more energizing or focused effects that are not necessarily conducive to sleep.
Cannabis can reduce the amount of time spent in REM sleep, which can be critical for those who suffer from conditions such as bipolar disorder.
Some studies suggest that the beneficial effects of cannabis for insomnia are short-lived, or that withdrawal can cause rebound insomnia.
More About the Condition
Sleeplessness is a common side-effect of many other conditions. Around about 30% of the US population suffers from some sort of sleep disturbance, and 10% of the US population could be said to have insomnia or at least insomnia-like symptoms. Those who regularly lack quality sleep (i.e. only being able to sleep a few hours a day) could also be said to be insomniacs. Insomnia has a little-researched but very intimate link to chronic pain as well. Many other conditions also have insomnia as a major symptom.
Insomnia can affect day-to-day functioning significantly, and can also weaken the immune system, increasing the chances of infection. Insomnia can both be caused by and be the result of anxiety, depression and migraines, and can magnify their symptoms. Alcohol/opioid/sedative withdrawal can cause insomnia, as can amphetamine use, high doses of caffeine, irregular heart rhythms, post-surgery recovery and hyperthyroidism can also cause insomnia. Highly active people may get exercise-induced insomnia.
Those who suffer from persistent sleep disturbances and insomnia have elevated levels of cortisol and adrenocorticotropic hormones, suggesting an elevated level of stress and anxiety at night time. This flight-or-fight response at night time may have proven useful to some extent for our ancestors, but is less useful nowadays. Those with insomnia are also likely to have drastic shifts in the levels of cytokines (which help send signals to other cells) in their bodies. Erratic sleep patterns may cause insomnia.
Having fixed sleeping patterns, exercise, cutting out refined sugar and caffeine, reducing alcohol use (which can decrease sleep quality), having a healthier diet and herbal remedies such as chamomile, lemon balm and lavender are the most common treatments for insomnia. Sedatives may be prescribed in extreme cases, but these are addictive and can make insomnia worse if withdrawn.
Quotes from Experts
“The final sample consisted of 72 adults presenting with primary concerns of anxiety (n = 47) or poor sleep (n = 25). Anxiety scores decreased within the first month in 57 patients (79.2%) and remained decreased during the study duration. Sleep scores improved within the first month in 48 patients (66.7%) but fluctuated over time. In this chart review, CBD was well tolerated in all but 3 patients.” Source: Shannon, Scott et al. ‘Cannabidiol in Anxiety and Sleep: A Large Case Series‘ The Permanente journal vol. 23 (2019): 18-041. doi:10.7812/TPP/18-041
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Case Studies – Patient Stories
Spears, Emma, ‘Mental health, pain, and insomnia are top reasons U.S. patients use medical cannabis: study‘ The Growth Op
