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medical marijuana and insomnia

Does Cannabis Help Insomnia?

In the United States and around the world, cannabis is more popular than ever. Attitudes about cannabis are changing fast—and so are laws that govern its use for medical and recreational purposes. As has been the case for thousands of years, people use cannabis for a variety of reasons, many therapeutic, including to alleviate anxiety and relieve pain. One of this ancient medicinal plant’s most popular uses through the ages? To help with sleep.

What does science tell us about cannabis’ effectiveness in treating the most common sleep disorder, insomnia? That’s what I’ll be discussing today, with a look at the latest science on the effects of cannabis on insomnia.

What is insomnia, exactly?

First, let’s tackle a quick refresher on what insomnia is, because it’s a term that carries a lot of meaning and detail. At its essence, insomnia is a difficulty falling sleep and/or staying sleep, when you have the time and circumstances to get the sleep you need. Insomnia exists both as a set of symptoms and a clinical disorder. That’s to say, people can experience symptoms of insomnia without necessarily having insomnia disorder. (That’s no reason not to address the symptoms; even insomnia symptoms that don’t meet the criteria for a clinical sleep disorder can be disruptive and undermining to sleep, health, well-being and performance.)

What distinguishes insomnia symptoms from insomnia disorder? To a great degree, the severity and frequency of symptoms, and—this is important—the impact of those symptoms on daily functioning. The more frequent, severe, and disruptive, the more likely insomnia symptoms constitute a sleep disorder.

The duration of symptoms can matter to—but keep in mind, insomnia disorder can flare up quickly and cause significant disruption before resolving, all within a short time span. Acute insomnia comes on suddenly and typically lasts for as little as a single night, up to a few weeks. Insomnia is considered chronic when it is present at least three nights a week for three months.

Scientific estimates suggest that somewhere between 35-50% of the adult population experience insomnia symptoms every year, with somewhere between 10-30% of the population suffering from insomnia disorder. Among that 10-30%, an estimated 40-70% have insomnia disorder that is chronic.

What are the symptoms of insomnia?

Trouble falling asleep

Difficulty staying asleep, with frequent and/or prolonged awakenings at night

Waking very early

Waking feeling unrefreshed

People with insomnia disorder also typically experience some form of daytime impairment, including:

Fatigue, daytime sleepiness

Irritability and mood disturbances

Problems with memory, concentration, attention

Decrease in energy, motivation, initiative

Lack of interest and/or capacity for social interactions

Physical pain and discomfort, including muscle tension, headache, gastrointestinal distress

Anxiety or worry about one’s ability to sleep

A person need not have all the sleep symptoms and daytime impairment in order to have insomnia disorder. Even one symptom and one form of daytime impairment is enough. Often, however, symptoms occur together, and daytime impairment is spread across multiple issues.

How does cannabis help insomnia?

Studies show cannabis is already widely used by people in treating their insomnia and sleep issues. That’s not new. With its long history as a medicinal herb, cannabis has been employed for centuries to help with trouble falling asleep and staying asleep, to make sleep more refreshing, and to extend sleep’s duration.

In recent years, scientific studies have found that insomnia is a top reason for using cannabis, along with issues including pain, anxiety and depression, which often co-occur with insomnia. One study published in 2019 found that among cannabis users who said they were using cannabis to improve sleep, 84% said it was “very” or “extremely” helpful. And 83% of people who reported having used over-the-counter sleep medications in the past were able to either reduce or eliminate those drugs from their routines, when they began using cannabis for sleep. That’s important because many of the OTC sleep aids have been linked to Alzheimer’s disease.

So, what does the science tell us about how effective cannabis is at improving insomnia?

Research into the effect of cannabis on insomnia and its symptoms stretches back decades. Studies from the 1970s, 80s, and 90s show cannabis can have a broad impact on sleep, including shortening the time it takes to fall asleep. Difficulty falling asleep is a hallmark symptom of insomnia.

Cannabis can be sedating

What’s behind the ability of cannabis to make falling asleep easier and faster? Most often, that’s been attributed to the sedative effects of the cannabinoid THC. (For a refresher on THC and other cannabinoids, read some of my previous articles here and here.) Indeed, most of the early studies of cannabis and sleep focused on THC-heavy strains of the plant.

Research on cannabis’ influence over sleep problems has been hampered historically, by laws making cannabis illegal even medicinally, and by long-embedded negative attitudes about cannabis. Now that those laws and attitudes are changes—and cannabis is showing up in so many products related to health and wellness—scientific interest and inquiry are on the rise. That’s important: we need plenty of rigorous research to show us precisely how cannabis affects different aspects of sleep, and how it may best be used therapeutically to help alleviate insomnia and other sleep issues.

Terpenes have sleep-boosting abilities

One promising element of more recent research is that scientists are looking more closely at the other active compounds of cannabis, and how they affect sleep. (The more we understand about how different cannabinoids and other components of this complex plant influence sleep, the better medical professionals and patients and consumers themselves will be able to identify the type of cannabis that’s right for their individual needs.)

For example, several different terpenes found in cannabis have been shown to have sedative effects. Terpenes are tiny molecules found across the plant world. They give taste and aroma to plants and fruit. They also have therapeutic abilities, from pain and inflammation relief to anxiety reduction. Cannabis contains hundreds of different terpenes; several have been identified as having sedative properties and at reducing specific insomnia symptoms.

Myrcene, Limonene, Terpineol, and Terpinolene all have been shown in research to function as sedatives

Pinene and Phytol have been shown specifically to shorten the time it takes to fall asleep, and phytol has also been shown to increase overall sleep amounts

We’re really just at the beginning of the investigation into how individual terpenes may address sleep problems, including insomnia. For a more in-depth look at terpenes—what they are, how they work, where to find them—you can read this recent article.

CBD is emerging as a sleep promoter

The cannabinoid CBD (cannabidiol) has shown up everywhere in recent years, and it’s being used for things like stress and anxiety relief, pain management, enhanced concentration/focus, and even sexual enhancement. We’ve still got a lot to learn about CBD’s impact on insomnia, and on sleep more broadly. Some recent research indicates that this cannabinoid may have a role to play in improving insomnia symptoms. I’ve talked before about CBD and its potential therapeutic benefits for sleep, both directly and indirectly through addressing anxiety, physical pain, and other sleep-disrupting conditions.

In particular, one 2018 study caught my eye recently. It’s perhaps the first study to analyze the effects of medical cannabis (in dried form) on insomnia, as measured under naturalistic, real-world conditions (i.e., not in a lab). Researchers found cannabis significantly improved insomnia symptoms overall. In particular, they found CBD was associated with more significant relief from symptoms of insomnia than THC. The study also discovered a pretty staggering range of cannabis strains being used to treat insomnia—more than 460 different strains among a group of slightly more than 400 individuals. That shows just how much choice is out there, and how much potential for specialization and targeting may be possible, in matching strains to sleep and specific sleep problems like insomnia.

To be clear, we need to see more laboratory-based, rigorously controlled studies. But this kind of real-world investigation also delivers valuable information and insight, and can point to future directions for scientific inquiry.

How cannabis may address comorbid insomnia

Another way to think about the influence of cannabis on insomnia is in terms of the type of insomnia. There isn’t just one kind. We’ve talked about acute and chronic, and I’ve discussed how cannabis appears to be particularly effective in addressing onset insomnia—trouble falling initially to sleep.

Comorbid insomnia (until relatively recently this was often referred to as “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 experienced signification 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.) This 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.

It’s not only anxiety and depression with insomnia that cannabis may effectively treat. 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 behavior 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.

One of the best-known uses of therapeutic cannabis is for relief from 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.

Coming soon in this series, a look at how the effects of cannabis on sleep compare to another common real-world sleep aid: alcohol.

What does science tell us about cannabis’ effectiveness in treating the most common sleep disorder, insomnia? That’s what I’ll be discussing today, with a look at the latest science on the effects of cannabis on insomnia.

Marijuana for Insomnia?

Is marijuana better or worse than currently available drugs?

Posted Apr 21, 2019

THE BASICS

  • Why Is Sleep Important?
  • Find a sleep therapist near me

Good sleep is an elusive luxury. After a stressful day it can take forever to get to sleep. The severity of insomnia typically worsens as we age. Every year after puberty it becomes more difficult to fall asleep and stay asleep. Insomnia leaves us feeling dissatisfied with our sleep and facing the new day with fatigue, low energy, difficulty concentrating, generalized anxiety and decreased performance in work or at school. There are many causes for insomnia, including changes in our sleeping environment, shift work, clinical disorders such as depression or mania and most medications. Over-the-counter and prescriptions medications are common solutions for the complex causes of insomnia.

Unfortunately, the treatment options currently available do not help most people who suffer from insomnia. A drug that can produce a normal sleep pattern does not currently exist. Worse, our current medications show tolerance with repeated use that requires us to take higher and higher doses. Ultimately, when we finally stop taking them, we suffer with unpleasant withdrawal symptoms, primarily severe insomnia. The insomnia is made worse by the terrible nightmares that occur during the first few nights of sleep after stopping many of the most popular prescription medications.

The internet offers many claims that marijuana, or one of its components, such as THC or CBD, can treat insomnia and provide a night of restful sleep. Is this true? This is what we know from the relatively few well-controlled studies that have been performed.

Medical marijuana is as safe as the standard OTC and prescription medications currently available. However, medical marijuana shares many of the same problems associated with standard OTC and prescription medications. The use of medical marijuana does not improve sleep quality or reduce the severity of insomnia. Marijuana dose-dependently produces poor sleep quality. The reason that marijuana does not improve sleep quality is related to the fact that the endogenous cannabinoid neurotransmitter system in our brain is not directly involved in the onset or maintenance of normal sleep cycles. Therefore, marijuana cannot, and does not, produce normal sleep patterns. Marijuana increases the lighter stages of sleep, known as NREM slow wave sleep; consequently, it decreases the amount of time spent in REM sleep. REM sleep is usually called dream sleep. Not getting enough REM sleep has many bad consequences, such as an increased risk for obesity, significant memory problems and mood disorders. Getting adequate REM sleep is critical for people with bipolar disorder. Depressed patients who used cannabis reported significantly more sleep impairments. Using marijuana to help fall asleep was also associated with frequent night-time awakenings.

Marijuana might be useful for people who suffer with chronic pain disorders. One study found a marked improvement in subjective sleep parameters provided by the patients with a wide variety of pain conditions including multiple sclerosis, peripheral neuropathic pain, intractable cancer pain and rheumatoid arthritis. Chronic pain, neurological illness, and sleep disorders are clearly comorbid conditions with insomnia. Marijuana likely improves sleep via its ability to reduce pain symptoms.

Cannabidiol (CBD), a constituent of marijuana, was much worse than marijuana. CBD disrupted sleep patterns by reducing both NREM sleep and REM sleep. CBD alone is useless for insomnia.

Similar to currently available medications, nightly use of marijuana produces tolerance that requires higher and higher doses. Withdrawal from marijuana use is associated with poor sleep quality and insomnia. Thus, overall, the available evidence shows that medical marijuana is not superior to currently available medications. The use of marijuana for the treatment of insomnia is associated with side-effects that are similar to those associated with standard insomnia therapies. Overall, the use of medical marijuana for insomnia should be limited to only occasional use in order to avoid the development of tolerance, rebound insomnia and the negative consequences of long-term REM sleep suppression upon daytime cognitive functioning.

© Gary L. Wenk, Ph.D.

I am the author of Your Brain on Food (3rd Edition, 2019; Oxford University Press) and I conduct pre-clinical studies on medical marijuana.

Sleep continuity, architecture and quality among treatment-seeking cannabis users: an in-home, unattended polysomnographic study. By: Pacek, Lauren R.; Herrmann, Evan S.; Smith, Michael T.; et al. EXPERIMENTAL AND CLINICAL PSYCHOPHARMACOLOGY, Volume: 25 Pages: 295-302, 2017

Marijuana use patterns and sleep among community-based young adults. By: Conroy, Deirdre A.; Kurth, Megan E.; Strong, David R.; et al. JOURNAL OF ADDICTIVE DISEASES, Volume: 35, Pages: 135-143, 2016.

Cannabis withdrawal and sleep: A systematic review of (36) human studies. By: Gates, Peter; Albertella, Lucy; Copeland, Jan. SUBSTANCE ABUSE Volume: 37 Pages: 255-269, 2016

Dose-dependent cannabis use, depressive symptoms, and FAAH genotype predict sleep quality in emerging adults: a pilot study. By: Maple, Kristin E.; McDaniel, Kymberly A.; Shollenbarger, Skyler G.; et al. AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE Volume: 42 Pages: 431-440, 2016

Effect of cannabidiol on sleep disruption induced by the repeated combination tests consisting of open field and elevated plus-maze in rats. By: Hsiao, Yi-Tse; Yi, Pei-Lu; Li, Chia-Ling; et al. NEUROPHARMACOLOGY Volume: 62 Pages: 373-384, 2012

Multicenter, double-blind, randomized, placebo-controlled, parallel-group study of the efficacy, safety, and tolerability of THC: CBD extract. Johnson JR, Burnell-Nugent M, Lossignol D, Ganae-Motan ED, Potts R, Fallon MT. J PAIN SYMPTOM MANAGE. Volume 39, pages 167-79, 2010.

The effects of cannabinoid administration on sleep: a systematic review of human studies. Peter J. Gates, Lucy Albertella, Jan Copeland, SLEEP MEDICINE REVIEWS Volume 18, pages 477-487, 2014

Cannabis use and the development of tolerance: a systematic review of human evidence. By: Colizzi, Marco; Bhattacharyya, Sagnik, iNEUROSCIENCE AND BIOBEHAVIORAL REVIEWS Volume: 93 Pages: 1-25, 2018

Marijuana works great for insomnia (for me)

I work with high voltage, usually about 60 feet off the ground. I also suffer from insomnia. Regular treatments for insomnia often left me groggy for hours after I would wake up. This would cause a dangerous work environment for me. I started using marijuana (specifically Indica dominant) about 7 years ago, and the change was amazing. I would fall asleep within minutes of going to bed. I would sleep the whole night, and I would not feel groggy when I woke up.
I would suggest more research be done, because for me, at least, marijuana has been the best medicine for my insomnia.

  • Reply to David
  • Quote David

Marijuana is the one thing I

Marijuana is the one thing I can use to sleep but doesn’t make me feel horrible for a couple of days afterwards. for me it’s better than any pharmaceutical put out by drug companies.

  • Reply to Anonymous
  • Quote Anonymous

I can say from experience that MJ doesn’t work for sleep.
It prevents me from dreaming, and I suspect that dreaming is necessary for good sleep. When I stop for a few days, I start to dream again. Coincidence? I don’t think so.
The best thing for sleep is not to take anything for a few days, then reassess what you need.

  • Reply to Nemo
  • Quote Nemo

Your experience is not universal

You can say the MJ doesn’t work for you for insomnia, but you cannot draw a generalization from your own experience. yeah, like most drugs, it will not work for everyone.

  • Reply to Randy
  • Quote Randy

Still helpful psychologically?

I am not surprised by the findings that marijuana did not produce restful sleep; anyone who has suffered from insomnia can attest that it can be incredibly stressful as one attempts to fall asleep and fears/dreads that sleep will not come, and then finds it becomes a self-fulfilling prophecy. I think that the simple fact that marijuana enables an insomnia sufferer to fall asleep at all and get past the psychological suffering of spending the entire night awake makes it worthwhile even if it doesn’t produce good-quality sleep.

  • Reply to Scarlett
  • Quote Scarlett

There are four questions that need to asked about any new sleep med:

1. Does it work and do you stay asleep?
2. Are you refreshed the next morning when you wake up or are you hung over?
3. Does it mimic sleep architecture? There is a difference between sedation and sleep.
4. How does it compare to good standard conventional treatment, like Lunesta or nonpharm treatment in mild cases? Until that triple or quad blind study is done, we should not entertain it as an alternative.

  • Reply to James OBrien MD
  • Quote James OBrien MD

marijuana for sleep

Dr OBrien
I’ve suffered a lifetime of severe refractory sleep onset insomnia.
No pharmaceutical or CB therapy has been effective in the long (or usually even short) term. Here’s how I would answer the questions you suggest asking oneself.
1. Does it work and do you stay asleep?
Consistently, night time use of marijuana shortens the delay of sleep onset in a way that no other therapy has.
2. I have zero hangover from small dose night time marijuana use. Conversely, I have had major hangovers from almost all other sleep aids I have tried, except Clonazepam, which I am now told is not okay to use long term because of the possibility for geriatric falls and dementia.
3. Does it mimic sleep architecture?
How do we really know what it does, because of such a paucity of real clinical trials due to the illegal status of marijuana at the federal level?
It allows me to initiate sleep, as it does many. Given the choice between zero – three hours of sleep because I can’t initiate sleep and 7-8 hours of sleep because night time low dose marijuana
allows me to initiate sleep and therefore be functional the next day as opposed to a sleep deprived zombie, sleep architecture is of secondary importance. What good does it do to talk about sleep architecture when you can’t even fall asleep? I’m sure you are aware of the health risks associated with severe sleep deprivation.
4, How does it compare to “good standard conventional treatment” like Lunesta? My doctors and clinical research tell me that “good standard conventional” are implicated in next day impairment, worsening depression and increased suicide risk, doing things in your “sleep” like eating and driving, headache, dizziness, falls, and the list continues. No sedative hypnotics are approved for long term use, which is of no help to the long term insomniac.
You also answered your own question in #4, saying that until triple or quadruple blind studies are done, we should not entertain marijuana as an alternative. Given how slow we have been to do any such study, and the relative efficacy and lack of next day side effects, many of use don’t have the luxury of waiting for this study. We need to get enough sleep to function at work and play. If a puff of marijuana can help us to do that, who are you to make the sweeping statement that we should not entertain it as an alternative? All you succeed in doing by saying this is to make it more of a taboo and thus to make users more hesitant to have honest conversations with our doctors about it.
Laura Nelson

  • Reply to Laura Nelson
  • Quote Laura Nelson

Marijuana and sleep

If it helps me sleep, then the four question are quite irrelevant to my results. When you consider drugs such as Ambien and Temazem have been found by scientific studies to put consumers at a much higher risk of Alzheimer’s and cancer, not considering it now is not a rational approach.

No sleep meds are known to mimic sleep architecture.
The question you didn’t ask and should have is “does it provide relief with less severe side effects?”

There are four questions that need to asked about any new sleep med:

1. Does it work and do you stay asleep?
2. Are you refreshed the next morning when you wake up or are you hung over?
3. Does it mimic sleep architecture? There is a difference between sedation and sleep.
4. How does it compare to good standard conventional treatment, like Lunesta or nonpharm treatment in mild cases? Until that triple or quad blind study is done, we should not entertain it as an alternative.

  • Reply to Randy
  • Quote Randy

The biggest thing for me is

The biggest thing for me is that I trust marijuana growers more than I trust western medicine and pharmaceutical companies. And it helps me sleep.

  • Reply to Anonymous
  • Quote Anonymous

Say what you want about pharma

and there’s a lot to criticize.

but at least it’s quantitative medicine.

marijuana seems to be the only drug where people aren’t too worried about taking the right amount. and don’t even ask

which is why Colorado is running into huge problems with ODs especially on edibles.

  • Reply to James OBrien MD
  • Quote James OBrien MD

Quantitative medicine

Yep, quantitative medicine that correlates zolpidem to a higher risk of Alheimer’s. Even if you take “the right amount.” is 2 people what you “quantify” as a “huge” problem with ODs in CO? 12 people? You offered no quantification of huge. Now let’s talk science too. What is your population? Are you talking about a huge OD problem with patients seeking insomnia relief?

It is really hard to believe you are an MD. You don’t support your arguments with the scientific rigor of any doctor I have ever talked to.

  • Reply to Randy
  • Quote Randy

Sources??

Did anyone take a look at this Doctors sources? They are a bunch of biased drug war sites.

Not one big evidence based research study or any for that matter, because he used all US studies and we consider marijuana a schedule I substance. Of course the FDA approved medicines are going to be “better”

And furthermore, saying the side effects of drugs like Ambien and Lunesta are comparable to marijuana.

How do you even live with yourself doctor? Maybe this is the reason you have so much trouble sleeping as you get older. You realize what you are saying isn’t actually true, but you keep saying it.

  • Reply to Jim K
  • Quote Jim K

Cannabinoid works for me!

Everyone differs when it comes to taking marijuana. Some feel relieve and see results when taking it but others do not have. But for me, I have been using cannabinoid for couple of months now and it really improves my sleeping quality. You can order it here momcanada. ca.

Many people suffer occasional insomnia. Is medical marijuana a good alternative to currently available medications? Will smoking weed give you a good night's sleep?