World Sleep Day: Cannabis for Insomnia

Insomnia, sometimes just known as “sleeplessness”, is such a common problem that many people just shrug their shoulders and carry on regardless. This is not surprising – we can lead busy lives, and sometimes getting more than 6 hours sleep can seem like a luxury. Yet, in the US, between 10 and 30% of adults may develop insomnia at any given time, and up to half of US adults can expect to experience insomnia (i.e. difficulty in getting to sleep or difficulty in getting enough sleep) in a given year. Due to insomnia being a major sign or symptom of other underlying issues, for example stress & anxiety, chronic pain, hyperthyroidism, depression and so on, cannabis could have a sedative effect for a range of conditions.

Insomnia; complications of insomnia; problems that insomnia can make worse.
Häggström, Mikael (2014). “Medical gallery of Mikael Häggström 2014”. WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.008. ISSN 2002-4436. Public Domain.

Why is cannabis such an effective sleep instigator? How do THC and CBD work for Insomnia?

Well, there are a few main reasons. Tetrahydrocannabinol (THC) induces sleep, whilst cannabidiol (CBD) can help a person relax and act as an anxiolytic (although CBD may promote wakefulness in small doses). THC in particular may be useful for insomnia due to two potential mechanisms of action: 1) THC arouses CB1 receptors and the neurons in the lateral hypothalamus, inhibiting the arousal system; and 2) THC increases the body’s level of adenosine, which promotes sleep. Terpenes such as myrcene, humulene and linalool may also induce sleep. However, in some people, THC may actually cause an initial phase of wakefulness, followed by sleepiness. Therefore, high THC alone may not be the answer to getting to sleep, and having the right balance of THC and specific terpenoids may also be more effective in helping a person get to sleep. Please check out our entry on insomnia to see more details on the science behind utilizing cannabis for insomnia. Nabilone and dronabinol have been used successfully for sleep apnea.

Now, let’s write a little on insomnia itself and the way it is treated. The most common symptoms of insomnia include:

  • Difficulty getting to sleep at night.
  • Inability to find a comfortable sleeping position.
  • Restless sleep – constantly waking up throughout the night.
  • Unrefreshing sleep.
  • Daytime sleepiness, irritability and anxiety.
  • In some cases, sleep apnea – “pauses” in breathing during sleep, or shallow breathing during sleep.
  • The problems above occur persistently, often lasting weeks or months.

Being unable to sleep, as well as sometimes being a sign of another issue (only around 6% of sufferers have insomnia that is not related to another underlying health issue), can also lead to other problems. Should you not be getting proper sleep, your immune system weakens and you become more susceptible to illnesses and injuries. Insomnia can also compound already-existing problems, such as chronic pain. Essentially, if you cannot sleep properly, you cannot heal properly. For brain and body to function efficiently, sleep is needed. Those who work night shifts are also more prone to insomnia, due to their anxiolytic effects.

How is insomnia treated currently?

Current treatments for insomnia include putting in place regular sleeping patterns, exercise, exposure to sunlight, a noise- and light- free room and cognitive behavioral therapy (CBT). Herbal remedies such as valerian root and chamomile are also used. Sleeping pills – usually benzodiazepine- or barbiturate- based – are not usually recommended unless other treatment methods fail and the insomnia lasts more than several weeks. Benzodiazepines and barbiturates are addictive and can only be used in the short-term. Long-term benzodiazepine and barbiturate use can often lead to worse sleep. Opioids, which are often prescribed for chronic and post-surgery pain, can also cause major sleep disturbances. Furthermore, for those with sleep apnea, using such drugs can potentially make such a condition worse, as benzodiazepines, barbiturates and opioids are central nervous system suppressants. Antidepressants are also used for insomnia, especially if the insomnia is anxiety-based.

Furthermore, withdrawal from benzodiazepines and barbiturates drugs can also cause insomnia! This is because such drugs can promote light sleep and decrease the amount of time spent in deep sleep, as they are rapid eye movement (REM) sleep suppressants. Whether cannabis acts similarly is up for debate, but it does seem to have one major difference: cannabis increases the amount of time spent in deep sleep, rather than REM or light sleep. Deep sleep is perhaps the most important stage for the reparation of the body, and it is not known how much REM sleep is needed. For those who suffer from particularly nasty nightmares, this might actually be a benefit to some extent, but for many people this may be a concern, as REM sleep may prove to have significant cognitive advantages. However, there is is little doubt that cannabis is generally less addictive and more tolerable than benzodiazepines, barbiturates and opioids. There is also the fact that such prescriptions come with the potential price of overdose.

Is there a particular cannabinoid-terpenoid profile that could be of use? How do I use CBD, THC etc. for insomnia?

To reiterate a common refrain, different people respond to different cannabinoids and terpenoids in different ways. What works for one may work differently for another. However, there are still some patterns, and it does seem that some THC combined with terpenes such as linalool, myrcene and humulene may be particularly effective for insomnia. Pinene and low doses of limonene may also help. CBD may help in small doses to some extent, and some have noted that CBD promotes restfulness, but many also report an “up”, “energetic” or “wiry” feeling with CBD, especially in high doses. Cannabinol (THC), which is what THC/THCA degrades into and has a mild psychoactive effect due to it being a partial agonist of the CB1 receptor, is also thought to promote sleepiness. Interestingly, CBN also has a high affinity to CB2 receptors in comparison to THC and CBD, at least when CBN has its phenolic hydroxyl group present. Hashish and other extracts with high amounts of plant material still in it may be particularly high in CBN.

Terpenoids also seem to make a difference to how both THC and CBD behave, and many people report wakeful effects from sativas high in THC that also contain a combination of a high amount of beta-caryophyllene and limonene. Of course, cannabinoids have biphasic effects, meaning that it can have different effects at different dosages. Time also makes a difference, as it’s possible that certain cannabinoid-terpenoid ratios have an “up” and energetic feeling initially followed by a “down” and restful feeling 1 or 2 hours later.

Overall

So, to summarize … Cannabis may increase the chances of actually getting to sleep (the first stage) due to its anxiolytic effects – CBD may be particularly useful in this area, although it should be noted that for some people, CBD can actually promote wakefulness. The second stage of sleep – light sleep – is not hugely affected by cannabis use, whereas more commonly-prescribed medications such as benzodiazepines increase the amount of time spent in light sleep. Alcohol has a similar effect. Cannabis may increase deep and non-rapid eye movement (NREM) sleep duration, but decrease REM sleep duration. Of course, more studies need to be done on how cannabis affects sleep, as there is so much conflicting information in this area. REM (or “dream state” sleep) certainly seems to serve a purpose in terms of how the mind functions (and possibly muscle memory formation), so unless you suffer from debilitating nightmares it may be worth “balancing” out which cannabinoids are used. However, when all the non-medicated ways of treating insomnia don’t work, cannabis could be a safer bet than benzodiazepines, barbiturates and opioids, or self-medicating with alcohol – all of which seem to make insomnia worse in the long-term. Hopefully, better, more thorough answers will be found in the future should the restrictions on cannabis be restricted.

sleep hypnogram; insomnia; sleep graph.
Picture by Razerm. Link: https://en.wikipedia.org/wiki/User:RazerM

If you feel that cannabis could help you, especially if your insomnia is connected to chronic pain, then feel free to make a profile and speak to one of the doctors at Leafwell.

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