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, we write about cannabis’s use as a sedative in our study as well.
So, why is cannabis such an effective sleep instigator? 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, due to THC’s stimulating effects, it may actually cause an initial phase of wakefulness, followed by sleepiness. Therefore, high THC alone is likely not the answer to getting to sleep, and having the right balance of CBD and terpenoids may also be more effective in helping a person get to sleep. Please check out our study and 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.
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. However, such drugs 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.
Furthermore, withdrawal from these 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, 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.
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. 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. However, when all the non-medicated ways of treating insomnia don’t work, it seems 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.