Deepening
Cannabis and insomnia have been the subject of extensive studies over the past few decades. Knowledge about the endocannabinoid system, receptors, and various phytocannabinoids has allowed us to draw increasingly convincing conclusions about the therapeutic profile of these substances in various cases of insomnia.
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What is insomnia – Introduction
Insomnia is the difficulty or inability to fall asleep or stay asleep. It can occur both as a primary disorder and as a symptom associated with various health issues such as depression, cancer, and other diseases marked by physical pain. We refer to “initial insomnia” when there is difficulty falling asleep, “central insomnia” when sleep is not continuous and the subject is disturbed by continuous awakenings, and “terminal insomnia” when awakening occurs early in the morning. The duration of insomnia is also classified, and therefore, based on the duration of the disorder, we can distinguish:
- occasional insomnia which usually lasts a few days and is related to the presence of particular factors such as illness states, anxiety, noise, inadequate ambient temperature, jet lag, etc.
- transient insomnia when the subject complains of the disorder for a period of up to three weeks;
- chronic insomnia when the disorder persists over time.
The factors that can influence the quantity and quality of sleep are numerous and varied; sometimes the origin of insomnia can be attributed to a single cause, while at other times multiple reasons contribute to the onset of the disorder. Sleep mechanisms are sensitive to the influence of psychological factors such as emotional tension, family concerns, economic problems, which cause anxiety and stress; sometimes the cause of insomnia is due to the presence of environmental factors related, for example, to altitude sickness or jet lag. When the disorder occurs in a healthy subject where the presence of known diseases is not recognizable, it is referred to as primary insomnia; when, on the other hand, the alteration of sleep mechanisms is related to the presence of specific pathologies, insomnia is defined as secondary. In fact, some physical dysfunctions or diseases such as liver, respiratory, gastrointestinal, cardiac disorders, as well as depression, neurological and psychiatric disorders of various types can be the main causes of sleep disturbances.
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Cannabis and insomnia
From Pliny the Elder in his “Naturalis Historia” and later as we also covered in our article: “Cannabis in Ancient Texts”, the association of medical cannabis with its sedative effect has always been known.
CBD, a metabolite present in medical cannabis, has the ability to modulate a receptor, serotonin 5-HT, to achieve antidepressant, anxiolytic, and neuroprotective effects. CBD therefore facilitates sleep as it promotes relaxation.
Since 1975, the year we recorded the first study conducted on the combination of cannabis and insomnia, the need to analyze it through increasingly sophisticated studies has grown to this day.
Below is a series of studies conducted since 1975.
Cannabis and insomnia, studies and reviews from ’75 to today
1975 — Feinberg I et al. — LINK
Effects of high-dose delta-9-tetrahydrocannabinol on sleep habits in humans
Placebo-controlled human trial
Conclusions “The administration of THC significantly reduced eye movement activity during REM sleep and, to a lesser extent, the duration of the same paradoxical phase.”
1976 — Feinberg I et al. — LINK
Effects of marijuana extract and tetrahydrocannabinol on electroencephalographic sleep habits
Human trial using nearly pure THC and full-spectrum cannabis material
Conclusions “The marijuana extract, administered in daily doses containing 70 to 210 mg of delta-9-tetrahydrocannabinol (THC), induced effects on sleep practically identical to those produced from the same doses of relatively pure THC (96%). Both drugs reduce the density of eye movements with some tolerance developing in this regard. The effects of THC administration on sleep are very similar to those induced by lithium.”
1981 — Pgs E. A, Cunha JM — LINK
Hypnotic and anti-epileptic effects of cannabidiol
Placebo-controlled crossover human trial
Conclusions “Subjects receiving 160 mg of cannabidiol reported significantly more sleep than those treated with placebo; volunteers also reported significantly lower dream recall, with all three doses of cannabidiol compared to placebo. Fifteen patients with refractory secondary generalized epilepsy received 200 to 300 mg of cannabidiol per day or a placebo for 4.5 months. Seven of the eight epileptics who received cannabidiol experienced improvement in their pathological condition, while only one patient on placebo improved.”
1982 — Freemon F.R — LINKS
Effect of chronically administered delta-9-tetrahydrocannabinol on normal sleep of volunteers monitored by polygraph
Placebo human trial
Conclusions “From about a week of THC administration and continuing for a week after drug withdrawal, there was a marked decrease in the type of sleep associated with slow waves in the electroencephalogram, in stages 3 and 4 of non-REM sleep. The fact that prolonged but non-acute use suppresses slow-wave sleep indicates that this commonly used drug produces a poorly understood change in brain physiology.”
1998 — Murillo-Rodriguez E. et al. — LINK
Anandamide modulates sleep and memory in rats
Conclusions “Anandamide significantly increases slow-wave sleep and REM sleep at the expense of wakefulness.”
2004 — Nicholson A.N et al. — LINK
Effect of delta-9-tetrahydrocannabinol and cannabidiol on nocturnal sleep and morning behavior in young adults
Double-blind, placebo-controlled 4-way crossover study
Conclusions “THC appears to have sedative effects. CBD, on the other hand, seems to have some properties capable of promoting alertness. With the concomitant administration of THC and CBD, stage 3 sleep decreased, and with a combination of higher doses (15 mg of THC and 15 mg of CBD), wake time increased. With a combination of lower doses (5 mg of THC and 5 mg of CBD), there were no changes in mood, drowsiness, fatigue, or performance the next morning. With the combination of higher doses (15 mg of THC and 15 mg of CBD), subjects reported increased drowsiness accompanied by fatigue and mood changes.”
2005 — Swift W, Gates P, Dillon P — LINK
Survey of Australians consuming cannabis for medical purposes
Survey conducted among 128 patients receiving cannabinoids
Conclusions “Cannabis was perceived as a ‘great relief’ overall, including for arthritic pain, depression, chronic pain, persistent nausea, and insomnia. Cannabis was also generally perceived as superior to other drugs in terms of side effects and the extent of relief it provided.”
2013 — Gorelick D.A et al. — LINK
Effects (24/7) of orally administered THC on the sleep of chronic cannabis smokers (men)
Human trial conducted on 13 young men
Conclusions “Higher concentrations of THC in the evening and 11-OH-THC (active metabolite) were significantly associated with shorter sleep latency, decreased difficulty falling asleep, and increased sleep the next day.”
2014 — Murillo-Rodríguez E et al. — LINK
Potential effects of cannabidiol as a wakefulness promoter
Conclusions “It may be plausible to consider using CBD to explore its medical properties in cases of drowsiness. This review examines the pharmacological evidence of CBD’s effects on sleep modulation and provides a presumed mechanism of action. To better understand the molecular and neuroanatomical mechanism by which CBD regulates sleep, this subject should be further explored.”
2016 — Gruber S.A. et al. — LINKS
Shining in the grass? A pilot study assessing the impact of medical marijuana on executive function
A survey of 11 patients receiving medical cannabis
Conclusions “The results suggest that, in general, patients receiving medical marijuana (MMJ) experienced improvements in measures of executive functioning, including Stroop color words and tracking tests, primarily by completing tasks faster without loss of accuracy. In self-assessment questionnaires, patients also reported moderate improvement in clinical status, including reduced sleep disturbances, decreased depression symptoms, mitigated impulsivity, and positive changes in some aspects of quality of life. Additionally, patients reported a significant reduction in their use of conventional pharmaceutical agents compared to baseline, with opioid consumption decreasing by over 42%. Although interesting, these results are preliminary and warrant further study at additional time points and larger samples.”
2016 — Shannon S, Opila-Lehman J — LINK
Efficacy of cannabidiol oil for pediatric anxiety and insomnia in PTSD: a case report
Case study of a pediatric patient with PTSD following sexual assault
Conclusions “This case study provides clinical data supporting the use of cannabidiol oil as a safe treatment to reduce anxiety and improve sleep in a girl suffering from post-traumatic stress disorder.”
2017 — Keith D.R et al. — LINK
Smoked marijuana reduces performance and mood disturbances during a simulated night shift
Placebo-controlled human trial involving ten experienced marijuana smokers
Conclusions “Marijuana mitigated some performance, mood, and sleep disturbances: participants performed better on vigilance tasks, reported being less unhappy and fatigued, and slept more minutes. These data show that sudden changes in shift work lead to deficits in performance, mood, and sleep during night work, and that smoked marijuana, containing low to moderate concentrations of Δ9-THC, may offset some of these effects in frequent marijuana smokers.”
2017 — Piper B.J et al. — LINK
Replacing medical cannabis with pharmaceutical agents for pain, anxiety, and sleep relief
A survey conducted among 1513 members of the New England Dispensary
Conclusions “About two-thirds of patients reduced their use of anti-anxiety medications (71.8%), migraine medications (66.7%), and sleep medications (65.2%) after consuming medical cannabis. In conclusion, most patients reported consuming fewer opioids and fewer medications to treat anxiety, migraines, and sleep after starting to consume medical cannabis. A smaller portion consumed less antidepressants or alcohol.”
Conclusions
All these results must be interpreted with great caution; randomized controlled trials are still necessary to provide definitive clinical guidance. It is important to emphasize that to date, the main advantage of cannabis as a form of treatment is safety. No cases of cannabinoid overdose have been reported, and additional complications are limited.
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