Cannabis and its relationship to sleep continues to be an area of focused interest for researchers. Cannabinoids appear to improve sleep in some cases, but not others. This leaves patients who struggle with insomnia to wonder if medical marijuana could help them sleep better.
Though sleep needs vary depending on genetics, most adults still fall in the seven-to-nine-hour range. Especially when battling other conditions like chronic pain, PTSD, or cancer, getting restorative sleep at night can be challenging. Lifestyle habits like poor diet, alcohol and caffeine consumption can negatively affect sleep, as can certain medications. It’s a common misconception that older adults don’t need as much sleep as they did when they were younger. Older adults should still aim for at least seven hours.
How Have Sleep Disorders Been Treated Historically?
It may be surprising to learn that humans haven’t always slept for eight hours straight. In The Odyssey, Homer refers to the intermission between two periods of sleep, a time for people to quietly socialize, play music, relax, have sex or do nothing. The original biphasic sleep schedule split sleep into two segments during the night. People would have their first sleep around 9 p.m. or 10 p.m., wake up around midnight for an hour or two, and then have their second sleep after that.
And as we understand it, people slept in two shifts like that for centuries. But, then the Industrial Revolution and artificial light came along and curtailed our sleep requirements to eight hours of continuous sleep each night. And it certainly affected people from the start.
Historically, drugs such as morphine, alcohol, and barbiturates were used to treat sleep disorders. In 1903, the first sleeping pill, barbital, hit the market. Within 30 years, it had become one of the most abused drugs in the United States. Back then, cannabis could be used to treat insomnia too, prior to its prohibition in 1937.
By the 1970s came the publication of Sleep, the first peer-reviewed medical journal devoted to sleep, and by the ’90s, there were over 200 sleep labs and centers to treat sleep disorders in the U.S.
Currently, three classes of medications have FDA approval for treating sleep disorders: benzodiazepines, barbiturates, and the newest class of non-benzodiazipine hypnotic medications like zolpidem, zaleplon, and eszopiclone. All have significant adverse side effects, including dependence, serious withdrawal, and complex sleep-related behaviors.
The Stages of Sleep
As the body sleeps, the brain cycles through four stages of sleep. Stages 1 to 3 are what’s considered non-rapid eye movement (NREM) sleep, also known as quiet sleep. Stage 4 is rapid eye movement (REM) sleep, also known as active sleep or paradoxical sleep.
REM sleep is characterized by dreaming and the absence of motor function with the exception of the eye muscles and the diaphragm. It occurs cyclically several times during sleep.
Most dreaming occurs during REM sleep. During the REM sleep stage, brain activity ramps up considerably compared to the non-REM stages, which helps explain the distinct types of dreaming during these stages. REM sleep can involve vivid, fantastical, and/or bizarre dreams, even though they may involve elements of waking life.
How Does Cannabis Interact With Sleep?
Research has measured what people have known and experienced since ancient times– that cannabis has relaxing and sedative effects. Sleep-promoting effects of cannabinoids may be due to their interactions with cannabinoid receptors in the brain. When cannabinoids bind to these receptors, they send messages to increase levels of sleep-promoting adenosine levels and suppress the brain’s arousal system. Together, these effects may help cannabis users feel sedated or sleepy.
A 2011 focused retrospective analysis of data previously collected from a cohort of 166 patients in a cannabis-oriented practice in California found that patients reported that they fell asleep more easily with cannabis, whether or not they had insomnia.
A 2018 study conducted on insomnia sufferers found that participants reported relief from their symptoms when using cannabis flower. This study follows our current understanding of the plant; flower from sativa plants were associated with more negative side effects pertaining to sleep than flower from indica or hybrid plants. The study concluded that consumption of cannabis flower caused participants to report significant improvements in insomnia with differential effectiveness and side effect profiles, depending on the product characteristics.
CBD, CBN & Terpenes
CBD interacts with the body’s endocannabinoid system to help it achieve balance and regulate its normal functions. It might slow the breakdown of anandamide, a lipid mediator that acts as an endogenous ligand of CB1 receptors. CBD has also shown to be great for helping to reduce stress and discomfort from normal inflammation– two issues that make it difficult to fall asleep.
While much of the focus has been on CBD, more than 100 cannabinoids may also play into how cannabis helps aid in sleep. Cannabinol (CBN), a less well-known cannabinoid than CBD appears to have powerful sedative effects. These effects may be enhanced when it’s combined with THC (known as the entourage effect). CBN is found in aged cannabis, when, over time, THC converts naturally to CBN.
Cannabinoids possess potential benefits for sleep as well as other health issues. But terpenes also appear to play a pretty significant role in the effects of cannabis, including its ability to affect sleep. Myrcene, Carophelline, and Limonene, Terpineol, and Linalool are all known to have sedative properties.
Strains with higher levels of THC could reduce the amount of REM sleep you get. Reducing REM sleep means reducing dreams. Scientists theorize that when you spend less time dreaming, you’ll spend more time in a “deep sleep” state. Scientists believe the deep sleep state is the most restorative, restful part of the sleep cycle.
For those who experience Post Traumatic Stress Disorder (PTSD), THC could reduce nightmares enough to get a restful night of sleep. However, some studies have found that while THC may have short-term sleep benefits, daily use could worsen your sleep quality. Higher THC levels could impair your sleep quality if taken long term.
While THC typically acts as a sedative, it can have a stimulating effect for some people, especially for those who are new to using cannabis. In these cases, using cannabis before bed may result in a longer time falling asleep, so patients should start low and go slow with their THC ratio when testing out its effect on sleep.
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