By: Joseph W. Anderson, CCSH, RPSGT, RST, RPFT, CRT-NPS on April 20th, 2020
Medical Marijuana’s Effect on Sleep
Many states are adopting the use of marijuana for medical purposes even though federal law does not yet support marijuana to be used in this context. Before we discuss its medical use, let’s discuss its use in society both historically and today.
For centuries, the plant we commonly call “marijuana” has been used for a variety of reasons. These reasons can include relaxation or fun, medical purposes, pain management, as a sleeping aid and for a variety of social interactions.
Ancient Hindus in India were against the use of alcohol but accepted social cannabis use. In ancient Rome, wealthy people finished banquets with a cannabis seed dessert that was known for the “good feeling” it caused. At ancient Indian weddings, cannabis (bhang) was served for good luck and as a sign of hospitality. Today, people often use cannabis for specific activities and occasions as well as perceived medical purposes.
Cannabis has a rich history of spiritual use. It is listed as one of the five holy plants in the “Atharvaveda,” a sacred Indian text from the second millennium BCE. The Scythians, who lived in what is now Eastern Europe, used cannabis at funerals to pay respect to departed leaders. Ancient Chinese texts say that cannabis can lighten a person’s body and allow them to communicate with spirits. They actually have been credited with “cannabis” and would throw hemp seeds on hot rocks inside enclosed tents and inhale the smoke.
The Persian prophet Zoroaster (7 BCE) relied on the intoxicating effects of bhang, a cannabis drink, to bridge heaven and earth. Some researchers believe that kannabosm, a plant mentioned in the Old Testament as an ingredient in the sacred anointing oil, was an ancient name for cannabis.
Though social use of marijuana has been occurring for centuries, it was during the 1960s and 1970s when the social use of the plant experienced an explosion in modern culture popularity. This popularity increase is partly attributed to music and social acceptance among the younger population of those decades.
Its use continued through the next several decades but seemed to slow in popularity when employers began drug-screening potential employees and with the increasing popularity of other widely used substances such as cocaine. Cocaine’s water solubility made it less likely to remain in the human system and thereby harder to detect its casual use than marijuana.
In the current decade, the use of marijuana has shown a dramatic increase. This might be contributed to more social acceptance, increased availability, decreased criminalization, medical use and recreational use legalization in some states.
Cannabis has been used medically for thousands of years. In 2700 BCE, Shen Neng, Chinese Emperor and father of Chinese medicine, used cannabis as a remedy for a variety of ailments. The Ebers Papyrus, an ancient Egyptian medical text, also mentions cannabis. It was written in 1500 BCE and is one of the oldest pharmaceutical works known.
Over the past decade, research has focused more on the use of cannabis for medical purposes. Individuals with insomnia tend to use medical cannabis for sleep at a high rate. Use for sleep is particularly common in individuals with PTSD and chronic pain.
When we ask what marijuana, or cannabis, does to our sleep, we are combining two vast unknowns: an insufficiently studied drug and a biological enigma. It is a universally acknowledged truth that marijuana can make you sleepy. Smokers everywhere have long sought to learn exactly why. But this ignores a larger question; namely, how does it alter sleep itself?
We know from studies on alcohol that falling asleep faster doesn’t necessarily correlate to better overall sleep. In fact, the opposite is true: Alcohol tends to disrupt our slumber, as it can cause breathing problems or sleepwalking. So, before we can assume using marijuana is a way to get some shut-eye, let’s consider what it can do to your body and brain after it causes sleep.
The effects of cannabis vary widely depending on the user, the strain, the dose and environmental factors. But the mechanism of its influence is always the same. Common research says marijuana influences the body’s endocannabinoid system, a complex network of receptors sensitive to chemical compounds found in the drug.
Researchers believe the endocannabinoid system plays a role in many of our daily biological functions, from hormonal and immune function to the regulation of appetite and pain. It also mitigates our stress and anxiety responses. You may have noticed that it’s hard to fall asleep if you’re not relaxed. New research suggests that cannabinoid signaling can directly promote sleep.
All this gives scientists hope that we will eventually develop therapeutic drugs that rely on the endocannabinoid system to deliver their physiological benefits. For now, though, marijuana makes use of this fascinating part of our anatomy. And we are just beginning to understand the subtleties of how its cannabinoids can modify our nightly rest.
The first thing to know about marijuana’s impact on sleep is that different cannabinoids have varying effects. The two main chemicals we are concerned with are THC, or tetrahydrocannabinol: the psychoactive ingredient that accounts for the marijuana ”high;” and CBD, or cannabidiol: a non-psychoactive substance increasingly valued for its therapeutic applications.
THC reportedly promotes sleep by activating the endocannabinoid system’s CB1 receptors. It has also been widely reported that THC shortens the period of sleep latency and causes the users to sleep longer. Research also connects THC to an increase in slow-wave sleep, an essential aspect of cerebral restoration and recovery.
Other studies, meanwhile, show that CBD may keep us awake. One study found this cannabinoid to be “wake inducing.” Another concluded that although THC appears to be sedative, CBD appears to have “alerting properties,” as it increased awake activity during sleep and even counteracted the sedative effects of THC.
In a different experiment, rats that received doses of CBD took longer to fall asleep in the daytime but slept more overall and had a slight increase in slow-wave sleep — however, not enough to be statistically significant. Since one consumes both these competing cannabinoids when marijuana is smoked, this could certainly account for mixed results in its confused reputation as a sleep aid.
Whether marijuana ruins your sleep is a subject of more dispute than whether it makes it easier to fall asleep on the couch. What’s less debatable is that both CBD and THC inhibit rapid-eye movement and the duration of REM sleep. Lack of REM sleep can lead to health conditions like migraines, and, as experts, we know REM sleep is crucial for proper rest.
If you speak to someone who has suffered from insomnia at all as an adult, chances are good that person has either tried using marijuana for sleep or has thought about it. This is reflected in the many variations of cannabinoid or cannabis-based medicines available to improve sleep such as Nabilone, Dronabinol and Marinol. Researchers seeking to learn how cannabis affects the sleeping brain have studied volunteers in the sleep laboratory and measured sleep stages and sleep continuity.
It’s also a common reason for many cannabis users to seek medical marijuana cards. While there are still many questions to be answered, existing research suggests the effects of cannabis on sleep may depend on many factors, including: individual differences, cannabis concentrations and frequency of use. Marijuana is the most common form of cannabis available in the United States and can vary widely in potency from less than 1% to 20%.
United States of Marijuana
Some studies showed that users’ ability to fall and stay asleep improves. A small number of subjects also had a slight increase in slow wave sleep. However, once nightly cannabis use stops, sleep clearly worsens across the withdrawal period. This research suggests that, while motivation to use cannabis for sleep is high, and might initially be beneficial to sleep, these improvements might wane with chronic use over time.
Interestingly, when controlling for the presence of anxiety and depression, the differences disappeared. This suggests that cannabis’s effect on sleep may differ depending on whether you have depression or anxiety. In other words, if you have depression, cannabis may help you sleep, but if you don’t, cannabis may hurt. One recent study showed the frequency of use seems to be an important factor as it relates to the effects on sleep. Thirty-nine percent of daily users complained of clinically significant insomnia. Meanwhile, only 10% of occasional users had insomnia complaints.
Cannabis is still a Schedule I substance, meaning that the government does not consider cannabis to be medically therapeutic due to lack of research to support its benefits. This creates a barrier to research. Few universities in the country are permitted by the National Institute of Drug Abuse to grow marijuana for research. One university that is approved is the University of Mississippi. This is expected to change.
New areas for exploration in the field of cannabis research might examine how various cannabis subspecies influence sleep and how this may differ among individuals. Research groups have been exploring cannabis types or cannabinoid concentrations that are preferable depending on one’s sleep disturbance. For example, one strain might relieve insomnia, while another can affect nightmares. Other studies suggest that medical cannabis users with insomnia tend to prefer higher concentrations of cannabidiol, a non-intoxicating ingredient in cannabis.
This raises an important question: Should the medical community communicate these findings to patients with insomnia who inquire about medical cannabis? Some health professionals (and some of you reading this article) may not feel comfortable due to the fluctuating legal status, a lack of confidence in the state of the science or personal opinion. At this point, cannabis’ effect on sleep seems highly variable, depending on the person, the timing of use, the cannabis type and concentration, mode of ingestion and other factors. Perhaps the future will yield more fruitful discoveries.
RTSleepWorld Vendor News on June 21, 2018, reported: “Melbourne, Australia-based nasal respiratory company Rhinomed is pleased to advise investors that it has signed a non-binding term sheet with Columbia Care LLC (“Columbia Care”) to license Rhinomed’s nasal platform for the delivery of medical cannabis and cannabinoid compounds, analogs and derivatives.”
All of this is to say: While many people do swear by marijuana as a way to get a good night’s sleep, they may not be getting the kind of rest they need. As with every topic in marijuana science, the matter of its effect on sleep is still up for debate, thanks in part to federal prohibition.
This article was originally featured in the A2Zzz Magazine Q3 2019 Issue