Let’s face it, who hasn’t battled insomnia at some point? Insomnia is no fun! Maybe you toss and turn, count sheep, or watch the clock, only to find the sun is coming up, and you haven’t slept. It can make getting through the next day almost unbearable. It sucks you dry of energy, affects your mood, disrupts your ability to concentrated, and if persistent, it can take a toll on your health.
Doctors seem to be a bit too enthusiastic in dispensing prescriptions for popular sleep medications like Ambien, or antianxiety medications like Valium or Xanax. However, these drugs often come with side effects, are habit forming, and can even be addictive.
Many people report using cannabis to help them sleep. But, few states allow doctors to recommend cannabis to treat insomnia. However, other conditions — like chronic pain — are often accompanied by difficulty sleeping. And, many people believe cannabis helps alleviate sleep issues.
But, since insomnia isn’t typically considered an appropriate condition to treat with cannabis, there isn’t a lot of credible information about whether or not cannabis is a safe and efficacious treatment for sleeplessness.
Fear not, we’ve got you covered with the straight facts and latest research on cannabis and insomnia, so you can decide for yourself if cannabis is appropriate to treat those pesky bouts of insomnia.
Let’s start by differentiating between the various forms of insomnia:
What is Insomnia?
Acute insomnia — usually short-term, lasting only a night or two, often triggered by something stressful going on in your life, like looming deadlines or financial concerns.
Chronic insomnia — defined as persistent bouts of sleeplessness occurring three nights or more per week over the course of a month. If this sounds like you, you’re not alone. Chronic insomnia affects more than a billion people across the globe!
Beyond differences between “acute” and “chronic”, insomnia can also be a “primary” or “secondary” condition:
Primary insomnia — a standalone condition not caused by a health condition or disorder.
Secondary insomnia — exists with (and caused by) a health condition or reaction to medication. For example, chronic pain often goes hand in hand with insomnia. Substances like alcohol or prescription medication can also be a source of insomnia.
Age and gender can influence your chances of developing chronic insomnia. Half of seniors report battling insomnia, while women experience insomnia at a rate double that of men.
Insomnia is no laughing matter. Left untreated, it’s not just a nuisance, it can elevate your risk of developing other health conditions including obesity, diabetes, and cardiovascular disease.
What Causes Insomnia?
There are many factors that can bring on insomnia, including:
Mental health issues such as anxiety or depression. These are the most common causes of insomnia
Emotional distress caused by persistent feelings of grief, excessive worrying, anger, and stress.
Medical problems or illness. Many medical conditions and diseases can contribute to insomnia, including asthma, allergies, Parkinson’s disease, hyperthyroidism, acid reflux, kidney disease, and cancer. Chronic pain is also a very common cause of insomnia.
Prescription drugs can disrupt normal sleep cycles. Insomnia is associated with a variety of medications including stimulants used to treat ADHD, antidepressants, blood pressure medication, even over-the-counter drugs like cold or flu medications, and pain relievers (like Excedrin) that contain caffeine.
External stimuli including leaving the television on, sleeping with your computer on or loud noises (like street traffic).
Poor diet and lifestyle choices can also be contributing factors.
Other conditions such restless leg syndrome, circadian rhythm disruptions related to jet lag or late-night work shifts, or sleep apnea.
Treating Insomnia: Start With Lifestyle
There's only so much we can control in our lives. We can prevent every stressful event, but we can find healthy ways to cope with stress. Dr. Mike Hart, the head physician from Marijuana for Trauma in London, Ontario, works with many patients who experience sleep issues. Hart advises patients to make lifestyle adjustments that include increasing physical activity (exercise); eating a healthy, balanced diet; and, practicing meditation and relaxation exercises." "After adopting lifestyle patients, many of my patients still need cannabis to help them sleep, but what I've found is that when they implement my recommendations, they don't need to rely on cannabis as a crutch every night," reports Dr. Hart. "Often, by making lifestyle changes, they need to use cannabis as sleep aid periodically, but not daily."
Hart continues, "Some people dread the thought of going to the gym to exercise, so find something you enjoy that also provides cardiovascular benefits. You can go for a walk around the lake. Play tennis. Swim. Anything to get your heart going."
An added benefit of exercise, notes Hart, is that exercise helps stimulate the production of anandamide, the body's natural cannabinoid that mimics THC. "You've heard of the 'runner's high?' That's anandamide at work!"
Hart provides other tips: "Don't bring media to bed (including your phone, tablet, or television, which overstimulate the brain and make falling asleep difficult. Also, try to create a sleep routine and go to bed at the same time every day." Hart adds, "Seemingly simple changes can have a profound impact on your sleep and help you feel better rested throughout the day."
Hart acknowledges that even after making lifestyle changes, “many people still need a little extra help from a sleep aid like cannabis.” Which Hart believes can be a safer alternative to many prescription drugs.
What’s Wrong With Prescription Sleep Drugs?
Advertisements for sleep medications are in abundance in the media, and many doctors enthusiastically prescribe popular drugs such as Lunesta and Ambien. From 1994 to 2007, the number of prescriptions grew by a factor of 30 times — which was five times more than the increase in insomnia diagnoses during the same period, and 21 times greater than patient complaints. These statistics suggest “Big Pharma” has done a good job of marketing to doctors and the public. But, while these drugs have become increasingly popular, their efficacy and safety have been called into question.
The National Institutes of Health (NIH) found that sleeping pills, on average, only add 11.4 minutes of sleep time, while reducing the time to fall asleep by just 12.8 minutes. Moreover, some of these drugs can come with severe side effects, including "temporary amnesia" (forgetting what happened between taking the medication and it wearing off).
Many people assume that if a doctor prescribes it, it must be safe. However, in recent years we’ve seen a dramatic increase in emergency-room visits from prescription sleep medications, particularly zolpidem, the active ingredient in Ambien®, Ambien CR®, Edluar®, and Zolpimist®.
According to a report conducted by the Department of Health and Human Services’ Substance Abuse and Mental Health Services Administration (SAMHSA), from 2005 to 2010 emergency room visits doubled. Reasons for visits included everything from a bad reaction to the correct dosage to suicide attempts. Just one-third of visits were attributed to patients taking more than the prescribed dosage. Interestingly, women account for two-thirds of patients, despite the fact they don’t make up a significantly greater proportion of consumers.
Similarly disturbing, Ambien, the most popularly prescribed sleep aid, has been associated with what’s been termed, an “Ambien blackout.” Patients have blamed "Ambien blackouts" for “sleepwalking,” "strange behaviors," "abnormal thinking," "sleep eating," “sleep shopping,” and even “sleep driving.”
Other side effects can include nausea, gastrointestinal issues, daytime drowsiness, and feeling "drugged." Many are also known to be habit forming, and can cause withdrawal symptoms upon cessation of use. Reported withdrawal symptoms include insomnia, restlessness, sweating, agitation, anxiety, and depression.
Further, the Department of Health and Human Services report that emergency room visits related to prescription sleep-aids have dramatically increased over the last twenty years.
Benzodiazepines (often called "benzos") -- such as Xanax, Klonopin, and Valium -- are commonly prescribed to treat anxiety, but many physicians also prescribe them for sleep. However, benzodiazepines can be highly addictive, and potentially toxic. In fact, benzodiazepines overdose deaths have soared in recent years, accounting for nearly one in three fatal drug overdoses in 2013, according to the Centers for Disease Control and Prevention (CDC).
Natural supplements including valerian root, chamomile, lemon balm, and melatonin are also popular sleep aids. While presumably safe, only melatonin has high-quality research that suggests efficacy.
How Can Cannabis Help Treat Insomnia?
How many times have you heard cannabis can help you fall asleep? Anecdotally, people have reported using cannabis as a sleep aid for several millennia. You may personally use it to help you sleep. However, few state medical marijuana programs consider insomnia a qualifying condition. But, why not? Unlike the numerous other approved medications, cannabis has few side effects, nor has been responsible for many emergency room visits or a single overdose death.
In fact, research is far more than anecdotal. There have been numerous studies on human subjects that validate what most cannabis users have long known: consuming a little pot before bed makes it easier to fall asleep, and sleep better.
Cannabis can help you fall asleep quicker, longer, and better
As noted, an NIH study that found that when analyzed as a group, popular prescription sleep medications reduce the average time to go to sleep 12.8 minutes, while only increasing sleep time by 11.4 minutes. In contrast, studies going back as far as 1973, found moderate doses of THC significantly decreased the time (up to an hour faster) it takes physically healthy insomniacs to fall asleep. And, once asleep, people experienced fewer sleep interruptions and awakenings through the night (particularly the first half of the night.) Notably, too high of doses were associated with a residual “hangover” feeling the next day, underscoring the importance of finding the right dose (not too much, not too little).
Curiously, the National Institute on Drug Abuse (NIDA) and a Cooperative Research and Development Agreement between Sanofi-Aventis and the National Institutes of Health (NIH) funded a study that showed consuming THC enabled subjects to fall asleep easier and more quickly. And, that next-day feelings of lethargy reported by some subjects was tolerable. Results from the study are especially interesting because Sanofi-Aventis is the maker of Ambien. Most likely, they expected a different outcome.
Enjoy deeper sleep with cannabis
Cannabis can positively impact the sleep cycle. Studies prove THC can increase deep sleep — or slow-wave sleep. Why is this important? Because scientists believe deep sleep plays a vital role in our body’s natural restoration process. That cannabis may promote slow-wave sleep is particularly notable because scientists believe the lack of deep sleep may be the most harmful effect of sleep deprivation, and can be a strong predictor of high blood pressure.
Cannabis can help you breathe better while you sleep
Sure, most of us take breathing for granted — that is, until breathing becomes difficult! And, for the roughly 17% of men and 9% of women who regularly have breathing problems when they sleep (clinically termed, “sleep apnea”) — trying to sleep can become a dreaded activity. Most people with sleep apnea never get diagnosed. But the good news is that early research published in Jan. 2013 by Frontiers in Psychology shows promise that cannabis can help people breathe easier when they sleep. According to the study, THC opens up breathing pathways and “blocks serotonin-induced exacerbation of sleep apnea.”
Who knows? Maybe someday sleep apnea sufferers can swap out their CPAP mask for a THC-infused brownie? But, I doubt Medicare will cover that!
Cannabidiol (CBD) may provide a ‘balancing effect’
Many people report, cannabidiol, better known as CBD, helps them sleep. However, results from studies have provided contradictory results. One study of the (largely) non-psychoactive CBD showed that it was “wake-inducing agent.” Translation: it makes you feel “awake.” True, CBD can be mildly alerting. Cannabidiol activates the same adenosine receptors as caffeine, a stimulant. But several patients with sleep issues report that ingesting a CBD-rich tincture or extract a few hours before bedtime has a balancing effect that facilitates a good night’s sleep. And, in another study of three dosage levels, patients who received 160 mg of CBD reported they slept significantly more than those who received a placebo.
An of CBD subjects receiving 160 mg cannabidiol reported having slept significantly more than those receiving placebo; the volunteers also reported significantly less dream recall; with the three doses of cannabidiol than with placebo.
Finding the Right Strain & Dosage is Important
Dr. Hart, who has also experienced bouts of insomnia, advises patients to find the right ratio of cannabinoids and terpenes. Hopefully, further research will lead to the development of highly effective, individually-targeted insomnia remedies to help patients alleviate stress, sleep longer, and awaken more refreshed.
For now, Hart says we must determine what our individual “subjective therapeutic window” is. Translation: we need to figure out what blend and dosage work best for us. He advises that, if possible, patients should have an open channel of communication with their cannabis care provider to help determine what will work best for their individual situation.
Why is dosage so important?
Too little may be ineffective, while too much may exacerbate the very symptoms you’re trying eliminate. Keep in mind that while THC appears to be safer with far fewer side effects than most prescription medications — and it typically increases initial sleepiness while helping users fall asleep quicker — like many prescription meds, some patients experience a feeling of lethargy the next day. This undesirable potential side effect underscores the importance of finding the right dosage, as the higher the dosage over a patient’s optimum, the more likely they would experience lethargy.
Bottom line: everyone is unique. What works for someone else, may not work for you. Prepare for a little trial-and-error to find the ideal strain. You may find an indica-dense edible that does the trick, or a moderate-dose CBD may work best. Eventually, you’ll find what works best for you!
On cannabis as a sleep aid, Uwe Blesching, PhD, author of The Cannabis Health Index, puts it best: “Cannabis can provide a 100 percent natural approach to managing insomnia free of side effects commonly associated with prescription drugs.”