Insomnia is a disorder characterized by difficulty in either falling asleep or staying asleep. While many adults experience short-term insomnia at various times in their lives, about 15 percent of adults are estimated to suffer chronic insomnia symptoms.
Patients frequently report consuming cannabis products as sleep aids[1-3] or as a substitute for conventional sleep medications.[4-5] Patients also frequently self-report using CBD products to improve sleep quality.[6]
Several studies identify an association between nighttime cannabis use and perceived reductions in insomnia severity. In 2018, University of New Mexico researchers assessed the influence of marijuana use on self-perceived insomnia severity levels in 409 subjects. Study participants recorded real-time ratings of their symptom severity on a zero to 10-point scale using a mobile software application. Authors reported that subjects “experienced a statistically and clinically significant improvement (-4.5 points on a zero to 10-point scale) in perceived insomnia levels.”[7]
A 2021 study utilizing similar methods reported comparable results. Canadian investigators assessed cannabis use trends in 991 subjects with self-reported insomnia. Researchers reported: “Results from this large naturalistic sample of medicinal cannabis users who tracked their insomnia symptoms before and after cannabis use suggest significant improvements in insomnia symptoms. … This general perceived improvement in insomnia symptoms highlights the potential for cannabis to be used as a treatment option for sleep disorders.”[8]
The results of a 2022 study involving 677 subjects reported similar results, concluding, “This naturalistic investigation of cannabis use for insomnia suggests that individuals with depression, anxiety, and comorbid depression and anxiety perceive benefits from using cannabis for sleep.”[9]
Observational trials similarly documented that patients with insomnia and other sleep disorders report improvements following the use of cannabis. A 2020 Israeli trial of 128 patients “showed that MC [medical cannabis] patients were less likely to report problems with staying asleep compared with non-MC patients, independently of potential confounders. … This suggests that MC may have a sleep-promoting characteristic in terms of minimizing awakenings during the night. … These findings may have large public health impacts considering the aging of the population, the relatively high prevalence of sleep problems in this population along with increasing use of MC.”[10]
In a 2022 study, 71 percent of subjects reported improvements in their sleep following the use of cannabis. Moreover, 39 percent of the study’s subjects were able to either “completely discontinue [their use of] insomnia medications or reduce their use from nightly administration to as-needed administration with the use of medical cannabis.”[11]
Clinical trial data assessing the use of oral cannabinoids for insomnia treatment have also yielded favorable results. A 2020 review paper of five studies involving 219 total subjects highlighted the “potential promise of cannabis-based products in the treatment of insomnia disorder.”[12]
A 2022 trial assessed the short-term administration of a sublingual compound consisting of 15mgs of melatonin and 2.5mgs of plant-derived CBD in a cohort of middle-aged to older adults (ages 43 to 96) with a history of sleep disorders and anxiety. Study participants self-administered 20 drops of the compound prior to bedtime for a three-month period. Researchers reported that CBD/melatonin co-administration was associated with reduced feelings of anxiety, pain, depression, panic, and paranoia, as well as with “good general health perceptions.”
They concluded, “These data suggest that the formula CBD-melatonin could be competitive with the classic hypnotic synthetic drugs; the antioxidant activity of melatonin offers a further benefit to the brain network, restoring the biological clock functions, while CBD, reducing chronic pain perception, helps to complete the neuromuscular relaxation and to relieve anxiety fulfilling a very balanced sensation of well-being during the sleep.”[13]
The results of a recent placebo-controlled trial from Australia also concluded that the use of plant-derived cannabis extracts is safe and effective in patients with chronic insomnia. Compared to patients using a placebo, subjects who consumed cannabis extracts experienced “significantly lower” Insomnia Severity Index scores. Investigators concluded: “This study has demonstrated that … a novel cannabinoid therapy, is well tolerated and improves insomnia symptoms and sleep quality in individuals with chronic insomnia symptoms.”[14]
Similar results were most recently reported in another placebo-controlled trial involving 29 patients diagnosed with clinical insomnia. In that study, the use of plant-derived cannabis oils containing 10mg THC and 15mg CBD improved symptoms in participants by up to 80 percent. Sixty percent of subjects were no longer classified as clinical insomniacs following the conclusion of the two-week trial. Authors concluded, “[M]edicinal cannabis oil was well tolerated and effective in improving sleep in adults with insomnia.”[15]
REFERENCES
[1] Azcarate et al. 2020. Medical reasons for marijuana use, forms of use, and patient perceptions of physician attitudes among the US population. Journal of General Internal Medicine 35: 1979-1986.
[2] Asselin et al. 2022. A description of self-medication with cannabis among adults with legal access to cannabis in Quebec, Canada. Journal of Cannabis Research [open access journal].
[3] Leung et al. 2022. Prevalence and self-reported reasons of cannabis use for medical purposes in USA and Canada. Psychopharmacology 239: 1509-1519.
[4] Doremus et al. 2019. Using recreational cannabis to treat insomnia: Evidence from over-the-counter sleep aid sales in Colorado. Complimentary Therapies in Medicine 47 [E-pub].
[5] Raman and Bradford. 2022. Recreational cannabis legalization’s associated with reductions in prescription drug utilization among Medicaid enrollees. Health Economics 31: 1513-1521.
[6] Shannon et al. 2019. Cannabidiol in anxiety and sleep: A large case series. The Permanente Journal 23: 18-41.
[7] Vigil et al. 2018. Effectiveness of raw, natural medical cannabis flower for treating insomnia under naturalistic conditions. Medicines [open access journal].
[8] Kuhathasen et al. 2021. The use of cannabinoids for insomnia in daily life: A naturalistic study. Journal of Medical Internet Research 23 [E-pub].
[9] Kuhathasen et al. 2022. An investigation of cannabis use for insomnia, depression, and anxiety in a naturalistic sample. BMC Psychiatry 22 [E-pub].
[10] Sznitman et al. 2020. Medical cannabis and insomnia in older adults with chronic pain: A cross-sectional study. BMJ Supportive and Palliative Care 10 [open access journal].
[11] Vaillancourt et al. 2022. Cannabis use in patients with insomnia and sleep disorders: Retrospective chart review. Canadian Journal of Pharmacy 15: 175-180.
[12] Bhagavan et al. 2020. Cannabinoids in the treatment of insomnia disorder: A systematic review and meta-analysis. CNS Drugs 34: 1217-1228.
[13] Palmieri et al. 2022. Insomnia treatment: A new multitasking natural compound based on melatonin and cannabis extracts. La Clinica Therapeutica 173: 91-96.
[14] Walsh et al. 2021. Treating insomnia symptoms with medicinal cannabis: A randomized, cross-over trial of the efficacy of a cannabinoid medicine compared with placebo. Sleep 44 [E-pub].
[15] Ried et al. 2022. Medicinal cannabis improves sleep in adults with insomnia: A randomized double-blind placebo-controlled crossover trial. Journal of Sleep Research [open access journal].