How cannabis affects sleep

Sleeping woman (Shutterstock)

Nearly one in three adults in the United States deals with short-term insomnia, while 10% struggle with various chronic sleep disorders.

Many turn to a range of sleep aids to remedy the situation, from pharmaceutical sleeping pills to melatonin. As cannabis becomes accessible in more states and countries, it is also becoming an increasingly popular alternative.

Numerous studies have shown that cannabis can indeed help people with sleep problems, though more thorough randomized controlled trials would solidify the consensus. A complete understanding of exactly how it impacts our sleep schedules has also not been fully developed.

One reason that scientists and doctors still have so many questions about cannabis and sleep lies in our nascent understanding of the endocannabinoid system (ECS), the body’s system of neurotransmitters that helps regulate a number of functions, including sleep stability. Scientists didn’t even know about the ECS until the late 1980s.

That, alongside the long-time prohibitions on medical cannabis research, means that the most definitive statement about cannabis and sleep that science has for us today is — it depends.

What Science Can (and Can’t) Tell Us

A 2017 analysis of the effects of cannabis on sleep, health, and workplace safety concluded that lab studies are unlikely to “reflect the users’ naturalistic experiences of sleep and of cannabis use in the present day” due to the multitude of factors affecting each consumer’s experience.

Studies on specific consumption methods, such as vaping and dabbing, are particularly lacking, the study noted, and absorption rate and bioavailability are both dependent on the consumption method. In the years since the study was published, few new revelations have been made.

But that doesn’t mean there isn’t data available.

While there aren’t many scientific studies that look directly at sleep and cannabis, there are many that nevertheless observed the effects of cannabis on sleep. Such ancillary results are often found in studies on pain management and other conditions where cannabis is being studied as a possible treatment. This is of immense value because insomnia is often a symptom of another condition that may potentially be treated with cannabis.

A 2010 randomized study of 21 people with chronic neuropathic pain found that patients experienced “significant improvements” when consuming three daily doses of 25mg of 9.4% THC cannabis.

Other studies have had less encouraging results. A 2008 study found that higher-THC strains have the ability to lessen the amount of REM sleep. A more recent study, from 2015, determined that regular cannabis use can actually impair sleep.

A 2014 University of Glasgow study of chronic pain expanded its subject pool to 246 patients. Instead of smoking cannabis flower, the research subjects used a sublingual THC/CBD spray during the 15-week, double-blind, placebo-controlled group study. Overall, the researchers found that “a meaningful proportion of otherwise treatment-resistant patients” experienced improvements in their sleep.

A 2006 analysis of rheumatoid arthritis patients using cannabis found that the cannabis-based drug Sativex improved sleep. Data from a 2014 open study of 22 patients indicated that cannabis may improve sleep in Parkinson’s patients as well.

Epilepsy is another condition where cannabis has been reported to help patients. A cannabis study of 190 adults with epilepsy found that 75% of subjects experienced significant improvement in sleep. Indeed, poor sleep or lack of sleep can increase one’s risk of having a seizure.

A 2014 open study of 104 men suffering from posttraumatic stress disorder (PTSD) found that the cannabis-derived drug Nabilone reduced nightmares and other sufferings in patients. “This study supports the promise of nabilone as a safe, effective treatment for concurrent disorders in seriously mentally ill correctional populations,” the researchers found.

Choosing the Right Cannabinoids for You

THC and CBD are just two of at least 140 cannabinoids in the cannabis plant. Each of these cannabinoids reacts differently in the human body. For example, THC and CBD have many similar effects, but CBD does not produce the psychotropic effects that THC does.

A 2017 study of cannabinoids and specific sleep disorders looked at two animal studies using CBD to determine its effects on sleep quality and the sleep-wake cycle. One of the studies found that a higher dose of CBD REM caused increased rapid eye movement (REM) sleep latency, or the time it takes to reach the REM stage of sleep. This effect comes despite cannabis showing the potential to put people in a deeper sleep.

The other animal CBD study reported a decrease in anxiety-induced REM sleep suppression. This effect was credited to CBD blocking such reactions while having no impact on non-rapid eye movement (NREM) stages of sleep, or dreamless sleep. The report also cited various findings to suggest CBD and THC combined may be useful while THC alone, as well as synthetics, decreases sleep latency.

Potential Side Effects

Most of the studies and anecdotal findings suggest that CBD has few to no adverse side effects on patients with sleep issues. Aside from a small number of cases, often with high doses, most people appear to respond well to CBD.

A 2019 case series focusing on the effect of CBD on anxiety and sleep reported that CBD was “well-tolerated” among 72 adults with anxiety issues. In all, two patients left the study after one week, citing fatigue. Another subject reported dry eyes, a common side effect in THC consumption. One patient with a developmental disorder was removed from the study after experiencing increased sexually inappropriate behavior.

A 2018 study of medical cannabis flower and insomnia analyzed 1,056 self-administered reports from 409 patients using the ReleafApp. In 57% of sessions, users reported one or more adverse side effects. On the other hand, 95% reported at least one positive side effect. The study noted that consumers used a variety of cannabis strains with various THC and CBD potencies.

In most cases, adverse side effects resembled that of THC consumption, like dry eyes. Another common side effect was fatigue, which, of course, is, in this case, the desired effect.

Adverse side effects can also occur when combining cannabis with other medications, herbs, supplements, and foods. The US National Library of Medicine published an extensive list of possible interactions with CBD. It also listed a series of medical conditions and symptoms many people use CBD for, noting that insufficient evidence makes it impossible to rate its effectiveness at this time.

“Early research suggests that taking 160 mg of cannabidiol before bed improves sleep time in people with insomnia. However, lower doses do not have this effect,” the report stated, referring to cannabis’ biphasic nature. “Cannabidiol also does not seem to help people fall asleep and might reduce the ability to recall dreams,” the report added.

The Bottom Line

Cannabis has shown the potential to address many sleep issues for patients. Be it a sleep disorder or a symptom of another condition, cannabis appears to help scores of people fall asleep easier.

That said, cannabis is not a one-size-fits-all solution. As some studies suggest, the cannabinoids you consume may drastically alter your outcome. CBD appears to be the more recommended cannabinoid to try, often paired with the intoxicating THC.

A number of other factors, from the strain and consumption method to dose and metabolism, can also influence how you may react to medical marijuana. As such, consult with your physician before using cannabis to treat a sleep disorder or disturbance.

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