How Does Cannabis Affect Sleep?

In a recent voluntary survey of adult cannabis users, 74 percent of respondents reported using cannabis as a sleep aid. The survey, published in the Journal of Psychoactive Drugs, found that of those using cannabis to promote sleep, 84 percent found it extremely helpful. Those respondents found it so useful that 87 percent reported reducing or stopping taking over-the-counter sleep aids and 83 percent said they stopped taking prescription sleep aids.

But do other medical studies support this enthusiasm? In this article, we take a look at the latest and most comprehensive research regarding using cannabis for sleep.

Cannabis in the U.S.: a recent change in status

In the last decade public support for the legalisation of cannabis has risen drastically, some states legalised the use of cannabis for both medical and recreational purposes, and Americans began to shed the stigmas and stereotypes about those who avail themselves of the drug.

Cannabis is now also used by retirees, and high-performing professionals, and veterans who may have no interest in getting high but want to sleep soundly and without pain.

In addition to the rise in medical and recreational cannabis, CBD oil is gaining popularity. Derived from the hemp plant, CBD oil contains little to no THC (tetrahydrocannabinol), which is responsible for the “high” cannabis produces. CBD oil is popular among people with health issues such as anxiety, epilepsy, pain, and sleep disorders.

According to The Pew Research Center, Americans favouring legalisation of cannabis outnumber those against it and continue to rise. Sixty-one percent of U.S. adults say the use of cannabis should be made legal, while 34 percent say it should be illegal — a reversal from just a decade ago. The support transcends political party and age group affiliations.

In 2018, 48 percent of Americans over the age of 18 reported using cannabis at some point in their lifetime. Sixteen percent said they’ve used cannabis within the past year. About seven in ten Americans believe that alcohol is more harmful than cannabis. With cannabis’s newfound respectability on the rise, cannabis use has increasingly become the subject of research.

In additional to the general population’s opinion about cannabis changing, legislation is changing, too. Recreational cannabis use is now legal in 11 states and the District of Columbia.

• Alaska
• California
• Colorado
• Illinois
• Maine
• Massachusetts
• Michigan
• Nevada
• Oregon
• Vermont
• Washington

Cannabis for medical use is legal in 33 states. Some states require a doctor’s recommendation for the use of cannabis while others states have imposed a limit to the level of THC allowed. Federally, cannabis is listed as a Schedule I controlled substance.

Economic impacts

The economic impacts of both cannabis and CBD are significant. Colorado legalised recreational cannabis in 2014 and since then sales have totalled over $6.5 billion. Taxes, licensing, and fees from the sale of cannabis has generated over $1.02 billion in tax revenue in that state since legalisation. In Colorado alone, over 41,000 licensed individuals work in the cannabis industry. Washington state collected more than $120 million in recreational cannabis excise tax in the 2018 fiscal year.

Similar trends are present in the CBD industry. Some reports estimate the industry was worth $390 million in 2018, doubling its value over the past three years. Growing hemp in the U.S. became legal in the 2018 Farm Bill, which could prove to be a large economic benefit to farmersacross the county. NPR reports one kilogram of purified CBD sells for about $6,000.

Obstacles to the study of cannabis and sleep

The users’ enthusiasm and the public’s support for cannabis notwithstanding, it has not been easy for scientists to study the effects of cannabis. It is so because legally, institutionally, and culturally embedded reservations remain.

While more space for serious, scientifically based conversation about the benefits and downsides of cannabis — including the use of cannabis for sleep — has opened up, we cannot underestimate the difficulties that federal regulations continue to pose.

Criminality at the federal level

Cannabis is still a Schedule I controlled substance, in the same category as heroin and LSD. The American Medical Association urged the government to reclassify cannabis so that trials can be conducted more easily.

Supplier paucity

Scientists and other critics also claim that the federal government is still ill-prepared to conduct meaningful cannabis studies. “Due to federal prohibition and regulations, all of the cannabis used for US research is provided by one facility at the University of Mississippi through the National Institute on Drug Abuse (NIDA),” write journalists at Vox.

“But researchers have complained for years that the quality of cannabis that NIDA supplies is terrible—typically far below what you can get from state-legal medical or recreational cannabis markets or even the black market.”

Poor sample quality

Researchers tasked with studying cannabis’s effects have been vocal about their frustration with the strength of the samples. The federally provided sample “doesn’t resemble cannabis — it doesn’t smell like cannabis,” lamented researcher Sue Sisley, who conducted a federally sponsored study about the effectiveness of cannabis as treatment for veterans with PTSD in February of 2019.

She said the cannabis she was provided with was, “generic batches of mouldy, green powder full of stems, sticks, and leaves.”

The potency of the federally provided samples that she and many other researchers report having received did not match the strength that they requested. “It’s unclear whether mould, lead or discrepancies in potency has been a problem in prior cannabis studies, because until now, it appears that no one looked,” PBS NewsHour notes in it March 2017 investigation.

In 2014, only six percent of studies on cannabis analysed its medicinal properties. In August of 2016, the DEA announced it would permit additional growers to register as producers qualified to provide cannabis for research purposes. Over 30 organisations applied for the license, with the DEA processing and accepting one application. In August of 2019, the organisation said it will begin processing the other applications.

Federal approval for clinical trials

Given the federal status of cannabis as a Schedule ? controlled substance and the supplier scarcity, clinical trials to study cannabis’s impact on humans is a lengthy procedure that can take years to gain approval, or more often denial.

To gain approval of a clinical trial involving cannabis approval first needs to come from the FDA through its Investigational New Drug (IND) Application. The study then needs to be registered and approved by the DEA. After that approval, the study must arrange with NIDA to gain access to the sample cannabis. Applications can fail in the initial IND application which requires specifics, which are difficult to define when studying a whole plant that can have natural variations.

Why talk about these limitations? They need to be kept in mind when we look into the results of the studies regarding cannabis’s use, including our focus here: the use of cannabis or CBD for sleep. Unlike with other, fully legal drugs and means to fall asleep, in the case of cannabis’s use to induce restful slumber, the answers that the medical field has so far provided are partial, often contradictory, lacking clear takeaways, and limited.

Doctors and researchers are confused, too. “Clinicians,” notes the American Thoracic Society’s cannabis workgroup, “and in particular pulmonary, critical care, and sleep physicians, although called on to make important clinical judgments on behalf of patients using cannabis, are no less subject to the confusion and politicisation surrounding the topic.” More robust, peer-reviewed, longitudinal research is needed.

Variations at the producer and consumer levels

Add to all this other complicating caveats: the effects of cannabis can vary greatly from person to person. A piece of dark chocolate containing CBD, THC, or both might relax and induce sleepiness for one person, but it might provoke another to excessive chattiness or rumination. It is also true that producers and distributors of cannabis, where it is legal, are still tweaking the dosage and predictability of various edibles, tinctures, and the weed for smoking.

Dosing and effects for both cannabis and CBD can vary heavily depending on the individual and ingestion method. Edibles, for example, take much longer for the body to process and can therefore be felt for a longer period of time. Topical CBD products will produce a different effect than taking CBD oil.

With advancing regulation and quality control, much progress has already been made in states where both medical and recreational cannabis is legal, like Colorado, Washington, and Oregon.

CBD and the FDA

The 2018 Farm Bill removed hemp from the definition of cannabis in the Controlled Substance Act. This opens the gates for growers to farm hemp to produce CBD. With the exception of one prescription drug used to treat rare forms of epilepsy, the FDA has not approved any other product containing CBD. Currently, the FDA has not studied any short or long term impacts CBD has on the human body, if any exist.

Most companies making CBD products conduct quality assurance tests through third-party labs. However, quality, potency, and purity could vary between producers.

What science tells us regarding cannabis’s effect on sleep

While difficulties with obtaining robust samples and studies persist, researchers have reached some conclusions, some of them contested and tentative, regarding cannabis and sleep. Here are the most important ones:

Cannabis is 114 times safer than alcohol and cigarettes

The risk of mortality that weed causes is extremely low. The findings were published in a 2015 issue of the journal Scientific Reports, which is a subsidiary of Nature.

Smoking cannabis poses some risks

The American Cancer Society cautions that along with THC and other cannabinoids, smoked cannabis delivers “harmful substances to users and those close by, including many of the same substances found in tobacco smoke.” The American Lung Association notes that cannabis smokers “tend to inhale more deeply and hold their breath longer than cigarette smokers, which leads to greater exposure per breath to tar.”

Edibles, tinctures, and oils do not pose those risks, but it’s worth keeping in mind that they can take longer to take effect — anywhere between 45 minutes to three hours. Ingestibles stay in the system longer than smoked cannabis, which activates and dissipates more quickly.

Cannabis may combat anxiety, but it can also provoke it

As we’ve established at the beginning of the article, many people report reaching for cannabis in order to calm anxiety and in order to fall asleep. cannabis contains THC (delta-9-tetrahydrocannabinol) and cannabidiol (CBD).“The paradox of cannabis both inducing and relieving anxiety is reconciled by understanding that effects on anxiety levels are dose-dependent,” according to a scientific review of cannabis and anxiety.

The Harvard-based authors of the same publication, “Medical cannabis and the Mind,” say that CBD appears to interact with the more high-producing THC to result in sedation and that it may have independently “anti-inflammatory, neuroprotective, or antipsychotic effects, although the research is too preliminary to be applied clinically.”

While a high dose taken by the unprepared might result in anxiety or even psychosis (the extreme results of a high), it is “not yet known whether cannabis increases the risk of developing a persistent anxiety disorder.” While it is true that many people who smoke cannabis have anxiety, the authors of the Harvard statement say that this is likely due to selection bias — meaning that anxious individuals are more likely to seek out cannabis, rather than cannabis causing the anxiety.

The power of cannabis to induce sleep has been confirmed by a number of studies

The Journal of Psychoactive Drugs published a study in early 2019 that examined the use of cannabis to promote sleep and relieve pain.In the study, 74 percent of participants were using cannabis as a sleep aid while 65 percent were using it to relieve pain. Of those taking cannabis as a sleep aid, 84 percent found it very helpful and over 8 percent reported reducing or stopping taking over-the-counter or prescription sleep aids.

A review of clinical trial data of the cannabis-based medicines containing primarily THC, CBD, and a 1:1 combination of the two published in the journal Chemistry & Biodiversity noted “a mild activating effect of CBD, and slight residual sedation with TCH-predominant extracts.” Authors remarked that most of the 2000 subjects that took cannabis extracts in clinical trials demonstrated “marked improvement in subjective sleep parameters.”In a Canadian study of 104 HIV-positive adults, two thirds endorsed the use of cannabis for sleep, among other benefits.

Some studies, including the 2016 one from Boston University’s School of Public Health, appear to contradict these conclusions, noting that cannabis contributes to the lowering of sleep’s quality. But it may be that self-selection bias is part of the picture: people who smoke cannabis tend to do so because they are anxious.

“Study participants who didn’t smoke every day usually smoked in the evening,” said one of the lead researchers. “But once you’re smoking multiple times a day, there’s a greater chance that you’ll report disturbed sleep. Only by stopping cannabis completely, and waiting for some time without using at all, will a person be able to determine how cannabis was affecting, or not affecting, his or her sleep.”

A 2017 study from the Nature of Science and Sleep noted that heavy cannabis users (more than five times per week for three months) may not see sleep benefits from cannabis, showing shorter sleep duration, less slow wave sleep, and longer sleep onset than counterparts in the study who did not ingest cannabis.

Studies indicate that cannabis can combat the ailments that can cause insomnia

Stress and depression are often comorbid with insomnia: they can either directly keep us up or they can coexist with sleep deprivation. Among several recent studies, the one that stands out, conducted by the neuroscientists at the University of Buffalo’s Research Institute on Addictions, examined stress and depression with particular attention on endocannabinoids, the brain chemicals similar to the ones contained in cannabis.

“Using compounds derived from cannabis — cannabis — to restore normal endocannabinoid function could potentially help stabilise moods and ease depression,” said lead researcher Dr. Samir Haj-Dahmane. Another recent study noted that cannabis can curb responses to triggers following severe stress and trauma (PTSD), which commonly result in startled responses, insomnia, and nightmares. The traumatised rats treated with cannabis fared much better than the rats treated with the SSRI antidepressant sertraline (Zoloft).

CBD can work well as a sleep aid in conjunction with THC or alone

Pain specialists often praise the way CBD offsets the rousing highs produced by THC. For some users, the more mellow indica strains of THC accomplish the task of providing the body with the unmistakable heaviness (sedation) just before falling asleep. But THC can be too rousing for many.

A 2019 study on 72 adults reporting issues with anxiety and sleep found 67 percent of participants to report getting better sleep while taking CBD. Anxiety scores decreased in 80 percent of the participants and remained lowered for the duration of the study. However, some studies indicate that CBD actually induces wakefulness and decreases the beneficial slow wave and REM phases of sleep.

Cannabis has been shown to mitigate obstructive sleep apnea

The January 2018 issue of Sleep, from the American Academy of Sleep Medicine, published a study showing a positive correlation between dronabinol (a synthetic, man-made form of cannabis) and treatment of obstructive sleep apnea with participants reporting overall treatment satisfaction.

In the June 2002 issue of the journal Sleep, researchers at the University of Illinois at Chicago Department of Medicine noted “potent suppression” of sleep-related apnea in rats that were given either exogenous or endogenous cannabinoids. More recent studies confirmed this effect in rats and in human adults.

Cannabis use by adolescents may affect brain development

Because children’s and teenagers’ brains are still forming and are thus susceptible to lasting damage, researchers caution that the detrimental effects of steady cannabis use are greater in the non-adult age group, and tend to outweigh the benefits.

A study published in The Journal of Neuroscience in 2019 showed changes in brain structure and cognitive effects in teenagers after one or two instances of ingesting cannabis. Susan Weiss, director of the division of extramural research at the National Institute on Drug Abuse (NIDA), notes that “there’s a growing literature, and it’s all pointing in the same direction: Starting young and using frequently may disrupt brain development.”

Source: Tuck