Medical use of cannabis for Insomnia
By Dr. Girivar Singhal
Insomnia is the complaint of inadequate sleep; it can be classified according to the nature of sleep disruption and duration of complaint. Insomnia is subdivided into difficulties falling asleep (sleep onset insomnia), frequent or sustained awakening (sleep maintenance insomnia), early morning awakening (sleep offset insomnia), or persistence sleepiness despite sleep of adequate duration (nonrestorative sleep). Insomnia affects all age groups and it is more common in woman than man. Stress very commonly triggers short-term insomnia. If it’s not properly addressed, short-term insomnia can develop into chronic insomnia. Chronic insomnia is often linked to an underlying medical condition – such as chronic pain of all varieties, chronic fatigue syndrome, acid reflux, and others. Common psychological problems that may lead to insomnia include anxiety, stress, bipolar disorder, and depression.
Treatment of insomnia generally includes non-medical as well as pharmacologic components. Studies have shown that such a combined approach in treating insomnia usually works best.
Non-pharmacologic or non-medical therapies for insomnia include such things as improved sleep hygiene, relaxation therapy, stimulus control, and sleep restriction. Improved sleep hygiene includes things such as avoiding alcohol, caffeine and exercise before bedtime, creating a comfortable bedroom environment, and following a regular sleep schedule. Alcohol and nicotine can interfere with sleep, despite the fact many patients use them to relax and promote sleep. Alcohol ingestion prior to sleep is contradicted in patient with sleep apnea because of the inhibitory effects of alcohol on upper airway muscle tone. Actually amphetamines and cocaine suppress both REM sleep and total sleep time, which returns to normal with chronic use. Withdrawal leads to REM sleep rebounds. A number of prescribed medications can produce insomnia. Antidepressant, sympathomimetics and glucocorticoids are common cause. In addition, severe rebound Insomnia can result from the acute withdrawal of hypnotics, especially following the use of high doses of benzodiazepines with the short half –life.
As an alternative to these prescription drugs, medical cannabis has also been found to be very effective in treating insomnia. In some cases, tiredness from medical cannabis can be a side effect. At night-time, however, it can be a very beneficial effect. Many patients report that when compared to conventional sleep medications, medical cannabis works better, is not habit-forming, and leaves them feeling better the next day. And there has never been a death from a medical cannabis overdose.
When using medical cannabis for insomnia, it is important to keep in mind which strain to use. Most patients find that Indica strains are more relaxing with a pronounced sedative quality. Sativa strains generally tend to be more energizing. For some patients, either strain works well.
Scientific evidence supports these reports. One study determined that the cannabinoid CBD helped with sleep better than THC. Cannabinoids such as CBD and THC are just two of over one hundred such molecules found in the cannabis plant which provide medicinal actions. Inhaled cannabis– preferably smoke-free vapor – generally provides an immediate effect and lasts for about 3–4 hours. Edible or ingested cannabis, on the other hand, takes up to an hour to work, but lasts for up to 6–8 hours. Therefore, an edible cannabis product, taken about an hour before bedtime, can work very well to help get a full night’s sleep.
The study was published in 1973 by researchers in the United States and involved 9 test subjects that were given varying doses of THC – 10, 20 and 30mg – once a week over a 6 week period. According to the results, each dose was able to reduce the time it took to fall asleep (sleep latency), with the most effective dose being 20 mg. 20 mg of THC was found to reduce the average time it took patients to fall asleep by more than an hour.
Overall, THC was found to be more effective in helping patients fall asleep once they got into bed, as opposed to getting them into bed sooner. Interestingly, the highest dose of THC (30mg) was found to be less effective than the 20mg dose, suggesting that the 30mg dose may have been too intoxicating. According to the study’s authors, the effects of being too high can outweigh the desire to sleep or simply make it harder to fall asleep.
The study also showed that THC could decrease the number of sleep interruptions that insomniacs experience, but only during the early part of the night. THC also seemed to increase the amount of time that patients spent sleeping – higher doses of THC were correlated with longer periods of sleep. Patients also reported a “hang over” effect in the morning, particularly at the 30 mg dose. On the other hand, 20 mg didn’t seem to negatively affect patients the next day.
Dr. Girivar Singhal for The Marijuana Company
Before using Marijuana for medical purposes, consult with a physician.