The Endocannabinoid System
There is a fair bit of interest in treating insomnia with cannabis, and the initial research shows that cannabis certainly has a significant impact on sleep. This seems to be in large part because of the way in which cannabis affects the human body’s endocannabinoid system.
The endocannabinoid system is one of the key systems in the human body, and it plays the important role of maintaining our body’s homeostasis (or internal balance). It can stimulate some of our bodies’ most important functions, such as:
- stress response
- memory building
- muscle control
- and sleep
Made of three main components, the endocannabinoid system is composed of endocannabinoids, enzymes, and endocannabinoid receptors. The endocannabinoids are chemicals produced by the human body, but interestingly, they have a lot of structural similarities to the cannabinoids in cannabis. When functioning properly, these endocannabinoids bond with endocannabinoid receptors (referred to as CB1 and CB2 receptors), which are found throughout the body on the surface of cells. Then, enzymes break down endocannabinoids, and clear them from our system.
Interestingly, the endocannabinoid system can also be stimulated by phytocannabinoids (some of cannabis’s active ingredients – usually just called cannabinoids). These molecules can also activate CB1 and CB2 receptors to stimulate these crucial bodily functions and restore balance. This is how cannabis can offer so many diverse and medicinal health benefits.
When it comes to sleep, activating these receptors could be particularly helpful, since endocannabinoid system signaling seems to regulate some aspects of our sleep. For instance, researchers have noted that the activation of CB1 receptors tends to induce sleep.
Studies on mice have also found that CB1 activation was associated with changes in the stability and length of non-rapid eye movement sleep (NREM) stages, which are crucial for getting a good night’s rest.
In addition, researchers also tested whether CB1 signaling was necessary for sleep homeostasis — the way in which humans account for lost sleep by sleeping more deeply and for longer periods when they are behind on rest. To do this, mice subjects were sleep deprived and had their CB1 signaling blocked. Still, blocking CB1 did not seem to reduce the amount of rebound NREM sleep after deprivation. When they were allowed to sleep, these mice still slept longer to account for the lost sleep. The authors say this work supports the idea that endocannabinoid signaling via CB1 is necessary for long and stable NREM sleep stages, but may not be necessary for sleep homeostasis in general.
So it’s clear that endocannabinoid signaling — particularly via CB1 — plays an important role in sleep regulation. Still, it’s not clear from this research exactly how cannabis might affect the sleep of humans when used to treat insomnia. For that, we will need to look at the clinical research.
Insomnia & cannabis
When it comes to cannabis and insomnia, there is a long history of people utilizing cannabis for better sleep. Since ancient times, people have noticed the sedating effects that come with some types of cannabis and have utilized it as a sleep aid.
Recent surveys of cannabis users also report similar trends. One 2018 survey of 1,000 cannabis users who purchase recreational cannabis found that 74% used marijuana to help them sleep, with 84% stating that it helped. Importantly, more than 83% also said they had reduced or stopped taking other sleep aids after switching to cannabis.
Still, the research on cannabis and sleep is still in early stages and experts are conflicted on whether it is a helpful solution, or one that may have long term negative effects. The dearth of research in this important topic is in large part due to the regulatory and legal status of cannabis until recently.
Some research points to cannabis’ ability to decrease the time it takes to fall asleep. For example, one study on physically healthy insomniacs tested the effects of THC on sleep patterns over a six week period. They found that THC significantly decreased the time it takes healthy insomniacs to fall asleep, and decreased the amount of time subjects woke up in the first half of the night.
In this study, subjects did experience one adverse effect — a hangover or continued high the next day. Since this increased with increased dosage, researchers recommended doses lower than 30mgs of THC.
Other research suggests that lower doses might be better for other reasons as well. One study found that cannabis has a dose dependant effect on the time it takes to fall asleep — decreasing time to sleep at lower doses, but increasing it at higher doses.
In addition to dose, strain and chemical composition may also have an effect on how cannabis impacts sleep. In one study, researchers examined cannabis strain preferences among cannabis users with sleep disturbances, and found that there were some notable trends. Those using cannabis to alleviate nightmares, for example, preferred sativa’s to indicas, while those who had current insomnia and also took longer to fall asleep tended to prefer strains with higher CBD. We should probably take any research on sativa/indica distinctions with a grain of salt, since it is often noted that the sativa/indica distinction doesn’t really mean much in terms of genetic or chemotype differences — this does point to the fact that some chemical profiles may work better for one aspect of sleep regulation, while another profile might work better for others.
Both these factors, along with genetic differences among medical marijuana users, might help to explain why some studies report benefits for sleep, while others say it might cause problems.
For example, some researchers argue that while THC may help some get to sleep faster, it could negatively impact sleep overall. One survey that supports this idea found that cannabis users tended to have more sleep disturbances than those who didn’t use cannabis.
Studies have also indicated the CBD could be helpful for sleep. A 2017 review of the literature found that CBD might be helpful for the treatment of both REM sleep behavior disorder (where people act out their dreams physically during REM sleep), and excessive daytime sleepiness.
While more research needs to be done to understand the different ways that cannabis can affect sleep, most of the reviews of the literature say that there is evidence that cannabis can help — particularly for those with sleep issues related to other conditions. For example, the National Academy of Sciences meta-review on cannabis from 2017 reported finding moderate evidence that cannabinoids can improve short-term sleep outcomes in patients with sleep disturbances associated with obstructive sleep apnea, fibromyalgia, chronic pain, or multiple sclerosis. So integration of cannabis into their regimen could help in multiple ways, including helping improve their sleep, which indirectly may improve their outcomes for the underlying condition, while also alleviating symptoms of chronic pain and other symptoms they may have.
A 2017 review from University of Pennsylvania agrees that cannabis can improve sleep for those with obstructive sleep apnea, and chronic pain, and also notes that cannabis may reduce nightmares associated with PTSD.
Still, both reviews caution that more research is sorely needed. While there is good evidence to point towards cannabis’ helpful abilities for sleep, we need more clinical trials on patients with insomnia to develop reliable cannabis treatments.
Based on the research above, there is promising evidence and real world data showing that cannabis can help improve sleep, but dosing, strain and user variability play significant roles. In general, low doses of THC may help cannabis users to fall asleep quicker. For those in chronic pain from conditions like fibromyalgia or multiple sclerosis, cannabis could be a big help in reducing pain so you can sleep through the night. For those with PTSD, it might aid in sleep quality and reduction of nightmares. Those with obstructive sleep apnea may see improvement from cannabis, and those with REM sleep disorder or excessive daytime sleepiness may find CBD particularly helpful.
Still, there is some risk that ongoing cannabis use adversely affect sleep quality, or that high doses might make it harder to sleep. Feeling high the next day is also a risk, though this can be mitigated with lower dosing. Inevitably, these factors need to be considered before you begin using cannabis for your own insomnia.
If you are planning to use cannabis for insomnia, it’s best to consult a medical doctor with an expertise in cannabinoid science. Given the complicated factors with cannabis and sleep, these medical professionals can help you to better determine what type of cannabis treatment is right for you.
You should also make sure that cannabis is legal as a treatment for insomnia where you live, before beginning cannabis use. Currently patients with insomnia and a doctor’s recommendation or prescription are able to use cannabis in the following countries:
- And Uruguay
You can also use cannabis if you have insomnia and a doctor’s recommendation in these US states:
- District of Columbia
- West Virginia
Insomnia is a very common disorder that affects your sleep. People with insomnia have trouble falling asleep, staying asleep, or both. It’s estimated that approximately 60 million Americans are affected by insomnia each year. One in three adults have mild symptoms, and one in seven have chronic insomnia, with women and older adults more likely to develop it. Poor or inadequate sleep can impact every aspect of your life including energy levels, concentration, memory, ability to function, and even be a risk factor for chronic diseases.
There are several ways to classify insomnia:
- Acute insomnia is when you have trouble sleeping for a short period of time. It’s usually provoked by stress or life changes, like facing a difficult exam or job interview, traveling to a different time zone, or hearing bad news. Acute insomnia can go away on its own, once you’ve adjusted to the changes in your life or the period of stress has ended.
- Chronic insomnia refers to insomnia that lasts for a longer period of time. It’s defined as having trouble sleeping for at least 3 nights per week, over at least 3 months.
- Primary insomnia is insomnia that doesn’t have any evident external cause.
- Secondary insomnia, or comorbid insomnia, contrasts with primary insomnia. Secondary insomnia is when your sleep issues are caused by an external trigger, like a medication that you’re taking, too much caffeine, a separate medical condition, or other sleep disorders such as sleep apnea. Often mood such as anxiety and depression can present as insomnia. Generally, secondary insomnia goes away on its own as long once you resolve the underlying cause.
- Onset insomnia means that you have trouble falling asleep.
- Maintenance insomnia means that you don’t have trouble falling asleep, but that you wake up much too early or in the middle of the night, and have trouble staying asleep for long periods of time.
Note: It’s possible to have more than one of these types of sleep disorder at the same time. For instance, people may have chronic insomnia in addition to other factors that may also contribute to insomnia such as poor sleep hygiene, depression, anxiety, or another external cause. This may exacerbate the primary insomnia.
The main symptom of insomnia is having difficulty sleeping, but there can be more to it than that. Symptoms associated with insomnia include:
- Lying awake for a long time before you can fall asleep
- Waking up in the middle of the night, or after a short time, and failing to get back to sleep
- Not feeling rested or refreshed when you wake up in the morning
- Feeling tired and sleepy throughout the day
Insomnia can also make it difficult for you to concentrate and focus during the day. You might find that you’re more irritable than usual, that you make careless mistakes even though you’re concentrating, and that you feel depressed and anxious. People with insomnia often worry about not being able to get enough sleep, which reinforces their difficulty sleeping.
When to see a doctor
Feeling tired can seem like a regular part of busy 21st-century life, but insomnia isn’t something you should ignore. If your sleep issues are affecting the way that you function during the day, it’s time to see your doctor. It could be a sign of an underlying health disorder, or be caused by something treatable like sleep apnea or poor diet choices.
Insomnia can also cause other health issues, like cardiovascular disease, obesity, or high blood pressure, and mental health issues like depression. Sleepiness is also the cause of almost 20% of all serious car crashes, and it increases the risk of falling in elderly people, making it important to do what you can to treat it as soon as possible.
Insomnia can have many, many causes. If you have primary insomnia, it could be due to stress, emotional upset, travel, work schedules like shift work that interfere with your usual sleep cycle, or major life events that upset your sleep routine.
Secondary insomnia can also have a number of causes, including:
- Emotional or mental health disorders. Depression, anxiety, and post-traumatic stress disorder (PTSD) are all mental or emotional disorders that can impact on your sleep.
- Neurological disorders. Alzheimer’s disease and Parkinson’s disease are just 2 neurological disorders that can lead to insomnia.
- Chronic pain and/or discomfort. This could be due to headaches, joint pain like arthritis, gastric pain like IBS or heartburn, and any other conditions that cause enough pain to prevent you from sleeping well.
- Medical conditions. An overactive thyroid, asthma, heart failure, stroke, diabetes, cancer, and other medical disorders.
- Menopause and hot flashes.
- Sleep disorders like sleep apnea or restless legs syndrome.
- Medications. Some medicines, like allergy medicines, medications for asthma or high blood pressure, beta blockers, and some weight-loss products can make it difficult for you to sleep.
- Other substances. Too much caffeine, nicotine, and alcohol can cause insomnia.
Sometimes, insomnia doesn’t get better even once the original cause has gone away. That’s because your body has already developed poor sleep habits, and those continue even after the underlying cause was dealt with.
Anyone can develop insomnia, but there are some people who are more likely to experience it. Here are some lifestyle habits and risk factors that increase your chances of developing insomnia:
- Gender- Women experience insomnia more than men, with 1 in 4 women having insomnia at some point in their lives. It’s thought that hormonal changes throughout the menstrual cycle, during menopause, and during pregnancy disrupt healthy sleep patterns.
- Age- Older people tend to have more difficulty sleeping, mainly due to underlying health conditions that are more common later in life, as well as a drop in physical activity.
- Stress- If you’re under a lot of stress at work, in your personal life, or emotionally, you’re more likely to experience insomnia.
- Irregular sleep schedule- People who work shifts or travel frequently, nap too much during the day, or generally don’t have a regular bedtime, are more likely to have trouble sleeping.
- Poor sleep habits- Eating a large meal, drinking caffeine or other stimulants, or using computers and smartphones shortly before going to sleep can all interfere with your sleep cycle.
There are many treatments for insomnia, but you might need to spend some time trying them out in order to find the one that works best for you. The first step is always to find out if your insomnia is caused by an underlying health condition or some external cause, like a poor sleep environment, and correct that issue. The next step is always to optimize sleep hygiene and make lifestyle changes that contribute to high quality sleep.
Medications for insomnia
There are different types of sleeping pills that help you fall asleep faster and stay asleep once you get there, but none of them are a long-term fix. Many sleeping pills get less effective the longer you use them, which can lead to sleeping pill abuse and addiction. It’s best to treat sleeping pills as just one part of a longer-term solution that focuses on therapies and lifestyle changes.
Some medications might make you feel groggy the next morning, or have other side effects.
Cognitive Behavioral Therapy for insomnia
Cognitive Behavioral Therapy (CBT) for insomnia teaches you how to break the cycle of insomnia by overcoming anxiety about sleep and learning how to relax. CBT is led by a counselor, usually once a week for 2-3 months. Most people who try CBT for insomnia find that it’s just as effective as medication, and that it lasts much longer.
If you do CBT, you’ll learn relaxation techniques, strategies to help you control your anxiety about falling asleep, and better sleep habits.
You might try sleep restriction, which limits the amount of time you can spend in bed and removes all daytime naps, so that you’ll become tired enough to sleep properly at night.
Light therapy is sometimes used as part of CBT, to reset your body clock and help you recognize that it’s time to sleep.
Alternative therapies, supplements, and sleep aids
Some people with insomnia use alternative therapies, like hypnosis, acupuncture, meditation, and yoga.
Alternative sleep aids include:
- Valerian extract or valerian tea
- L-tryptophan supplements
- Herbal remedies
Natural and herbal remedies aren’t regulated by the FDA, so their strength can vary and they might not match up to their advertising. Also, some sleep aids interact badly with some prescription drugs, so you should always consult your doctor before you start taking a new product.
You can do a lot on your own to develop healthy sleep habits to get the sleep you need. Here are some of the main ways to improve your sleep health:
- Don’t eat big meals just before going to sleep, since this can cause heartburn that keeps you awake.
- Avoid stimulants like caffeine, nicotine, and soft drinks like Coke or Pepsi. Some people are more sensitive to these substances and need to stop drinking them earlier in the day in order to be able to sleep well at night.
- Avoid doing serious exercise within a few hours before your bedtime.
- Check that none of your medications, like over-the-counter cold or allergy medicines, causes insomnia as a side effect.
- Don’t drink alcohol shortly before going to sleep. Although it can help you to fall asleep, it also causes you to sleep more lightly and wake up too early.
- Develop a relaxing bedtime that helps you to wind down before you go to sleep. It could involve playing calming music, taking a hot bath, or reading a book.
- Avoid using computers or smartphones just before you go to sleep, because the blue light from the screen affects the signals that your brain sends to your body to get ready to sleep.
- Prepare a sleep-friendly environment that is the right temperature, dark, and quiet. Take out all distractions from your bedroom, including a TV or computer, so that it’s only a place to sleep.
- Set up a regular sleep schedule so that you go to sleep and wake up at around the same time every day, even on weekends and holidays. This helps your body prepare for sleep by releasing the right hormones on time.
- Try to avoid napping during the day even if you’re tired. This can throw out your body’s sleep cycle and make it even harder for you to sleep the following night.