The Effects of Cannabinoids on Sleep

Abstract

The use of cannabis products to help with sleep and various other medical conditions by the public has increased significantly in recent years. Withdrawal from cannabinoids can lead to sleep disturbance. Here, we describe a patient who developed significant insomnia leading to worsening anxiety, mood, and suicidal ideation in the setting of medical cannabis withdrawal, prompting presentation to the Emergency Department and inpatient admission. There is a limited evidence base for the use of cannabis products for sleep. We provide a comprehensive review evaluating the literature on the use of cannabis products on sleep, including an overview of cannabis and related psychoactive compounds, the current state of the law as it pertains to the prescribing and use of these substances, and potential side effects and drug interactions. We specifically discuss the impact of cannabis products on normal sleep and circadian sleep-wake rhythms, insomnia, excessive daytime sleepiness, sleep apnea, parasomnias, and restless legs syndrome. We also describe the effects of cannabis withdrawal on sleep and how this increases relapse to cannabis use. Most of the studies are observational but the few published randomized controlled trials are reviewed. Our comprehensive review of the effects of cannabis products on normal sleep and sleep disorders, relevant to primary care providers and other clinicians evaluating and treating patients who use these types of products, shows that cannabis products have minimal to no effects on sleep disorders and may have deleterious effects in some individuals. Further research examining the differential impact of the various types of cannabinoids that are currently available on each of these sleep disorders is required.

Updates in the use of cannabis for insomnia

“…Although cannabis can have some benefits for insomnia, at least in the short term, there are societal, health, and safety risks to be aware of. Examples include; increased risk of addiction to marijuana and other substances, motor vehicle accidents, cardiovascular complications (including in otherwise young and healthy users), chronic bronchitis, abnormal brain development, schizophrenia, depression, anxiety, lung and other cancers, and a decrease lifetime achievement [2 ▪ ]. Also, high levels of marijuana use at earlier ages (e.g.…”

“…Cannabis withdrawal is associated with sleep disturbance and cannabis withdrawal syndrome appears to be common among regular users of cannabis. Kolla et al [2 ▪ ] found that withdrawal from cannabis can result in sleep disturbances characterized by changes in sleep architecture and increased periodic limb movements of sleep. Cannabis withdrawal syndrome can be identified in inpatient or outpatient settings.…”

“…THC is a CYP1A2 inducer which can reduce the blood concentration of multiple medications such as; duloxetine, olanzapine, haloperidol, and chlorpromazine [2 ▪ ]. CBD on the other hand, is a potent inhibitor of CYP2C9 and mild inhibitor of CYP3A4 [2 ▪ ].…”

“…THC is a CYP1A2 inducer which can reduce the blood concentration of multiple medications such as; duloxetine, olanzapine, haloperidol, and chlorpromazine [2 ▪ ]. CBD on the other hand, is a potent inhibitor of CYP2C9 and mild inhibitor of CYP3A4 [2 ▪ ]. Thus, CBD can affect metabolism of multiple medications as well as the international normalized ratio (INR) in the setting of warfarin use [2 ▪ ].…”

“…Although multiple studies have shown beneficial effects of cannabinoids for sleep in studies that were conducted for nonsleep related conditions [2 ▪ ], evidence for cannabis products for the management of insomnia remains varied. Here, we will review recent updates in the evidence for cannabis products and insomnia, as well as make note of other recent considerations that may be of clinical value…”