With an estimated more than 5,000 strains of cannabis having been bred worldwide — and some experts claiming there are as many as 5,700 in existence today — the efficacy of the herb for sleep and particular conditions such as insomnia is highly variable, but undeniably present. Different strains can produce markedly different reactions from humans.
A potent landrace sativa, such as Durban Poison, offers an energizing and cerebral experience for those who consume it, while an indica like Afghani may deliver the polar opposite effect and result in lethargy, grogginess, and even sleep. Each of these sets of side effects is of great medical value, although to very different patient populations and involving important variables, such as the time of day or the nature of one’s work responsibilities.
Sleep disorders are conditions that cause a person to have difficulty sleeping or that significantly and negatively impact the quality of sleep. Disorders include many types of disturbances, such as sleeping too much (hypersomnia) or not enough. They can also involve symptoms that occur during sleep that do not necessarily affect the amount of sleep that a person experiences, such as somnambulism (sleep walking).
Other conditions, like narcolepsy, cause sufferers to spontaneously fall asleep, although typically for only a brief period. Such conditions can have a dramatic effect on one’s quality of life (like some epileptics, severe narcoleptics cannot hold a driver’s license).
Wide Range of Sleep Disorders
Sleep disorders involve a wide range of conditions that, in some manner, cause a person to experience difficulty with falling asleep, staying asleep, or in terms of the quality of their slumber. Often, other activities are involved, such as the grinding of one’s teeth (bruxism).
To properly treat sleep issues, discovering the root cause is an important first step. For example, many patients experiencing depression also suffer sleep disturbances, especially insomnia or too much sleep (sometimes a symptom of avoidance behavior and procrastination). Many trauma patients and veterans suffer from stress-related nightmares that are the result of PTSD. Because cannabis is so effective for anxiety, it often is an valuable treatment for PTSD and related disorders that may lead to sleep issues.
Sleep disturbances are also often a negative side effect of pharmaceutical drugs. In fact, the medical profession has been well aware of the sleep problems caused or exacerbated by both alcohol and prescription drugs for many decades.
Cannabis: Proven Sleep Aid
Cannabis is known to help patients fall asleep faster, remain in asleep, and spend more time in “deep sleep” (Stage 3) and Rapid Eye Movement (REM; Stage 4). Although patients report a wide range of reactions to all strains of cannabis, indica varieties are known to induce and maintain sleep better than sativa-dom or pure sativa types.
John Cline, a psychologist and fellow of the American Academy of Sleep Medicine, has noted that some people are more sensitive to the effects of cannabis and that different strains can deliver significantly different terpene and cannabinoid profiles. In 2012, he wrote in Psychology Today:
“As it turns out, cannabis is an exceedingly complex drug preparation and its effects depend on the variety of the plant….”
It should be noted that most strains of cannabis available via either legal dispensaries and retail outlets — and especially on the black market — are hybrids, meaning they are a mix of indica and sativa. Breeders and cultivators create hybrids with the goal of giving patients and adult use consumers the best of both worlds and characteristics of both genetic parents. This sometimes results in “sleepy time weed,” but may produce an uplifting, energizing strain that is best consumed in the morning or mid-day and not recommended before sleep.
Listen to Your Budtender
While all medical cannabis patients can consult with their recommending physician for his or her advice on the most appropriate strains of cannabis for sleep, one of the best resources is a seasoned budtender. Unfortunately, only a few million patients in a handful of states like Colorado, Oregon, and California enjoy safe access to cannabis medicine that involves free consultation with a budtender.
Those who have access to trained, professional budtenders are foolish to not leverage the wisdom and experience of these cannabis medicine experts. Budtenders are exposed to and gather feedback from literally hundreds of patients per week, learning the strains of cannabis that produce particular results — and for whom.
One strain might be perfect for an octogenarian cancer patient simply trying to abate the nausea of chemotherapy in an effort to get some sleep, but not the best solution for a 25-year-old single mother of two suffering from menstrual cramps who desperately needs a nap.
Several studies and a wealth of anecdotal testimonies reveal that cannabis is an excellent sleep aid, improving both ease of onset, duration, and quality. Some studies, like this 2010 research, also indicate that heavy consumers of cannabis, such as very sick patients who suffer pain, nausea, or severe anxiety, often experience sleep disturbances when they suddenly abstain from the herb (something that can easily occur due to financial pressures or the realities of black markets).
All studies should be approached cautiously with respect to the fact that the exact strain of cannabis employed has a dramatic effect on the results obtained. Many research efforts, especially any conducted in the United States, are forced to use low-quality cannabis that is lacking potency, especially compared to the varieties employed in some studies in Israel and Europe.
A 1973 study revealed that the infamous cannabinoid tetrahydrocannabinol, or THC, helped patients suffering from insomnia to fall asleep about an hour earlier than they would have otherwise. However, researchers noted that a potent dose could actually be detrimental and stave off the onset of sleep. This study also identified a cannabis “hangover.” Anecdotal reports indicate that this hangover effect is greatly reduced and typically absent in patients who consume cannabis on a regular basis.
“The most significant side effect, however, was a ‘hangover’ phenomenon, or continued ‘high,’ the next day….”
In 1986, a study conducted by The American Society for Pharmacology and Experimental Therapeutics and published in the journal Pharmacological Review found that THC, in doses of 10, 20, and 30 mg, helped patients fell asleep faster.
A 2002 study published in the journal American Academy of Sleep Medicine and conducted at the University of Illinois revealed that rats given THC and an endocannabinoid called oleamide experienced significant suppression of sleep apnea. Concluded the researchers:
“This study demonstrates potent suppression of sleep-related apnea by both exogenous and endogenous cannabinoids.”
A 2008 study found that THC increases the amount of deep sleep, also known as “slow-wave” or REM sleep. The study concluded: “Acute administration of cannabis appears to facilitate falling asleep and to increase Stage 4 [REM] sleep.”
In terms of hard research regarding the ease with which patients are able to fall asleep and stay asleep, a study published in 2013 in the American Journal on Addictions revealed that THC not only helps people fall asleep, but that it occurs faster than in those who do not consume (participants were “chronic daily cannabis smokers”). Concluded the study, which was funded in part by the National Institutes of Health:
“Higher evening THC…concentrations were significantly associated with shorter sleep latency [and] less difficulty falling asleep….”
A study involving human trials that was conducted in 2010 found that nabilone, a synthetic cannabinoid, was effective as a sleep aid for those suffering from fibromyalgia. The study, conducted at McGill University in Montreal and published in the journal Anesthesia and Analgesia, concluded:
“Nabilone is effective in improving sleep in patients with fibromyalgia and is well tolerated.”
Researchers in 2013 wrote in the journal Frontiers in Psychiatry that THC, administered over a three-week period, significantly reduced the symptoms of Obstructive Sleep Apnea (OSA). The study’s authors concluded that “[Cannabinoid] treatment may be a viable alternative or adjunctive therapy in selected patients with OSA.”
More Research Needed
Until the federal government and Congress allow more robust research to be conducted in the United States, including human trials, patients and medical cannabis advocates will remain ignorant of many aspects of how the herb can alleviate the symptoms of a wealth of diseases and conditions, including sleep disorders such as insomnia and apnea.
Those wishing to help create positive change should advocate for the reclassification of cannabis under the Controlled Substances Act. Currently Schedule I, cannabis is considered as dangerous and addictive as heroin and bath salts, which also reside in this category. Even cocaine and methamphetamines are classified under less restrictive Schedule II, meaning they can be prescribed by a physician.
This post was originally published on February 25, 2016, it was updated on October 5, 2017.