Medical Cannabis for Sleep Disturbance

Sleep problems can have a significant impact on daily life, affecting energy levels, concentration, mood and overall wellbeing. Difficulties falling asleep, staying asleep or getting restorative sleep can occur alongside conditions such as chronic pain, neurological disorders and other long-term health problems. While conventional treatments and lifestyle changes can help many people, medical cannabis for sleep-related symptoms may be considered for some eligible patients when other treatments have not provided adequate relief.

What are Sleep Issues?

Sleep issues can include difficulty falling asleep, waking frequently during the night, waking too early or feeling unrefreshed despite spending enough time in bed. When these problems persist, they can affect physical and emotional wellbeing and make everyday activities more difficult.

Poor sleep can have many different causes. It may occur as a primary sleep problem or as a symptom associated with another condition, such as chronic pain, neurological conditions, anxiety or other health problems. Understanding what is disrupting a patient's sleep is therefore an important part of determining the most appropriate treatment.

Common Sleep Conditions Treated with Cannabis

Insomnia is a common sleep problem characterised by difficulty falling asleep, staying asleep or getting good-quality sleep. Persistent insomnia can lead to daytime tiredness, difficulties with concentration and changes in mood and quality of life.
Sleep Disturbance Associated with Chronic Pain
Chronic pain can make it difficult to fall asleep or remain asleep throughout the night. In turn, inadequate sleep can make coping with pain and fatigue more difficult. For some patients being treated for chronic pain, improving sleep may therefore be an important part of their overall symptom-management plan.
Sleep Disturbance Associated with Neurological and Other Conditions
A number of neurological and long-term health conditions can affect sleep. Symptoms such as pain, muscle stiffness, restless legs, anxiety or changes in normal sleep patterns may contribute to disrupted or poor-quality sleep.

Traditional Treatment Methods for Sleep Issues

Treatment for sleep problems depends on their underlying cause, how long they have been present and how significantly they are affecting daily life. Your GP or specialist may advise:

Improving sleep habits and maintaining a regular sleep routine
Cognitive behavioural therapy for insomnia (CBT-I)
Relaxation and stress-management techniques
Addressing underlying conditions that may be disrupting sleep
Medication where clinically appropriate
Lifestyle changes, including exercise and reducing caffeine or alcohol

For persistent sleep difficulties, identifying and treating the underlying cause can be just as important as managing the sleep problem itself.

How Medical Cannabis Can Help with Sleep Issues

Cannabis contains compounds known as cannabinoids, including THC (tetrahydrocannabinol) and CBD (cannabidiol), which interact with the body's endocannabinoid system (ECS). This system is involved in a range of physiological processes that include sleep and the sleep-wake cycle.

THC and CBD have different effects, and responses can vary considerably between individuals. THC can have sedating effects for some people, while the relationship between CBD and sleep is more complex and may depend on factors including dose, formulation and the symptoms being treated.

For some eligible patients, medical cannabis may be prescribed to help manage symptoms that are contributing to poor sleep, such as chronic pain. Treatment is individually prescribed according to the patient's underlying condition, symptoms, previous treatments and clinical history.

Efficacy of Cannabis in Treating Sleep Issues

Research into cannabis-based medicines and sleep is continuing. Some studies have reported improvements in aspects of sleep among patients using cannabis-based medicines, particularly where sleep disturbance occurs alongside conditions such as chronic pain. However, the quality and strength of evidence varies according to the condition and cannabis-based medicine being studied.

Medical cannabis may help some patients manage sleep-related symptoms, but it is not suitable for everyone. A specialist doctor will assess the underlying cause of your sleep difficulties, your medical history and previous treatments before determining whether medical cannabis may be an appropriate treatment option.

What Type of Cannabis Treatment is Best for Sleep?

There is no single standard cannabis prescription for sleep issues. Treatment is tailored to your underlying condition, symptoms, previous treatment history and individual response.

Depending on your clinical assessment, you may be prescribed CBD, THC or a combination of both. Medical cannabis can be prescribed in different formulations, including cannabis oil and dried flower for vaporisation.

During your initial consultation, a specialist doctor will assess your eligibility, discuss the difficulties you are experiencing with sleep and review treatments you have previously tried. If medical cannabis is considered appropriate, your doctor will discuss the treatment option and formulation that may be most suitable for your individual circumstances.

Patient Testimonials

"Amazing clinic, really straightforward to sort everything out all the staff are really helpful. It’s been lifechanging for me with my adhd and sleepissues feel like I have my life back".

Dean Mattocks, Patient. Trustpilot.

Individual experiences with medical cannabis vary, and another patient's experience does not guarantee that you will experience the same results.

Combining Other Treatment Options with Cannabis

Medical cannabis, when prescribed, may form one part of a wider approach to managing sleep difficulties. Depending on the cause of your symptoms, treatment may be combined with good sleep habits, cognitive behavioural therapy for insomnia (CBT-I), regular physical activity, relaxation techniques and treatment of underlying conditions such as chronic pain.

Patients should continue to follow the advice of their healthcare professionals and should not stop or change existing prescribed medication without discussing it with their doctor

Clinical research into medical cannabis and sleep.

What does the research say?

Research into medical cannabis for sleep and related conditions is growing, with evidence coming from both clinical studies and real-world patient experience. Research has reported improvements in sleep for some patients, helping us better understand where medical cannabis may have a role in managing sleep difficulties.

Here is just some of the growing body of clinical research and real-world evidence exploring medical cannabis for sleep related conditions, and the outcomes patients have experienced.

Research study: Use of a synthetic cannabinoid in a correctional population for posttraumatic stress disorder-related insomnia and nightmares, chronic pain, harm reduction, and other indications: a retrospective evaluation.

In a study exploring nabilone for chronic pain and sleep-related problems, 61 of 68 patients treated for chronic pain reported improvements, highlighting the potential relationship between better pain management and better sleep.

In this study a retrospective chart review was conducted of 104 patients from a mental health center, who were prescribed a single dose or more of nabilone for any indication. The mean initial dose of nabilone was 1.4 mg daily, whereas the mean final dose was 4.0 mg. The mean length on nabilone was 11.2 weeks for a total of 1229.9 weeks of nabilone treatment for the entire cohort.

There were 68 patients who took nabilone for chronic pain, 61 reported a subjective improvement in their pain, typically within the first 1 to 2 weeks of treatment, and this was largely maintained for the balance of the trial. The improvement reported was seen regardless of whether the pain was of neuropathic, musculoskeletal, or other origin.

The adverse effects that were experienced by the chronic pain cohort was not mentioned in the study; however out of the 104 patients, there were 31 patients that reported adverse effects of which 10 withdrew from the study due to these. Adverse effects reported included, sedation, 12.5%; dry mouth, 6.7%; feeling “stoned,” 3.8%; orthostatic hypotension, 1.9%; agitation, 1.9%; and headache,

1.0%. the most serious adverse effect was psychosis, which was reported by 2 patients – yet both of these patients did suffer from preexisting psychotic illness.

Study by Cameron C, Watson D, Robinson J. Use of a synthetic cannabinoid in a correctional population for posttraumatic stress disorder-related insomnia and nightmares, chronic pain, harm reduction, and other indications: a retrospective evaluation. J Clin Psychopharmacol. 2014 Oct;34(5):559–64.

Read the full study on the National Library of Medicine website

Research study: The nonpsychoactive cannabis constituent cannabidiol is a wake-inducing agent.

Research suggests that CBD may promote wakefulness rather than sleep, with this study finding increased alertness and reduced deep and REM sleep when CBD was administered during waking hours.

Cannabidiol (CBD) is a constituent of Cannabis sativa that induces nonpsychotropic effects, and some of its biological actions in sleep have been described by the authors' group. Here, the authors report that when administered 10 or 20 μg/1 μl during the lights-on period directly into either lateral hypothalamus (LH) or dorsal raphe nuclei (DRN), which are wake-inducing brain areas, CBD enhanced wakefulness and decreased slow wave sleep and REM sleep. Furthermore, CBD increased alpha and theta power spectra but diminished delta power spectra. Additionally, CBD increased c-Fos expression in LH or DRN. These findings suggest that this cannabinoid is a wake-inducing compound that presumably activates neurons in LH and DRN

Study by Murillo-Rodríguez, E., Millán-Aldaco, D., Palomero-Rivero, M., Mechoulam, R., & Drucker-Colín, R. (2008). The nonpsychoactive cannabis constituent cannabidiol is a wake-inducing agent. Behavioral Neuroscience, 122(6), 1378–1382. https://doi.org/10.1037/a0013278

Read the full study on the American Psychological Association website.

Research study: Effect of Delta-9-tetrahydrocannabinol and cannabidiol on nocturnal sleep and early-morning behavior in young adults.

A small study of healthy adults found that THC had sedative effects, while CBD appeared to promote alertness and, at higher doses, reduced some stages of sleep and increased wakefulness during the night.

The effects of cannabis extracts on nocturnal sleep, early-morning performance, memory, and sleepiness were studied in 8 healthy volunteers (4 males, 4 females; 21 to 34 years). The study was double-blind and placebo-controlled with a 4-way crossover design. The 4 treatments were placebo, 15 mg Δ-9-tetrahydrocannabinol (THC), 5 mg THC combined with 5 mg cannabidiol (CBD), and 15 mg THC combined with 15 mg CBD. These were formulated in 50:50 ethanol to propylene glycol and administered using an oromucosal spray during a 30-minute period from 10 pm. The electroencephalogram was recorded during the sleep period (11 pm to 7 am). Performance, sleep latency, and subjective assessments of sleepiness and mood were measured from 8:30 am (10 hours after drug administration). There were no effects of 15 mg THC on nocturnal sleep. With the concomitant administration of the drugs (5 mg THC and 5 mg CBD to 15 mg THC and 15 mg CBD), there was a decrease in stage 3 sleep, and with the higher dose combination, wakefulness was increased. The next day, with 15 mg THC, memory was impaired, sleep latency was reduced, and the subjects reported increased sleepiness and changes in mood. With the lower dose combination, reaction time was faster on the digit recall task, and with the higher dose combination, subjects reported increased sleepiness and changes in mood. Fifteen milligrams THC would appear to be sedative, while 15 mg CBD appears to have alerting properties as it increased awake activity during sleep and counteracted the residual sedative activity of 15 mg THC.

Study by Anthony N. Nicholson, Claire Turner, Barbara M. Stone and Philip J. Robson

Read the full study on Ovid.

Research study: Cannabidiol can improve complex sleep-related behaviours associated with rapid eye movement sleep behaviour disorder in Parkinson's disease patients: a case series.

A small study of people with Parkinson’s disease and REM sleep behaviour disorder found that CBD was associated with a substantial reduction in nightmares and other sleep-related symptoms, with no side effects reported.

Cannabidiol (CBD) is the main non-psychotropic component of the Cannabis sativa plant. REM sleep behaviour disorder (RBD) is a parasomnia characterized by the loss of muscle atonia during REM sleep associated with nightmares and active behaviour during dreaming. We have described the effects of CBD in RBD symptoms in patients with Parkinson's disease. Four patients treated with CBD had prompt and substantial reduction in the frequency of RBD-related events without side effects. This case series indicates that CBD is able to control the symptoms of RBD.

Study by: M. H. N. Chagas MD PhD, A. L. Eckeli MD PhD, A. W. Zuardi MD PhD, M. A. Pena-Pereira MD, M. A. Sobreira-Neto MD, E. T. Sobreira PhD, M. R. Camilo MD, M. M. Bergamaschi PhD, C. H. Schenck MD, J. E. C. Hallak MD PhD, V. Tumas MD PhD, J. A. S. Crippa MD PhD.

Read the full study on the National Library of Medicine website

Research study: Use of Cannabis to Relieve Pain and Promote Sleep by Customers at an Adult Use Dispensary.

In a survey of 1,000 adults using cannabis, 65% reported using it for pain and 74% for sleep, with most of these users reporting that they found it very or extremely helpful.

Medical cannabis patients consistently report using cannabis as a substitute for prescription medications; however, little is known about individuals accessing cannabis through adult-use markets. A survey at two retail stores was conducted in Colorado, United States. Between August 2016 and October 2016, store staff asked customers if they wanted to participate and, if so, provided an electronic survey link. All customers reporting medical certification were excluded. Of 1,000 adult-use only customer respondents, 65% reported taking cannabis to relieve pain and 74% reported taking cannabis to promote sleep. Among respondents taking cannabis for pain, 80% reported that it was very or extremely helpful, and most of those taking over-the-counter pain medications (82%) or opioid analgesics (88%) reported reducing or stopping use of those medications. Among respondents taking cannabis for sleep, 84% found it very or extremely helpful, and most of those taking over-the-counter (87%) or prescription sleep aids (83%) reported reducing or stopping use of those medications. De facto medical use of cannabis for symptom relief was common among adult-use dispensary customers and the majority reported that cannabis decreased their medication use. Adult use cannabis laws may broaden access to cannabis for the purpose of symptom relief.

Study by: Marcus Bachhuber, Julia Arnsten, Gwen Wurm

Read the full study on the National Library of Medicine website

Research study: Effectiveness of Raw Natural Medical Cannabis Flower for Treating Insomnia under Naturalistic Conditions

In a real-world study of 409 people with insomnia, medical cannabis use was associated with a significant reduction in self-reported insomnia symptoms, although effects varied depending on the product and how it was used.

Background:

We use a mobile software application (app) to measure for the first time, which fundamental characteristics of raw, natural medical Cannabis flower are associated with changes in perceived insomnia under naturalistic conditions.

Methods : Four hundred and nine people with a specified condition of insomnia completed 1056 medical cannabis administration sessions using the Releaf App TM educational software during which they recorded real-time ratings of self-perceived insomnia severity levels prior to and following consumption, experienced side effects, and product characteristics, including combustion method, cannabis subtypes, and/or major cannabinoid contents of cannabis consumed. Within-user effects of different flower characteristics were modeled using a fixed effects panel regression approach with standard errors clustered at the user level.

Results : Releaf App TM users showed an average symptom severity reduction of −4.5 points on a 0–10 point visual analogue scale (SD = 2.7, d = 2.10, p < 0.001). Use of pipes and vaporizers was associated with greater symptom relief and more positive and context-specific side effects as compared to the use of joints, while vaporization was also associated with lower negative effects. Cannabidiol (CBD) was associated with greater statistically significant symptom relief than tetrahydrocannabinol (THC), but the cannabinoid levels generally were not associated with differential side effects. Flower from C. sativa plants was associated with more negative side effects than flower from C. indica or hybrid plant subtypes.

Conclusions : Consumption of medical Cannabis flower is associated with significant improvements in perceived insomnia with differential effectiveness and side effect profiles, depending on the product characteristics.

Study by: Jacob M Vigil, Sarah S Stith, Jegason P Diviant, Franco Brockelman, Keenan Keeling, Branden Hall

Read the full study on the National Library of Medicine website

Explore Eligibility for Medical Cannabis

If struggling to sleep continues to affect your daily life despite trying standard treatments, you may be eligible for a specialist assessment. Medicann Clinics is a specialist-led UK medical cannabis clinic offering free consultations, no repeat prescription fees, and same-day UK despatch.

You can check your eligibility online today to take the next step toward personalised support.

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