Cannabis and Insomnia
Article by Dr. June Chin, Cannabis Expert
According to the National Sleep Foundation, some 50 to 70 million Americans experience insomnia at some point in their lives. Based on what I'm hearing from my patients, this number is through the roof thanks to the scourge of COVID. If getting some shut-eye is becoming harder for you, know that you're not alone.
Make no mistake; sleep is crucial to our physical and mental functioning. The most recent research indicates that sleep is essential to all of the body's repair and restore functions. When we are at rest, the body learns what's wrong and physically "relearns" how to contend with the complexities and stressors of everyday life. Restful sleep has been proven to improve memory recall, regulate metabolism, and reduce mental fatigue. During sleep, the brain reorganizes and recharges itself, and the body removes waste byproducts that have accumulated throughout the day. It's almost as if our dream life represents our struggle to get back to balance.
When people are sleep deprived, they suffer. Their cognitive abilities decline, their behavior, and their judgment becomes erratic. Fatigue makes us more emotional, anxious; more strung out, more on edge. It's no fun, and yes, it gets worse as we age in large part due to hormones, prescription medications, and chronic diseases.
As you've probably noticed, not all sleep aids work for everyone. There is no perfect drug that produces a regular sleep and dream pattern like a genuinely restful night sleep does. Many medications produce a tolerance that requires higher and higher doses. When some people stop taking them, they suffer nasty withdrawal symptoms, including severe insomnia.
There's no conclusive evidence that cannabis works infallibly for everyone with insomnia. Still, my own clinical experience of treating patients with it for over 15 years shows it is at least as effective as conventional pharmaceuticals. Getting to the right dose requires some experimentation, so if you're not willing to invest a little time doing this, medical cannabis may not be a solution for you.
Below are some of the most common questions I'm hearing about insomnia and cannabis these days.
Why and how does cannabis work for sleep disruption?
Anxiety, stress, and chronic sleep deprivation all inhibit GABA, a naturally occurring brain chemical that directs neurons to slow down or stop firing. This neurotransmitter also helps to induce sleep, relax muscles, and calm down. In essence, GABA directs the body to chill out.
Cannabis modulates GABA, helping return the body to its more normal functions. Careful cannabis dosing may help stop the racing thoughts that cause disrupted sleep and panicked awakenings during the night. It can also be used to treat what is called "parasomnias," sleep disorders characterized by abnormal movements, behaviors, or perceptions during sleep, like jaw grinding, sleepwalking, or nightmares.
The cannabis molecules produced by your own body (endogenous cannabinoids) make you resistant to stress, similar to the way endorphins provide natural relief from pain. Integrating optimally dosed cannabis products can help bring the body back into a state of balance.
Some of the research I've read online and in blogs say marijuana is no better than sleeping pills, that it doesn't provide a good night's sleep, and robs the body of REM sleep.
Prescription sleep aids (i.e., Ambien, Lunesta, etc.) don't deliver a restorative sleep. They replace our normal sleep cycles and dreams and result in "counterfeit sleep" -- studies show they only increase natural sleep by 8 minutes. Instead, they produce a type of sleep amnesia -- you forget that you had a crappy night! Benzos (i.e. Xanax, Klonipin, etc.) are often prescribed for insomnia, but they are only supposed to be used short term, 2 - 4 weeks maximum. If taken longer than that, they can be as addictive as opioids. Weaning from Xanax and Ambien can take up to a year because of the severe withdrawal symptoms and emotional dependence.
THC will decrease the amount of time it takes you to fall asleep, however, it does block REM sleep just like alcohol. CBD also reduces the amount of time it takes to fall asleep and helps you get a more restful night's sleep. Combining both THC and CBD in the right dosage and ratio can be very useful in helping chronic sleep sufferers in my clinical experience.
I've heard that once I start using medical cannabis, I'll have to increase the amount I use constantly.
You can indeed build a tolerance to cannabinoids if you use them regularly. But it's also easy to reset or "resensitize" your receptors by stopping use for a few days. If you need increasingly higher doses of cannabinoids to get to sleep, simply take a break for 4 or 5 days. (You can take 2 to 5 mg of melatonin, or 650 mg of Valerian, and Magnesium Taurate while you take your cannabis holiday). Staying off cannabinoids for 4 or 5 days will allow your receptors to flush themselves out. After this break, you can begin again by taking a minimal amount -- one or two vapor puffs or a few milligrams of tincture -- until you feel a shift. Start there. You'll probably be surprised to learn that you'll get the same relief on a much lower dose. You can increase that dose slowly over the next few days if required.
CBD reduces the amount of time it takes to fall asleep, and it decreases overall body inflammation and calms the nervous system. If taken throughout the day in a microdose regime, it can balance your circadian rhythm and help you with effortless sleep.
I often notice that when something upsets me during the day, it comes back to haunt me in the middle of the night, and I wake up and can't get back to sleep. Any ideas on how to contend with this?
That's a stress response, and cannabinoids also work to mitigate stress. In these cases, 10-40 mg of CBD -- or in some cases CBD that is supplemented with 1-3 mg doses of THC -- can reduce the anxiety that occurs during the day.
Here's how CBD directs the brain to activate the parasympathetic nervous system, which induces a state of calm. It works well for social anxiety and everyday stress, plus more extreme forms of anxiety such as panic attacks. One small study showed it even "reduced anxiety in public speakers," so if you're gearing up for that online TED Talk, take note!
Some of my patients carry a CBD vape pen or tincture with them during the day. If they know they have a stressful situation like a job interview or a confrontation coming up; they use it in advance to help keep calm. Others use it to steady themselves after an anxiety-provoking situation. You may want to try these strategies.
I just can't get to sleep these days. My mind won't stop chattering.
To fall asleep faster, you'll want to use a CBD: THC combination before bedtime. A little THC is a good idea because, as the feelings of being mildly high taper off (60-90 mins), it produces a sedative effect that encourages sleep. Low light enhances CBD's calming effects.
If you're inhaling flowers, begin with a small dose the size of a matchhead.
If you're using a vape pen, begin with a few puffs of a CBD or 1:1 CBD: THC oil and keep the room dark.
If using a tincture, try 20-25 mg of 20C:1T or 1C:1T tincture 60-90 minutes before bed. You can experiment with the time you dose. This should keep you asleep for 4-6 hours.
I can get to sleep, but I'm up in the middle of the night and can't get back to sleep.
Try a capsule or an edible to stay asleep--the effects take longer to come on, but they last longer.
Try adding 1mg THC to a CBD capsule three or four hours before bed. If that's not enough to keep you asleep for 6-8 hours, gradually titrate the dose 1 or 2 mg every few nights until you get to the optimal, minimum effective dose and reach your desired effect.
Be sure to titrate slowly in small 1mg increments. Too much THC can amp you up -- you don't want that -- or leave you foggy in the morning!
Another option is to keep a CBD: THC vapor pen by the bed. If you awaken in the middle of the night, take a few puffs to lull you back to sleep.
Can I use other supplements? Can I mix with sleeping pills?
Some of my patients alternate between cannabinoids, pharmaceuticals, and other supplements like 650 mg Valerian or 2 to 5 mg Melatonin, a hormone released in response to darkness. They find that alternating their meds produces different sleep quality and doesn't make them reliant on just one form of medication.
CBD. What is the right dose? Some say it makes you drowsy. Others say it makes you alert. What's the deal?
CBD can be either sedating or stimulating, depending on your endocannabinoid system and the dose. Generally, CBD doses higher than 40 mg may cause drowsiness while lower doses (under 40 mg) may cause alertness--this isn't true for everyone, and you'll need to experiment.
Everyone says I need to use Indicas to get to sleep, but last night, I vaporized an Indica strain, and my mind just raced all night. It was crazy.
Right. Indica and Sativa aren't the most reliable indications of effects. Research indicates that terpenes -- those powerful smell molecules that give cannabis its pungent odor -- are better guides to what might make you sleepy. If you're in a legal state, you'll be able to find the flower's terpene content by checking the lab tests. Any good dispensary staff can help you with this.
There are at least 17 terpenes in cannabis, and each strain has a different combination in a different amount. If you're shopping for sleep-inducing flowers be sure to look for strains (chemovars) high in linalool and myrcene. Avoid more stimulating strains with high amounts of pinene or limonene. I have read about CBN. What are some of CBN’s effects/benefits? CBN is another cannabinoid that has stronger sedative properties than CBD. When THC degrades due to exposure to air and light, CBN is formed. CBN is prominent in old, dried cannabis flower. Consumed in large quantities, CBN can produce paranoia, something you might experience after smoking low-quality, improperly stored pot. Storing cannabis in airtight containers makes it last longer and slows the process of naturally produced CBN. When dried cannabis is crispy or completely brown, that could be a sign that it is older or was stored improperly, and may make you sleepy. How is CBN different from CBD? CBN is a different cannabinoid. CBN has stronger sedative properties than CBD. It has demonstrated anti-convulsant, appetite stimulation, and anti-inflammatory effects, especially when in the context of other cannabinoids. Adding CBN boosts the relaxing and sedative effects of CBD. Tetrahydrocannabinol (THC) can produce euphoric and sedating side effects. As a byproduct of THC degradation, cannabinol (CBN) retains the sedating effect without the euphoria. Some consumers prefer the less euphorigenic effects of CBN. What else can I do? I hate not knowing if I'm going to sleep or lay awake all night.
I don't blame you--not knowing if you'll be able to sleep in itself stressful, and you're wise to avoid that!
There is a lot of research in the field of "sleep hygiene." Much of it is based on common sense methods of winding down. Make these tips habits or create some rituals for yourself.
Begin winding down about 90 minutes before sleep. Turn off your screens and lower the lights. Illuminated screens can reduce melatonin production and keep cortisol levels raised at night
Put your phone on "Silent" and dock it outside your bedroom
Turn the clock away from you to avoid obsessing about sleep
Have a soothing cup of herbal tea—chamomile or "Sleepy Time" are relaxing. Stop taking caffeine by 2 or 3 pm and don't drink more than one or two glasses of alcohol at night
Take a warm Epsom salt bath at night
Try a weighted blanket. Research indicates that sleeping under a heavier weight reduces the cortisol stress hormone and stimulates the production of serotonin, the feeling good hormone
Go to bed at the same time every night and set the alarm at the same time every morning. The body likes consistency.
Take an early morning walk. Thirty minutes of exposure to light within two hours of waking can help sleep disorders as well as seasonal affective disorder. Avoid exercising in the evening -- it can make your heart pump faster and keep you awake longer.
Intermittent Fasting or Time-restricted eating. This idea is constraining our eating within a specified time window during the day ranging from only 8 hours to up to 12 hours per day, usually earlier in the day to align better with our circadian rhythm. For example, if you wake up at 7 am, you should stop eating at 7 pm. Research shows that the benefits of time-restricted eating include more restful sleep by balancing our circadian rhythm and improved metabolism.
Check prescription drugs for side effects. Note that many medications contain caffeine.
Rule out hormone imbalance/deficiencies, hypothyroidism, hypoglycemia, and weak adrenal function.
The bottom line on using cannabinoids for insomnia:
CBD can be either sedating or stimulating, depending on your dose and your endocannabinoid system.
Small amounts of THC are sedating.
Cannabis meds can work well with supplements and pharmaceutical sleeping meds. In many cases, they may help you decrease the dosage, frequency, or need for prescription sleep aids.
Using cannabis meds is not "take two pills and call me in the morning." One size does not fit all. You have to do some experimentation to titrate and find your optimal dose, but once you do, stick with it!
As always, consult your health care provider before making any changes to your prescription medication.