Since Washington state legalized marijuana in November 2012, a key question in the field of sleep health has been raised repeatedly:
Can marijuana help us sleep better?
People with insomnia say that it does. However, the research is limited, though we do know a few things about marijuana and its impact on sleep.
How does marijuana impact sleep architecture?
- For most people who use marijuana as a sleep aid, the main benefit is that it helps them to fall asleep faster. Research tends to back up the observation that using marijuana can improve sleep onset.
- According to research reported in Sleep Medicine Reviews in 2008, marijuana that has been smoked is shown to reduce rapid-eye movement (REM) sleep.
Oral consumption of THC, a primary component of marijuana, also shows the same result.
REM sleep is critical for cognitive function and memory. People who do not get adequate REM sleep may suffer other problems with their health as a result.
- Stage 3 sleep, also known as deep sleep, has been shown to increase as the result of using marijuana at bedtime. Stage 3 sleep allows the brain to release human growth hormone into the bloodstream, which helps with cellular repair and reinvigoration.
- Other observations can be made regarding cannabis withdrawal. For instance, when someone stops using marijuana regularly, they may experience the following:
Difficulty falling or staying asleep
Less stage 3 sleep
REM rebound (the return of REM sleep, which may be so intense that it occurs more than 25 percent of the evening and which could be problematic for people with moderate to severe sleep apnea if they aren't treating it).
Is there a marijuana-apnea connection?
Possibly. A synthetic form of THC, dronabinol, is currently being investigated as a potential oral treatment for obstructive sleep apnea (OSA). A 2013 University of Illinois-Chicago study found its use greatly reduced the apnea hypopnea index (AHI) of its subjects by nearly a third for those with moderate to severe sleep apnea.
Research in Chicago continues, with the PACE clinical trial still underway. Researchers are examining the impacts of dronabinol on outcomes related not only to AHI and daytime sleepiness, but to sleep latency, blood desaturation, adverse side effects, and more.
Worth noting: Dronabinol is already FDA approved for treating chemotherapy side effects. It has also been shown to improve upper airway tone in ways that are similar to the effects of using continuous positive airway pressure (CPAP), which may give patients who cannot tolerate CPAP therapy hope for a different treatment.
Is smoking marijuana different than consuming it in edible form?
Yes. Smoking (or vaping) marijuana introduces the same or similar problems that smoking cigarettes brings: inhaled particulate matter has a long-term detrimental effect on the respiratory system.
However, consuming marijuana in edible or capsule forms does not seem to result in the same systemic inflammation caused by inhaling smoke. This bodes well for people who are turning to marijuana for treatment of pain (such as those with fibromyalgia, arthritis, diabetic neuropathy, or multiple sclerosis).
Another synthetic cannabinoid, nabilone, is an oral treatment that may eventually find its way into cannibis-based approaches to pain management. Pain is the enemy of sleep, after all; finding adequate treatment for it, without stressing sleep architecture, is important for hundreds of thousands of Americans who suffer from it.
Still, conclusive large-scale evidence about using marijuana to improve sleep is lacking. It needs more and larger controlled studies to confirm its value as a prescribed treatment. Safety issues, side effects, and unintended consequences (such as the loss of valuable REM stage sleep) continue to be Big Picture concerns for medical researchers.
Patients in Washington state, who need to visit the sleep lab, should still feel safe reporting their own personal marijuana use to their doctors (types, amounts, delivery system, frequency). In this way, they can help sleep specialists to fine tune their own understanding about how this newly legalized drug may be of service to people with insomnia, pain issues, and sleep apnea in the future.
Expert Opinion on Emerging Drugs
Frontiers in Psychiatry
Journal of the American Medical Association
Journal of Clinical Sleep Medicine
Sleep Medicine Reviews