A Complicated Profile: Balancing the Benefits with the Risks

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Sleep is consistently one of the primary reasons why people turn to cannabis-based therapies. Within RYAH Data it’s the fifth most common ailment treated, no matter the demographic. This preference is replicated across the literature.  

 

For example, a 2014 survey of medical cannabis patients in Hawaii found a full 45 percent of respondents used the plant to relieve insomnia. A newer study, from 2017, reported sleep disorders as the fourth most common condition treated among patients in Canada. Clearly, patients find the plant valuable as a sleep aid.

 

But the relationship between cannabinoids and sleep isn’t as clear cut in the research. Most literature reviews recognize the potential of cannabis for treating sleep disturbances but also find several concerns. As the authors of the 2017 article “Cannabis, Cannabinoids, and Sleep: a Review of the Literature” determined, “Research on cannabis and sleep is in its infancy and has yielded mixed results.”

 

Last week, RYAH explored the exciting and beneficial potentialities cannabinoids hold for sleep. This week, we explore the complicated underbelly, where sometimes cannabis doesn’t make sleep better, no matter how many patients report the benefits.

 

The Yin and Yang of Cannabinoids for Sleep

 

Although patients rely heavily on cannabis to improve their sleep, it looks as if dose size, strain profile, and frequency all impact the therapeutic value. 

 

Short bursts of low doses and low-THC products could make sleep better, but with too much THC too frequently, patients might find themselves addicted to cannabis for sleep. 

 

Studies are starting to discover that patients become trapped in a cycle of chronic cannabis use whereby cannabis is required to get to sleep, but where cannabis also deteriorates the quality of sleep. 

 

A Catch-22 of Chronic Use

 

As researchers Gustavo A. Angarita et al. report, chronic users experience a catch-22, balancing cannabis for sleep and developing a tolerance. As they discovered, “increased use contributes to worsening overall sleep and therefore leads to continued and greater use.” 

 

While cannabis might consistently have good reviews when researchers ask patients about its sleep-improving effects, the science reveals that chronic users often fall into a period of problematic use. Many studies find that study participants who have little to no experience with cannabis have much better improvement to sleep than those who would be considered chronic users. 

 

Heavy users begin to build tolerance, thereby upping the dose size, frequency, or THC. However, these are all tactics that may eventually contribute to negative consequences for sleep. The current scientific consensus is that cannabis does not measurably improve sleep latency or reduce time spent awake during the night, especially with frequent use. 

 

Cannabis may also impact the duration and frequency of rapid eye movement (REM) sleep. REM is a crucial phase of sleep, which improves learning, memory, and mood. With unhealthy unhealthy sleep cycles, including reduced REM time, people may experience lower cognitive ability, reduced coping skills, and several physical health issues. If the preliminary studies are true and chronic cannabis use damages the duration and frequency of REM sleep, could this impact someone’s physical and mental well-being over the long term?

 

Sleep Benefits Impacted by Increasing Tolerance 

 

Angarita et al. highlighted some of these long-term problems in their piece “Sleep abnormalities associated with alcohol, cannabis, cocaine, and opiate use: a comprehensive review.” They describe how chronic use created a tolerance to many, if not all, of the original sleep benefits. In their words, “With chronic use, individuals develop tolerance to most of the effects observed in naïve users, including its sleep-inducing effects and slow-wave sleep enhancement.”

 

In a 2015 study from Addictive Behaviors, researchers discovered that if patients preferred stronger types of cannabis (higher THC) for sleep disorders, these patients were at greater risk for developing cannabis use disorder. Tolerance development (the need for higher and stronger doses) is an aspect of cannabis use disorder. Like Angarita et al., this is yet another study that connects the long-term use of cannabis for sleep with tolerance.

 

According to the DSM-5, cannabis use disorder is “the continued use of cannabis despite impairment in psychological, physical, or social functioning.” Approximately nine percent of people who use cannabis develop it, and while the pathology is not totally understood, it seems at least partially connected to prolonged, heavy cannabis use. 

 

One of the primary signs of cannabis withdrawal and the main trigger of relapse for people with cannabis use disorder is the onset of sleep disturbances. In one investigation, 65 percent of study participants reported sleep issues as the main reason for relapse following an attempt to quit. Nightmares, vivid dreams, and other disturbances are all common withdrawal symptoms and may linger for up to 45 days after ceasing consumption. The lengthy duration of this challenging withdrawal symptom leads many people to relapse.

 

It’s a daunting back and forth, as patients use cannabis to fight sleep disturbances but over time grow a tolerance. Tolerance increases the drive to up the dose and to increase the frequency of use. Together, these eat away at all the therapeutic value for sleep. Furthermore, cases of cannabis use disorder compound all these issues on top of each other. 

 

Controlled Clinical Trials Needed to Clarify Impact on Sleep

 

No matter the risk, the sheer popularity of the plant for sleep indicates that cannabis will continue to be a go-to at-home remedy for sleep disturbances. It would take a significant effort to convince patients that the benefits they report feeling are, in fact, detrimental over the long run. 

 

Much of the research thus far is limited in scope and approach. For example, some studies rely on patient-reported information exclusively, from sleep quality details to strain type. The 2017 piece from the Journal of Substance Abuse Treatment highlighted above worked solely with patients in a medication trial for cannabis use disorder. In the Addictive Behaviors study exploring patient-preferred strains of cannabis for sleep disturbances, they relied on patient supplied products, leaving a lot of room for error.

 

Almost all studies in this category also fail to appropriately control for cannabinoid profile, dose, and frequency of use. Plus, nobody has examined the role of terpenes on sleep. And, there is no research narrowing down the suggested dose or duration of treatment to avoid tolerance and the many detrimental effects.

 

As is often the case with medical cannabis research, the decades of scientific suppression have made it challenging to perform well-controlled human studies on how the plant impacts sleep. Until recently, it was much easier to secure funding to examine the health risks of cannabis than the potential benefits. Therefore, the research often comes from an addictions perspective rather than an investigation into its therapeutic value.

 

As it stands, cannabis remains complicated. It is a plant with hundreds of compounds, thousands of profiles, and, therefore, many different faces. For some patients it has proven to be an effective natural option for sleep; for others, it may have become a problematic bedtime habit. Until then, patients should work closely with a healthcare professional to balance the benefits and risks of cannabis for sleep.