Marijuana as a Sleep Aid for Insomnia and Nightmares
There is increasing legalization of the use of marijuana within the United States and across the world. As such, it is important to understand the research supporting the role of cannabis as a sleep aid. It may help to treat insomnia and to ease nightmares associated with anxiety and post-traumatic stress disorder (PTSD). There may be potential side effects, however, and its usefulness requires an assessment of the costs and benefits.
The Science of Marijuana
There are over 100 types of chemicals called cannabinoids present in marijuana. The receptors for these chemicals are found throughout the central nervous system, affecting the function of the brain. Two cannabinoids are found in the largest amounts: delta-9 tetrahydrocannabinol (THC) and cannabidiol (CBD). These may have differing effects on sleep and mood.
There are two commonly used species of plants within the genus cannabis: indica and sativa. Generally, indica is more frequently used for the treatment of chronic insomnia, anxiety, and pain. Sativa is more often used to relieve nightmares.
The blends and concentrations of THC and CBD within the species may vary. THC may be associated with hallucinations, paranoia, feeling high, and other psychoactive effects. CBD may have a greater benefit in reducing anxiety and improving insomnia. Cannabinol, a sedating chemical, seems to be found in increasing levels as marijuana ages and dries out.1
Administration of the drug may occur in several ways. It can be smoked via blunts, joints, or pipes. Oils, concentrates, or tinctures may be placed in the mouth or breathed through vaporizers (commonly known as vaping). Marijuana may also be consumed via edibles (brownies, cookies, and the like), but the delay in the onset of action of several hours makes this method of delivery less desirable when it is used as a sleep aid.2
How Marijuana Affects Sleep
Federal restrictions have limited scientific research into the use of marijuana for many years. As legal restrictions are lifted, increasing access for medical and recreational uses will also allow further study of the potential medicinal utility. Nevertheless, there are some early findings in the body of scientific literature that deserve special attention.3
Preliminary research suggests that CBD may have a greater impact on enhancing sleep. THC may decrease the time it takes to fall asleep (sleep latency), but may impair sleep quality over the long term by suppressing slow-wave sleep.
Interestingly, synthetic cannabinoids, including nabilone and dronabinol, may have short-term benefits for sleep apnea due to impacts on serotonin. This potential impact requires further study, and currently there are no medications available for the treatment of the condition. Instead, the condition is most often treated with continuous positive airway pressure (CPAP) therapy or oral appliance use.
CBD also suppresses REM sleep, which may benefit those who experience the dream-enactment behaviors of REM sleep behavior disorder. Withdrawal from marijuana use may cause a rebound of REM sleep, and this may have important implications in some people.4
Synthetic nabilone may also reduce nightmares associated with PTSD and relieve chronic pain.5
The Problems Associated With Cannabis Use
Though legalization and access to cannabis has increased markedly in the past several years, federal law presents a potential legal jeopardy. Possession of marijuana, or transport across state lines, can lead to criminal prosecution in certain jurisdictions. There may also be other legal implications, including potential risk of job loss.3
As with the use of any medication, there may be potential risks and side effects associated with the use of marijuana. Impairment of cognition, judgment, and driving safety may occur. These side effects may not be fully understood due to the limited scientific research that has been conducted. Further funding of clinical research trials would help to elucidate these issues.
There is some concern that those who use marijuana frequently suffer from persistent sleep difficulties. The cause-and-effect relationship remains uncertain. It is possible that insomnia persists, requiring the drug’s ongoing use to alleviate the symptoms, or that the marijuana use itself leads to the chronic insomnia. Daily use leads to more sleep disturbances, according to studies.
Cannabis dependence is more often associated with indica use. Withdrawal from the chronic use of marijuana seems to worsen insomnia and may lead to vivid dreams, especially among men. Women more commonly complain of anxiety and nausea during periods of withdrawal.6
Marijuana can also be an expensive treatment option. If used daily as a sleep aid, these expenses may quickly exceed hundreds (and eventually thousands) of dollars. These costs are often not covered by medical insurance. In many cases, more effective treatments with fewer potential side effects may be preferred.
Marijuana may have an important role in treating insomnia, pain, anxiety, PTSD, and nightmares—but this remains to be seen. Further research is needed to determine the appropriate role in treatment. As part of this, the optimal chemical composition, concentration, and method of delivery must be determined. Side effects, including the potential for long-term harms, must be delineated so users can make informed decisions. Regulations to ensure quality standards and safety are paramount.7
For those who suffer from chronic insomnia, consider evaluation by a board-certified sleep physician. As needed, a diagnostic sleep study may identify the cause of difficulty falling asleep or sleeping through the night. Sleep aids, including the use of prescription medications, may be used over the short term. In addition, cognitive behavioral therapy for insomnia (CBTI) may provide relief without the potential for any side effects. Our Doctor Discussion Guide below can help you start a conversation with your doctor about finding the best treatment option.8