How medical cannabis can be used in the treatment of insomnia has been of great interest to researchers and patients alike. Wide-spread reliance on drugs such as benzodiazepines, barbiturates and other strong sedatives has been up for public debate due to their risk of drug dependence and withdrawal symptoms. In light of this, utilising cannabis and cannabinoid medicines in treating sleep disorders is gaining serious traction.
Approximately one third of Australians have sleeping problems, including difficulty getting to sleep and staying asleep. Sleeping complaints turn chronic when an individual has difficulty falling asleep or maintaining restorative sleep for more than one month.
If you’ve ever had sleeping troubles, even for a short period of time, you know how debilitating it can be. There is a reason sleep deprivation has been used as torture, its effects on mood, memory, gastrointestinal health and immunity can be dramatic.
The Endocannabinoid System (ECS) can be found in all animals, from invertebrates to humans. This system produces endogenous (originating from within the body) cannabinoids, and its receptors react to ingested cannabis as well as pharmacological interventions. The ECS has been shown to play a significant role in sleep patterns and the circadian rhythm, our biological clock.
Cannabis has been used to promote sleep for centuries. In the last few decades anecdotal evidence and researchers’ curiosity has given rise to increased interest and clinical research into the modern application of cannabis for sleep disorders.
By and large there are three cannabinoids most posited to improve sleep disturbances: THC, CBD and CBN.
Both CBD and THC, paradoxically, have the capacity to be either sedating or alerting. These actions are apparent in a dose dependent manner and points to the concept of the entourage effect: elucidated by Raphael Mechuloam this theory states cannabinoids (and indeed other plant compounds) enact their beneficial effects most potently when delivered in combination.
The dose dependent efficacy of cannabinoids can also explain the conflicting results regarding human trials using cannabis for insomnia. Yet there is enough evidence suggesting its positive impact on sleep to continue investigating.
CBN, a lesser known cannabinoid than its famous counterparts THC and CBD, comes from the oxidation of THC. CBN instills a state of tranquility and relaxation (much like CBD), yet despite being derived from THC it has a significantly reduced psychoactive response. Whether it has a sedating action on its own, or acts synergistically with THC is yet undiscovered. However it is still widely used in regions where cannabis is legal in sleep formulations.
The effects of CBD and CBN on pain and systemic inflammation have not yet been concretely linked to their impact on insomnia. However, in trials using medical cannabis to treat other chronic or autoimmune disorders, the effects on sleep have been significant enough for researchers to take note and in some cases have measurably improved patients quality of life.
There has been much stirring in the recreational cannabis landscape surrounding terpenes, and this association with recreational use should not discredit the potential that terpenes have in treating medical conditions, specifically sleep.
Terpenes are aromatic compounds found in a vast number of plants that have therapeutic use in their own right. Those most associated with improving sleep disturbances include pinene, myrcene, limonene and linalool. These terpenes, amongst others, also engage in the entourage effect – acting synergistically with cannabinoids to improve symptoms.
More research needed to achieve optimum sleep formulations
While there is plenty of research out there regarding medical cannabis and insomnia, as well as endless anecdotal accounts, further investigation will aid in determining optimum formulations (without side effects on next day cognition) that will be efficacious for those suffering chronic sleep disorders.
In Australia currently two clinical trials are investigating this intriguing topic, in NSW and WA. There are high hopes for clinical trials here and internationally to facilitate speedier access to quality treatments for insomnia patients throughout the globe.