Insomnia, Sleep Apnea, Nightmares a Thing of the Past with Cannabis
Studies show that high-dose CBD and low-dose THC help treat sleep disorders.
Increased scientific interest in using cannabis and cannabinoids to help treat sleep disorders has resulted in a recent spike of studies. These investigate the ability of cannabis to help: sleep apnea, insomnia, REM behaviour disorder and nightmares (particularly associated with PTSD).
Studies found that cannabidiol (CBD) and delta-9-tetrahydrocannabinol (THC) may have therapeutic benefits for treatment of insomnia, while others considered synthetic cannabinoids as a treatment for sleep apnea and REM behaviour disorder. What is the potential here?
Recent work has demonstrated that the endocannabinoid system regulates circadian rhythm and sleep, and that a dysregulated endocannabinoid system is a consequence of irregular sleep.
Improvement of the endocannabinoid signaling (at the receptor level) restores previously abnormal sleep. Studies conducted in humans have revealed that THC and CBD have differential impact on sleep, and that depending on the dose and route of administration, different effects can be achieved.
Specifically, high-dose CBD and low-dose THC can have therapeutic effects on sleep. For example, in a study among people suffering from insomnia, administration of 160mg/day of CBD resulted in increased total sleep time and decrease nocturnal awakenings, likely indicating a higher depth and thus quality of sleep. On the other hand, low dose CBD administration was found to promote wakefulness in other studies.
Pre-clinical studies corroborated these findings, showing that CBD has beneficial effects on sleep quality and the sleep wake cycles. Furthermore, CBD oil has been associated with decreased insomnia and PTSD-related sleep disturbances. While some medicinal cannabis users experience earlier onset of sleep, and others did not experience this benefit. Altogether, these studies suggest that the mechanism of CBD in improving sleep quality and duration is related to its anxiolytic (anti-anxiety) effects, while the effects of THC vary depending on its concentration and route of administration.
Obstructive sleep apnea (OSA) is the most prevalent form of sleep-disordered breathing affecting approximately 10% of the adult population in North America. It is characterized by at least 15 episodes of cessation of breathing per hour (apneic events) during sleep due to the collapse of the upper airway. This, of course, is detrimental to the oxygenation state of all organ systems, and results in a myriad of symptoms such as daytime sleepiness, irritability, inability to focus etc.
Recently, it has been shown in pre-clinical studies that both endogenous (oleamide) and exogenous cannabinoids (THC and synthetic THC dronabinol) reduced the number of apneic events. These studies found that the reduction of apneic events was associated with serotonin-induced modulation of upper airway muscles, indicating that the cannabinoid signaling interacts with serotonergic signaling, making the upper airway more rigid and less likely to collapse, preventing the apnea from occurring.
Further work has demonstrated that this effect is conveyed via both CB1 and CB2 receptors, suggesting the potential for THC modulation of both receptors. Synthetic THC dronabinol was used in a preliminary study in humans with OSA, and the authors found that it was safe, well tolerated and efficacious in reducing apneas when administered in doses from 2.5 mg-10 mg daily. Taken together, THC and THC synthetic cannabinoids seem to be beneficial in treatment of OSA as shown by both human and animal studies and that the mechanism of action includes modulation of serotonin signaling which prevents the collapse of the upper airway.
Other sleep-related ailments, including REM behaviour disorder, insomnia, daytime sleepiness and sleep in pain conditions have also shown some promising data regarding the use of cannabinoids. Namely, CBD was found to suppress REM behaviour disorder and was tolerated well among the study participants. CBD and THC administered in a 1:1 ratio was found to mitigate daytime sleepiness. The same mixture of cannabinoids in form of Sativex was found to result in improvement in sleep quality among chromic pain patients.
Research conducted so far on cannabinoids and sleep is relatively limited. Nevertheless, the connection between the endocannabinoid system and regulation of circadian sleep patterns provides a theoretical link between cannabinoids, sleep and sleep-disordered breathing.
The work that has been conducted so far points out that the medium to high doses of CBD may be the winning strategy to improve sleep, while a mixture of 1:1 of CBD and THC may aid sleep in patients with chronic pain. As new formulations of products containing different doses of cannabinoids are produced and new cannabinoids discovered, the gaps in knowledge will become filled and the full potential of cannabinoids’ therapeutic benefit in sleep revealed.