Insomnia is a sleep disorder characterized by difficulty falling asleep, staying asleep or a combination. More than one third of the population suffers from this condition. Some sleep disturbances classified as Secondary insomnia are related to underlying health issues such as pain, anxiety, depression, asthma, Gerd as well as side effects from medications. Insomnia affects people of all ages, women more than men. Lack of sleep leads to a decrease in productivity, missed days of work and an increase in susceptibility to and exacerbation of other health related ailments.

When treating insomnia, one should attempt to identify any behaviors that may be causing poor sleep such as using caffeine, alcohol, tobacco or exercising within a short period of bedtime. Naps should be avoided; a routine should be established before bed that includes setting the tone for sleep consisting of a dark and quiet room. There are a number of prescription medications used to promote sleep however many have side effects such as amnesia, lack of coordination, blurred vision, confusion, anxiety, muscle pain or the potential for addiction. In particular, the class known as benzodiazepines are short term anti-anxiety medications with high potential for addiction. These effects may be more severe in the elderly causing potential balance disturbances and impaired thinking.

Cannabis has been used for thousands of years and in the 19th century, Dr. William, O’Shaugnessy recommended the use of cannabis for the treatment of insomnia. Cannabis carries no risk of overdose with an extremely low rate of possible addiction. Recent evidence has confirmed the endocannabinoid system’s role in regulating sleep with a current belief that conditions such as insomnia and chronic fatigue syndrome may be caused by an endocannabinoid deficiency. Marijuana has been shown to affect the sleep cycle causing increases in stage 3 sleep and decrease in REM sleep. Clinical research has confirmed the physiological effects of cannabis in treating insomnia. A study done in 1973 in the Journal of Psychopharmacology showed that 20mg of Delta9-tetrahydrocannabinol (THC) reduced the average time it took to fall asleep by more than thirty minutes.

One study determined cannabidiol (CBD), the non-psychoactive component of cannabis can reduce physiologic non-REM sleep and REM sleep in rats, may block anxiety induced REM sleep alteration. In a clinical trial published in 1981 in the Journal of Clinical Pharmacology, CBD was shown to increase time spent sleeping as well as decrease dream recall. This could be a potential treatment for patient with Post-Traumatic Stress Disorder (PTSD). Conversely, CBD has been shown to modulate waking by activation of neurons in the hypothalamus and dorsal raphe nucleus, two areas involved in alertness. This may lead to a decrease in feeling tired in the morning or sleepy during the day.

There has been a resurgence of interest in marijuana research. A study published in 2008 concluded that the activation of the CB1 receptor by THC leads to an induction of sleep. In 2010, a human trial conducted at McGill University in Montreal and published in the journal of Anesthesia and Analgesia reported that synthetic THC (nabilone) was more effective than amitriptyline (a tricyclic antidepressant commonly used to treat insomnia) in improving sleep quality in patients with fibromyalgia and was well tolerated. In addition, many studies have shown that sleep quality has improved in patients with Cancer and multiple sclerosis. Studies suggest cannabis can be used as a safe and effective treatment for insomnia secondary to sleep apnea. A majority of patients suffering from insomnia also experience depression and anxiety therefore the treatment of medical cannabis for insomnia results in a dual benefit by improving mood as well.

These studies reiterate the importance of the endocannabinoid system in regulating sleep and thus playing a role in memory, pain and homeostasis. I strongly suggest consulting a health care provider when seeking out treatment for any chronic and debilitating medical condition that affects one’s quality of life. Moreover, when discussing cannabis treatment, it is imperative that one consults with a provider with clinical experience and knowledge in this field similar to any other specialty in medicine. It is necessary to individualize one’s treatment plan considering other medical diagnoses, prior history of marijuana use to determine the correct strain, administration route, dose, etc. Delivery methods range from vaporization, tinctures, tea, edibles. If a patient desires a full night sleep an edible may be a first option as it has the longest duration of action. Vaporization may be a good alternative for patients who wake up throughout the night or have difficulty going back to bed due to its fast onset. Indica strains are excellent sleep inducers and Cannabinol (CBN), one particular cannabinoid seems to be the most effective in treating sleep issues. The reality is people suffering from chronic debilitating medical conditions like insomnia are seeking cannabis for medicinal relief not for the euphoria. Medical marijuana is a viable alternative to sleeping pills with far great benefit and a much smaller side effect profile.

Dr. Michelle Weiner, is an Interventional Pain Management Physician board certified in Physical Medicine and Rehabilitation. She completed her residency and fellowship training at the University of Miami. Her specialty is focused on prevention, treatment, reversal of health deterioration, increasing function and managing pain. Dr. Weiner focuses on diagnosing and treating spine and musculoskeletal pain as well as chronic migraines.

Spine and Wellness Centers of America