Cannabis Can Reduce Sleep Disruption or Exacerbate Symptoms of Insomnia

Approximately 70 million Americans have insomnia or other types of sleep disorders. Insomnia is one of the most common sleep disorders, affecting about 30% of adults at some point in their lives, with around 10% experiencing chronic insomnia.

Did you know that insomnia is one of the most common uses of medical cannabis? As insomnia isn’t a qualifying health condition on its own, patients can be certified for a medical card if it is a symptom associated with another diagnosis, like neuropathic pain.

While many patients share that they get a better night of sleep when they take medical cannabis, it may not be helpful for everyone. In fact, some people can find that cannabis can disrupt sleep and make symptoms of insomnia worse.

Let’s learn some facts about how cannabis affects sleep and what to look for if you think medical marijuana use is causing you to experience more frequent sleep disturbances.

How Does Poor Sleep Quality Impact Your Health?

Many people do not know that poor sleep quality (or lousy sleep hygiene) can really damage our health. Even if you eat a nutritious diet, optimize your physical fitness, and live a healthy lifestyle, you could still experience higher-than-average health risks caused by lack of sleep.

Your body and brain require “mandatory slow-down periods” to maintain good health. If you are not getting enough sleep daily (7-9 hours) and your sleep schedule is inconsistent, you are significantly damaging your health.

There are many health risks associated with chronic sleep disturbances:

Cardiovascular Disease

Chronic insomnia significantly increases the risk of cardiovascular diseases, including hypertension, coronary artery disease, and heart failure. Sleep is essential for maintaining heart health, as it lowers the heart rate and blood pressure, reducing stress on the cardiovascular system. Insufficient sleep disrupts these processes, leading to elevated blood pressure and inflammation, which can damage arteries and the heart over time.

Chronic sleep deprivation is associated with increased levels of stress hormones, which further contribute to cardiovascular strain and a higher likelihood of heart attacks and strokes. Maintaining good sleep quality is thus critical for cardiovascular health and overall longevity.

Obesity and Metabolic Syndrome

Poor sleep quality can lead to obesity and metabolic syndrome, a cluster of conditions that increase the risk of diabetes, heart disease, and stroke. Chronic insomnia disrupts the balance of hormones that regulate hunger, such as ghrelin and leptin, leading to increased appetite and cravings for high-calorie foods.

Additionally, sleep deprivation impairs insulin sensitivity, making it more challenging for the body to regulate blood sugar levels. This can result in weight gain and the development of metabolic syndrome. Ensuring adequate and quality sleep is vital for maintaining a healthy weight and preventing metabolic disorders.

Mental Health Disorders

Chronic insomnia is closely linked to a range of mental health disorders, including depression, anxiety, and bipolar disorder. Sleep plays a crucial role in emotional regulation and cognitive function. Lack of sleep can exacerbate symptoms of mental health conditions by increasing stress, irritability, and mood swings.

Furthermore, insomnia can disrupt the brain’s ability to process emotions and cope with stress, leading to a vicious cycle where poor sleep and mental health issues perpetuate each other. Addressing sleep quality is a critical component of managing and treating mental health disorders.

Impaired Immune Function

Chronic insomnia weakens the immune system, making individuals more susceptible to infections and illnesses. During sleep, the body produces and releases cytokines, proteins that help fight off infections and inflammation. Insufficient sleep disrupts the production of these protective proteins, reducing the body’s ability to combat pathogens effectively.

Impaired immune response can increase the frequency and severity of common colds, flu, and other infections. Additionally, chronic sleep deprivation can slow recovery from illness and increase the risk of developing chronic conditions such as autoimmune diseases. Prioritizing sleep is essential for a robust immune system and overall health.

Diabetes

Chronic insomnia is a significant risk factor for the development of type 2 diabetes. Poor sleep affects the body’s ability to regulate glucose metabolism and increases blood sugar levels. Insufficient sleep impairs insulin sensitivity, making it difficult for cells to absorb glucose efficiently. Over time, this can result in consistently elevated blood sugar levels and the onset of diabetes.

Additionally, sleep deprivation can increase cravings for sugary and high-carbohydrate foods, further exacerbating the risk of diabetes. Ensuring adequate and restorative sleep is crucial for maintaining healthy blood sugar levels and preventing diabetes.

Cognitive Decline and Dementia

Chronic insomnia is linked to cognitive decline and an increased risk of dementia, including AlzheimAlzheimer’se. Sleep is vital for brain health, as it allows for the clearance of neurotoxic waste products, including beta-amyloid plaques, which are associated with AlzheimAlzheimer’ssleep quality disrupts these processes, leading to the accumulation of these harmful substances and contributing to cognitive impairment.

Chronic sleep deprivation affects memory consolidation, problem-solving skills, and attention. Over time, these deficits can lead to significant cognitive decline and increase the risk of developing dementia. Prioritizing sleep is essential for preserving cognitive function and preventing neurodegenerative diseases.

Reduced Life Expectancy

Chronic insomnia is associated with a reduced life expectancy. Persistent sleep deprivation has a cumulative effect on overall health, contributing to the development of various chronic conditions, including cardiovascular disease, diabetes, and obesity.

Poor sleep quality is linked to increased inflammation and oxidative stress, which can accelerate aging and damage vital organs. The combination of these factors leads to a higher risk of premature death. Ensuring adequate and high-quality sleep is crucial for promoting longevity and overall health.

Different Types of Sleep Disorders

A variety of things can cause insomnia, and sometimes, a combination of one or more factors causes sleep disturbance. The symptoms are the same, from problems falling asleep to short sleep duration, but a diagnosis is essential in order to treat it successfully.

You can have one (or more than one) of the different types of sleep disorders:

Periodic and Chronic Insomnia

Insomnia is a common sleep disorder where individuals have trouble falling asleep, staying asleep, or getting restful sleep. It can be short-term (acute) or long-term (chronic). Acute insomnia often results from stress or traumatic events and lasts for a few days or weeks.

Chronic insomnia lasts for a month or longer and can be caused by underlying conditions, medications, or lifestyle factors. Symptoms include difficulty falling asleep, waking up frequently during the night, waking up too early, and feeling tired upon waking. Treatments include improving sleep habits, therapy, and medications.

Sleep Apnea

Sleep apnea is a serious disorder in which breathing repeatedly stops and starts during sleep. There are two main types: obstructive sleep apnea (OSA), where throat muscles relax excessively, and central sleep apnea (CSA), where the brain does not send signals to the muscles controlling breathing.

Symptoms include loud snoring, gasping for air during sleep, and excessive daytime sleepiness. Risk factors include obesity, age, and a family history of the condition. Treatments range from lifestyle changes and continuous positive airway pressure (CPAP) therapy to surgery in severe cases.

Restless Legs Syndrome (RLS)

Restless legs syndrome (RLS) is a condition characterized by an uncontrollable urge to move the legs, usually due to uncomfortable sensations. These sensations are typically described as aching, tingling, or crawling, and they usually occur in the evening or nighttime when lying down.

Movement temporarily relieves the discomfort. RLS can lead to difficulty falling asleep and staying asleep, resulting in daytime fatigue and decreased quality of life. The exact cause of RLS is unknown, but it can be associated with certain chronic diseases, medications, or pregnancy. Treatments include lifestyle changes, medications, and addressing underlying conditions.

Narcolepsy

Narcolepsy is a chronic sleep disorder characterized by overwhelming daytime drowsiness and sudden attacks of sleep. People with narcolepsy often find it difficult to stay awake for long periods, regardless of the circumstances. Symptoms include excessive daytime sleepiness, cataplexy (sudden loss of muscle tone), sleep paralysis, and hallucinations.

The exact cause is unknown, but it may involve genetic factors and abnormalities in the brain that regulate REM sleep. Treatment focuses on managing symptoms with medications and lifestyle changes, such as scheduled naps and good sleep hygiene.

Circadian Rhythm Sleep Disorders

Circadian rhythm sleep disorders occur when the body’s clock is misaligned with the external environment. This misalignment can make it difficult to sleep at desired times, stay asleep, and wake up.

Common types include delayed sleep phase disorder (falling asleep and waking up later than desired), advanced sleep phase disorder (falling asleep and waking up earlier than desired), and shift work disorder (sleep problems due to irregular work hours). Treatments often involve light therapy, melatonin supplements, and maintaining a consistent sleep schedule.

Parasomnias

Parasomnias are disruptive sleep disorders that include abnormal behaviors, movements, emotions, perceptions, and dreams occurring while falling asleep, sleeping, or waking up. Common parasomnias include sleepwalking, sleep talking, night terrors, and REM sleep behavior disorder (acting out dreams). These disorders can result in injuries and poor sleep quality.

The exact cause of parasomnias is often unknown, but stress, sleep deprivation, medications, or other underlying conditions can trigger them. Treatment may involve improving sleep hygiene, medications, and addressing any underlying conditions.

REM Sleep Behavior Disorder (RBD)

REM sleep behavior disorder (RBD) is a condition where people physically act out vivid, often unpleasant dreams with vocal sounds and sudden, violent arm and leg movements during REM sleep.

Unlike normal REM sleep, where the body is typically paralyzed, those with RBD retain muscle tone and can move. This disorder can lead to injuries and is often associated with neurodegenerative conditions like Parkinson’s disease.

Sleep-Related Eating Disorder (SRED)

Sleep-related eating disorder (SRED) involves episodes of eating during sleepwalking, with little to no memory of the event. These episodes usually occur during the first half of the night and can include consuming strange or unsafe foods.

SRED can lead to weight gain, injuries, and disrupted sleep. It is often associated with other sleep disorders or certain medications. Treatment includes improving sleep hygiene, avoiding triggers, and sometimes medications to reduce episodes.

Bruxism (Teeth Grinding)

Bruxism is a condition where individuals grind or clench their teeth during sleep. This can lead to jaw pain, headaches, damaged teeth, and disrupted sleep. The exact cause is not always clear, but it is often linked to stress, anxiety, sleep apnea, or misaligned teeth. Treatment includes managing stress, wearing a mouthguard at night, and treating underlying conditions.

Hypersomnia

Hypersomnia is characterized by excessive daytime sleepiness or prolonged nighttime sleep. Individuals with hypersomnia can fall asleep at any time, even while working or driving. This disorder can result from other sleep disorders, medications, or medical conditions like depression. It impacts daily functioning and quality of life.

How is Insomnia Diagnosed?

You may think you have insomnia symptoms, but how do you actually know if you have a clinical sleep disorder? There are six primary ways healthcare providers can diagnose insomnia and determine whether more than one condition contributes to sleep disturbances.

1. Sleep Diary

A sleep diary is a simple and effective tool for patients to record their sleep patterns, including bedtimes, wake times, night awakenings, and daytime naps. It often includes notes on diet, exercise, and mood. This diary helps doctors identify patterns and potential triggers of insomnia over a one—to two-week period. By tracking these details, healthcare providers can gain insights into lifestyle factors and habits that might contribute to sleep disturbances.

2. Actigraphy

Actigraphy involves wearing a wristwatch-like device called an actigraph that monitors movement. The device records activity and rest periods, objectively measuring sleep patterns over days or weeks. It helps detect irregularities in sleep-wake cycles, such as those seen in circadian rhythm disorders. Actigraphy is particularly useful in distinguishing insomnia from other sleep disorders like sleep apnea or restless legs syndrome.

3. Polysomnography (PSG)

Polysomnography is an overnight sleep study conducted in a sleep lab. It monitors various physiological parameters, including brain waves (EEG), eye movements (EOG), muscle activity (EMG), heart rhythm (ECG), breathing patterns, and oxygen levels. PSG is considered the gold standard for diagnosing sleep disorders. It helps identify sleep apnea, periodic limb movement disorder, and other conditions that can cause or worsen insomnia.

4. Multiple Sleep Latency Test (MSLT)

The MSLT measures how quickly a person falls asleep in a quiet environment during the day. It involves several scheduled naps throughout the day at two-hour intervals. This test is primarily used to diagnose narcolepsy and hypersomnia. In the context of insomnia, it helps determine if excessive daytime sleepiness is present and if it might be due to another underlying sleep disorder.

5. Home Sleep Apnea Testing (HSAT)

HSAT is a simplified version of polysomnography that can be conducted at home. It uses portable monitors to record breathing, heart rate, oxygen levels, and sometimes limb movements. This test is used to diagnose sleep apnea, which can contribute to insomnia. While not as comprehensive as PSG, it is more convenient and accessible for patients suspected of having obstructive sleep apnea.​

6. Blood Tests

Blood tests can help identify underlying medical conditions that may cause or contribute to insomnia. These tests check for thyroid problems, anemia, or vitamin deficiencies. Identifying and treating these conditions can improve sleep quality and alleviate insomnia symptoms.

Understanding the Role of Cannabis For Sleep Disorders

Some patients share that medical cannabis has helped them sleep better. Others find that getting deep sleep after taking cannabis is virtually impossible. More cannabis research is needed to understand why the same strains have different effects on different people.

What science has figured out is how cannabis affects sleep. Why does medical cannabis work so well for some people with chronic sleep problems? Cannabinoids (and terpenes) affect the human body in some interesting ways.

Cannabis and the Endocannabinoid System

Cannabis interacts with the body’s endocannabinoid system (ECS), critical in regulating various physiological processes, including sleep. The ECS consists of receptors (CB1 and CB2) and endocannabinoids. THC, the psychoactive component of cannabis, binds to CB1 receptors in the brain, promoting sleepiness by affecting the sleep-wake cycle and reducing sleep latency.

CBD, another major component, influences the ECS indirectly, potentially alleviating anxiety and promoting relaxation, which can enhance sleep quality. This interaction helps modulate the balance of neurotransmitters and hormones involved in sleep regulation.

The Sedative Effects of THC

THC is known for its soothing properties, which can help individuals fall asleep faster. By binding to CB1 receptors in the brain, THC reduces the release of neurotransmitters like norepinephrine, which is associated with alertness and arousal.

Fewer “hyper-” alert” neuro” transmitters firing off can lead to quicker sleep onset and increased sleepiness. However, high doses of THC may disrupt the sleep cycle and reduce overall sleep quality over time. It is crucial to balance the dosage to get the effects you want without crossing the line where the potency is going to keep you up all night.

The Anxiolytic Properties of Cannabidiol (CBD)

CBD is renowned for its anxiolytic (anxiety-reducing) effects, which can indirectly promote better sleep. By interacting with serotonin receptors, CBD can reduce anxiety and stress, common culprits of insomnia. Lower anxiety levels help create a more conducive environment for sleep, allowing individuals to fall asleep more quickly and experience fewer disturbances during the night.

Unlike THC, CBD does not have psychoactive effects, making it a preferred choice for those looking to avoid the high associated with cannabis. In fact, CBD has a unique ability to reduce some of the psychoactive effects of cannabis and make the experience milder.

Cannabis May Cause a Reduction in REM Sleep

One significant effect of cannabis, mainly THC, is the reduction in REM (rapid eye movement) sleep. REM sleep is the stage associated with dreaming and is crucial for cognitive functions like memory and emotional regulation.

Cannabis users often report fewer dreams, which indicates less time spent in REM sleep. While this reduction can be beneficial for individuals with PTSD who experience distressing nightmares, it might have long-term implications for cognitive health and emotional stability if REM sleep is consistently reduced.

Increased Deep Sleep Phases

While cannabis reduces REM sleep, it tends to increase deep sleep (slow-wave sleep). Deep sleep is essential for physical restoration, muscle repair, and overall bodily recovery. Think about this most important sleep cycle as mandatory daily maintenance on your body and brain.

Cannabis can enhance the restorative aspects of sleep by promoting longer periods of deep sleep, making users feel more refreshed upon waking. Sufficient deep sleep can also help boost the immune system and contribute to reduced inflammation.

Impact on Sleep Latency

Sleep latency, or the time it takes to fall asleep, can be significantly reduced by cannabis use. Both THC and CBD have been shown to decrease sleep latency, helping individuals fall asleep faster. This effect is particularly beneficial for those who struggle with the initial phase of falling asleep due to anxiety or pain.

However, the effectiveness of cannabis in reducing sleep latency can vary based on the strain, dosage, and individual tolerance levels. The culprit for sleep disturbance is usually higher potency THC. Our physicians suggest using the lowest potency and quantity to get a better night of sleep.

Cannabis Causes Sleep Cycle Alterations

Not only do you have to spend enough time in each sleep phase, but you have to make sure the sequence of those sleep phases is what your brain actually wants. It sounds complicated because it really is.

The bulk of your time asleep (75%) is spent in the NREM stages, and most of your sleep time will be spent in the N2 stage. However, during your average night of sleep, your body and brain will pass through 4 to 5 sleep cycles that average 90 to 110 minutes in duration.

See why you need more than seven hours of sleep? Your Mom was right. Some studies have found that regular cannabis use (1-2 times weekly) can alter the human sleep cycle and shorten the duration of the rest phases. Fragmented or irregular sleep patterns are as bad for your health as not getting 7-9 hours per evening.

The Impact of Cannabis Tolerance and Dependence on Sleep Quality

Over time, regular cannabis use can lead to tolerance, where higher doses are required to achieve the same sleep-inducing effects. This can result in increased consumption and potential dependence. Long-term use may also alter the body’s body’s ability to regulate sleep without the aid of cannabis, leading to withdrawal symptoms such as sleep disturbances and vivid dreams when usage is stopped.

Withdrawal and Sleep Disturbances

Discontinuing long-term cannabis use can lead to withdrawal symptoms that negatively impact sleep. These symptoms include difficulty falling asleep, vivid dreams or nightmares, and increased time spent in REM sleep (REM rebound). These disturbances can last for several weeks as the body readjusts to the absence of cannabis.

Potential Benefits for Sleep Disorders

Cannabis has shown potential benefits for various sleep disorders, including insomnia, sleep apnea, and restless leg syndrome. For instance, THC can reduce the frequency of breathing interruptions in sleep apnea patients, while CBD can alleviate symptoms of anxiety-related insomnia.

The anti-inflammatory and analgesic properties of cannabis can also help individuals with chronic pain achieve better sleep. However, the efficacy and safety of cannabis for these conditions require further clinical research to establish standardized treatment protocols.

Will Medical Cannabis Help With Your Chronic Insomnia?

Living with chronic sleep disturbance comes with an increased risk of physical and mental health problems. Medical marijuana is helpful for some people who struggle to sleep well, whereas other people have difficulty sleeping after consuming marijuana.

If you struggle to induce sleep or regularly sleep less than six hours per night, other symptoms or factors (such as prescription medications) may be causing your sleep deficits. Extended periods of insomnia put your health at risk, but there are effective and alternative health options to explore.

Talk to a healthcare provider for a complete review, especially if you are experiencing daytime sleepiness. If you have one or more qualifying health conditions and you are applying for your medical marijuana card, get expert advice from one of our caring healthcare providers.

Robert Dotson Jr., M.D.

A U.S. Army Reserve Veteran (Major), Dr. Dotson graduated from the University of Tennessee Center for the Health Sciences, College of Medicine. Dr. Dotson also served as Clinical Adjunct Faculty at the Debusk College of Osteopathic Medicine. For more than thirty years, Dr. Dotson has provided quality patient care specializing in ophthalmology and family medicine, and he is a Certifying Physician for DocMJ.