Sleep and Cannabis


     The ability to get a good night’s sleep is critical to maintaining health and well being and can impact a whole host of medical and psychological issues. These would include chronic pain, neuropathic pain, anxiety, depression, fatigue, mental alertness, mood regulation, and feeling of wellbeing.  While sleep requirements may differ from person to person, usual recommendations are for 7-9 hours of sleep on average per night for optimum health. Less than this is detrimental, and also excessive sleep can be harmful as well!


     Millions of individuals worldwide suffer from sleep disorders and are prescribed a wide array of pharmaceutical and naturopathic drugs. These may include Valium, Soma, Lunesta, Ambien, Klonopin, Trazadone, melatonin, tryptophan, valerian, etc.…

Many of these pharmaceuticals can also have adverse side effects, and users quickly become dependent on them and may require increasing doses. Sometimes these drugs lose their effectiveness as well over time. Once you are committed to one of these medications, it will become difficult to sleep without having them every night. In my own experience with patients, I have seen the use of cannabis help to eliminate these drugs or allow the patient to reduce their dosages. One of the most common and universal effects that I have seen with patients using cannabis is to promote and aid sleep.


     Some common sleep disorders include sleep apnea, early awakening, difficulty in falling asleep, inability to stay asleep, nightmares, narcolepsy, daytime sleepiness and fatigue. Insomnia is a general term and refers to the inability to obtain adequate sleep by being unable to fall asleep or to stay asleep. Patients suffering from PTSD often have difficult sleep patterns and can be awoken from sleep due to nightmares and adverse dreams. These events normally occur during REM (rapid eye movement) sleep and can be prevented by limiting the REM sleep phase. The use of cannabis overall has an inhibitory effect on REM sleep thereby often eliminating the phase of sleep where dreams and nightmares occur. Note that REM sleep is not required for adequate rest and rejuvenation, as other sleep phases accomplish this task for your body.


     While there are multiple stages and possible sleep pattern cycles, in general, there are 5 distinct phases of sleep.


Stage 1 – this is the first sign of sleep and the transitional phase between being awake and asleep. A short stage one phase will allow you to fall asleep quickly.


Stage 2 – the majority of sleep is spent in phase two, which is categorized as light sleep. Your body temperature falls and heart rate starts to slow down in this phase of Non-Rem sleep (NREM). Muscle tone also can decrease and fluctuate during this stage.


Stage 3&4 – these are stages of deep sleep, and the hardest to wake up from. Brain waves produce slow waves during this stage known as delta waves, and blood pressure drops, breathing slows, and your body becomes immobile.  Stages three and four are extremely rejuvenating and recovery and renewal from daily life occur in this phase. Hormonal release of growth and regulatory chemicals in this phase help with muscle replenishment and appetite control.


Stage 5 – this is also called REM sleep as rapid eye movements can occur in this phase, and the brain has ramped up activity. The body however is relaxed and immobile. Most adults spend about 20% of their sleep in this phase, and it occurs later in the sleep cycle, and this phase can occur cyclically throughout the night. Most dreaming takes place in stage five, and there is an alteration in brain waves almost similar to being awake. During this phase, the brain is revitalized to support alert daytime wakefulness, and patients usually awaken at the end of stage five sleep.


     Cannabis has been demonstrated to be beneficial in treating chronic insomnia, and sufferers of this disease report that a moderate dose ingested one hour before retiring can aid in sleep. THC is similar to other drugs used for insomnia in that it inhibits REM sleep. The use of cannabis can shorten the stage one sleep phase as well so that you fall asleep faster.  Please note, however, that it is recommended to allow a one-hour period after ingestion as during this initial hour the psychoactive effect of the cannabis may inhibit sleep. Also, THC and CBD are also biphasic drugs – this means that small doses of THC or CBD can aid sleep, whereas large doses can cause excitation and inhibit sleep. Typically CBD is thought to be the sedative cannabinoid used for sleep, but the real sleep promoter is the THC. THC is metabolized in the body to CBN (cannabinol), and cannabinol is a sedative cannabinoid. Some sleep tinctures include this cannabinoid, as well as the sedative terpenes linalool and myrcene.


     Dosing for sleep can be vaping, smoking, tinctures, troches, or edibles.  Nighttime patches of CBN can also be employed. Usually, an indica or hybrid strain works best with high THC but some balancing CBD (.2-2.0 %) is acceptable. Smoking or vaping can allow the most rapid effect, with tinctures taking 20 minutes or so, and edibles requiring up to a few hours for onset. Use of cannabis products very late at night, doing edibles, or taking a high dose can cause a rebound hangover in the morning. Experienced users learn how to best use cannabis for sleep, and the timing, dosage technique and strength are important. Often new users will require a period of adjustment and experimentation with different techniques to arrive at the best result for aiding in their sleep. A wide variety of products and strains are available for experimentation.  


     Results can be measured and quantified by the use of a biometric monitoring device that you wear on your wrist (i.e. Fitbit charge HR 3) or wear as a ring (oura). You can also feel the results of a good night’s sleep as you wake up feeling refreshed, restored, and rejuvenated.

These monitoring devices are very informative when studying your own sleep patterns and recommended for patients who want to track their sleep. They will give information on resting pulse, muscle activity, time spent awake, time spent asleep, and also record and display your sleep cycles. While these devices are not as accurate as a hospital sleep study using an electroencephalogram, they are convenient and allow a study in your own bed every night with little or no preparation (just wear the device in bed while sleeping). After a few weeks of experimentation and trying different products and techniques, the vast majority of patients report better sleep habits using cannabis. The use of medical cannabis can allow individuals to sleep more effectively without the need for harmful or ineffective pharmaceuticals, or to use a reduced dose. This in turn permits a better quality of life and increased ability to function effectively during the day without feeling sleepy, tired, or fatigued.