What is Insomnia?

Insomnia is the difficulty or inability to fall asleep or stay asleep. While many possible causes exist for insomnia, it is interesting to note that the initial symptoms reflect its effects. 

Insomnia can have major effects on an individual’s physical and mental health as well as their daily functioning. Some of the consequences associated with insomnia include an increased risk of mental health problems such as anxiety and depression, reduced immunity and hormone dysregulation, impairment of daily activities, and increased susceptibility to chronic diseases such as obesity, diabetes, hypertension, heart attack, and stroke. In addition, insomnia can negatively affect people’s cognitive, emotional, social, and biological functioning, greatly impacting overall quality of life.

The conventional approach to insomnia begins with determining the underlying causes. Common pharmacological treatments for insomnia include psychoactive benzodiazepines such as Clonazepam, sedative-hypnotic medications such as Zolpidem, opioids for the co-treatment of pain, and antidepressants (all of these can have serious side effects and/or addiction potential). While these agents help control symptoms, none of them cure chronic insomnia, which often returns shortly after medication is discontinued.

Sleep is an essential behavior that supports brain function and cognition throughout life, in part by acting on neuronal synapses. The synaptic signaling pathways that mediate the restorative benefits of sleep are not yet fully understood, especially in the developmental context. However, there is already evidence indicating the involvement of the Endocannabinoid System (ECS)  in sleep. We know, for example, that the endocannabinoids 2-arachidonyl glycerol (2-AG) and anandamide (AEA) activate the CB1 receptor to regulate synaptic transmission and mediate cognitive functions and behaviors, including sleep. 

Currently, there are a total of 219 studies involving cannabis,  the ECS, and insomnia. Of these, 70% show positive results. 

Effects of Cannabinoids on Sleep

The effects of using individual cannabinoids depend on the dose. Using too much or too little of a single cannabinoid (such as THC and CBD) can result in unwanted effects. The ratio between THC and CBD, as well as the presence of other plant constituents (such as CBN and the terpenes myrcene, linalool, and limonene), can play a significant role in determining what will work best for each patient, creating the four pillars of a good night’s sleep: 

Ease of falling asleep

Deep sleep 

Staying asleep 

Absence of residual sleepiness upon waking up in the morning

Overall, THC promotes sleep and reduces the time to fall asleep, but it can also cause residual morning drowsiness. In addition, higher doses, especially in susceptible patients, can cause panic and anxiety, worsening insomnia.

CBD, especially in higher concentrations, also favors deep sleep. The anxiolytic effects of CBD and its action on serotonin receptors (5-HT1A) influence sleep quality. However, at low doses, it can increase wakefulness. A literature review on the effect of CBD on sleep disorders found that medium to high doses of CBD increased REM sleep latency time, while medium to low doses decreased REM sleep latency time. 

A clinical meta-analysis published in 2023 evaluated 34 studies and found that both CBD-rich formulations and formulations with equal amounts of CBD and THC can help treat insomnia. A 2022 review of 38 patients using cannabis in Canada found that 39% of participants were able to reduce or completely stop using prescription sleep medications, while 71% reported a subjective improvement in their sleep.

A 2023 double-blind, randomized, placebo-controlled study investigated the effects of CBN and CBN+CBD on sleep quality in participants aged 18-55 with poor sleep. Results showed that 20mg of CBN potentially improved sleep quality by reducing nighttime awakenings and overall sleep disturbance without causing daytime fatigue. 

These numbers cannot be ignored! Cannabis, combined with sleep hygiene measures, can aid many people in sleeping better and avoiding potentially dangerous medications. Getting quality sleep is one of the cornerstones of a healthy life, and everyone deserves a good night’s sleep.

Creating the best possible synergy for sleep by finding the best chemotype for insomnia depends on needs that differ significantly from patient to patient. A good therapeutic approach can make all the difference.

The current interest in the use of medical cannabis for sleep disorders has been on the rise, with several ongoing clinical research studies. This is probably due, in part, to the failure of conventional medications but also to reports of patients who started using cannabis for other conditions and ended up noticing improvements in sleep. There is a strong rationale to continue investigating the therapeutic potential of cannabinoids, and our evidence base should be expanded to better meet individual demands.

References:

• AminiLari M, Wang L, Neumark S, Adli T, Couban RJ, Giangregorio A, Carney CE, Busse JW. Medical cannabis and cannabinoids for impaired sleep: a systematic review and meta-analysis of randomized clinical trials. Sleep. 2022 Feb 14;45(2):zsab234. doi: 10.1093/sleep/zsab234. PMID: 34546363.
• Bonn-Miller MO, Feldner MT, Bynion TM, Eglit GML, Brunstetter M, Kalaba M, Zvorsky I, Peters EN, Hennesy M. A double-blind, randomized, placebo-controlled study of the safety and effects of CBN with and without CBD on sleep quality. Exp Clin Psychopharmacol. 2023 Oct 5. doi: 10.1037/pha0000682. Epub ahead of print. PMID: 37796540.
• de Almeida CMO, Brito MMC, Bosaipo NB, Pimentel AV, Tumas V, Zuardi AW, Crippa JAS, Hallak JEC, Eckeli AL. Cannabidiol for Rapid Eye Movement Sleep Behavior Disorder. Mov Disord. 2021 Jul;36(7):1711-1715. doi: 10.1002/mds.28577. Epub 2021 Mar 22. PMID: 33754375.
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