Estimating the number of individuals suffering from sleep disorder is difficult if only because of the variety of sources. While sleep can be interrupted by chronic pain, as is often the case for arthritis patients, other sources such as gastrointestinal activity, breathing difficulties, epilepsy, Alzheimer’s, etc. can also prevent restful sleep. To date, while multiple over-the-counter sleep medications exist, all have large flaws. Benadryl and other anti-histamines, usually diphenhydramine, are known to have the side effect of sleepiness and are often taken as sleeping pills. However, diphenhydramine can be habit-forming. Melatonin, on the other hand, can help re-enforce natural sleep cycle/rhythm, but can’t overcome serious sleeping barriers. Finally, prescription sleeping medications, such as Ambien, which are much stronger and more resilient, often have semi-psychotic side effects and can produce uncomfortable and sometimes dangerous experiences. While cannabis and cannabinoids may not provide a complete answer, they represent another potential avenue for eliciting sleep, and as a result, the relationship between sleep and the endocannabinoid system should be a priority of researchers.
Unfortunately, despite the fact that we all need sleep, we actually understand little about it. We’ve managed to determine that sleep plays an important role in restoring and healing both the body and mind, with the brain passing through several stages of sleep characterized by the pattern of brain waves in each stage. Truly restful sleep seems to be characterized by attainment of the last stage in the sleep cycle, REM. However, much of the specific brain chemistry remains unclear, meaning that for testing sleep medication, we are still very limited. Often the most data we can obtain comes from simply measuring total time in each stage of sleep, as determined by electrodes placed on patients’ scalps, and combining this information with measured performance the next morning on memory tests. Since this type of research is fairly straightforward to perform, you might think we’d have an abundance of sleep research related to cannabis. Unfortunately, the medical community actually has very little. In fact, one of the most currently relevant and interesting studies is from 2004 and involves testing of THC and THC/CBD combinations.
The last time we wrote about sleep on the Cornerstone blog, we discussed the somewhat opposing effects of THC and CBD in regard to sleep. THC alone has been shown to increase sleep in large quantities, whereas CBD has been shown to increase alertness and wakefulness. In this study from 2004, performed by Anthony Nicholson at the Centre for Human Sciences in Hampshire, UK, the research team chose to administer THC and CBD through an oral-mucosal spray, almost exactly like prescription Sativex (which is 1:1 THC to CBD). This spray, which alternately contained no active ingredient, 15 mg of THC, 5 mg of THC and 5 mg of CBD, or 15 mg of THC and 15 mg of CBD, was administered over a roughly 30 minute period prior to bedtime. Care was taken to ensure that no other drugs, such as alcohol or nicotine, interfered with results.
Interesting enough, there were no effects on “sleep onset, duration, or quality” following any combination. On the one hand, this study used particularly low doses of THC. To give context, past evidence has suggested that upwards of 70 mg of THC a day can lead to increased sleep, which unfortunately is well outside of the 15 mg range. On the other hand, the specific amounts of THC and CBD represent a dose range similar to that required for treating chronic pain. However, while general sleep time may not have been affected with such low dosing, cannabinoid administration did alter sleep quality. Patients receiving only 15 mg THC reported feeling more tired the next day. Additionally, THC and CBD combinations decreased stage 3 sleep, in which slow brain waves first appear. The 15 mg combination of THC and CBD also resulted in sleepiness the next day, while the 5 mg combination had no noticeable effect.
In any case, for any dosage, all effects on memory or cognitive performance were absent by 24 hours after ingestion. Additionally, adverse side effects of cannabinoids remain much lower than those of other sleeping medications. While overdose of diphenhydramine may lead to death, in contrast, consuming the entire bottle of an oral-mucosal spray of cannabinoids poses no physical threat to health (although would likely be very mentally uncomfortable!). Cannabinoids are also easier on the liver and cardiovascular system than many other sleeping medications, meaning consuming cannabinoids to aid sleep comes at a lower “cost”.
At this point, readers may be wondering how a substance that has no large, direct effect on sleep would actually aid sleep:
The idea here is that if pain or discomfort can be diminished without adding another sleep disturbance, then total disturbance is lowered, and sleep quality is therefore increased. For instance, if taking THC decreases the number of times a patient wakes in the night from arthritis pain, then total sleep time and quality for that patient both rise.
Unfortunately, this study, despite being one of the best available, included only eight test subjects, which is a small number for any serious medical study. Ideally, we’d see a study like this duplicated with several thousand patients, testing much higher doses of THC, CBD, and other cannabinoids. Sadly, with competition from the myriad of research goals involving the endocannabinoid system, sleep research has not taken a position at the forefront of exploration, and such large-scale studies are not available. For the time being, individuals experiencing sleep trouble from chronic pain or gastrointestinal illness may be better off evaluating the effects of THC and other cannabinoids on their own sleep quality and hours, varying doses as helpful.
Anthony Nicholson, Claire Turner, Barbara Stone, et al. Effect of Delta-9-Tetrahydrocannabinol and Cannabidiol on Nocturnal Sleep and Early-Morning Behavior in Young Adults. Journal of Clinical Psychopharmacology (2004) 24:3.