Will cannabinoids one day be a mainstream treatment for sleep disorders? In the short-term, it’s more likely that cannabis will be the subject of more research on how it works to treat sleep issues, as medical professionals try to better understand everything from doses to consumption methods.
Last week, the Oregon Health & Science University hosted a Neurology Grand Rounds focused on Cannabis and Sleep. Kimberly Hutchison, an associate professor in the Sleep Medicine Program within the Department of Neurology at OHSU, gave a presentation centered on the intersection of cannabis consumption and sleep patterns and issues.
Insomnia is particularly difficult for patients and medical providers because it’s often a long-term issue, and many traditional therapies are sedatives that shouldn’t be taken over a long-term period. Today, there are only a handful of states without some kind of medical or adult use cannabis law, and, in some, patients with insomnia can access medical cannabis, yet research still lags.
“Research on cannabis and sleep is in its infancy, and has yielded mixed results with significant biases. So, additional control and longitudinal research is critical to advance our understanding of research and clinical implications along with short and long term risks,” Hutchison said.
Still, as state laws evolve, people’s views are changing, too, Hutchinson said.
“People that have been very hesitant about marijuana in the past are becoming more and more open to trying it. A lot of that has to do with conditions that aren’t being adequately treated with our regular medical system,” Hutchison said, highlighting that most frequent citations for medical cannabis use are pain and insomnia.
Hutchison referenced a review published last year in the peer-reviewed journal Sleep Medicine Reviews, which covered cannabinoid therapies in the management of sleep disorders. Researchers at the University of Sydney’s Lambert Initiative for Cannabinoid Therapeutics and Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research noted that while cannabinoids like THC and CBD “are known to interact with the endocannabinoid and other neurochemical systems to influence,” among other things, the sleep and wake cycle, “their therapeutic efficacy and safety as treatments for sleep disorders are unclear.”
Broadly, Hutchison said, studies have shown that cannabis “decreased sleep onset latency,” or the amount of time it takes someone to go from being fully awake to sleep, as well as WASO, or “wake after sleep onset,” meaning periods of “wakefulness” that occur after sleep. Additionally, THC increased “slow wave sleep,” or the deepest phase of non-rapid eye movement sleep, and decreased REM sleep, which is “rapid eye movement sleep,” when people typically dream.
When it comes to CBD, studies have shown some “inconsistent results.” For example, while literature has shown “benefits noted with very high dosages,” cannabis shops typically sell bottles of CBD oil in much smaller dosages, prompting Hutchinson to call for studies that look specifically at CBD use in lower doses.
On the topic of REM Sleep Behavior Disorder, or RBD, while there are no randomized controlled trials, small studies show that synthetic cannabinoids “may be an area of promise,” Hutchinson said.
Synthetic cannabinoids also show potential in the area of post traumatic stress disorder and nightmares. Of two studies completed, both showed “decreased frequency and intensity of the nightmares,” Hutchinson said.
When it comes to sleep apnea, a condition during which someone pauses breathing or has times of shallow breathing while sleeping, research hasn’t been conclusive. In fact, the American Academy of Sleep Medicine issued a position statement in 2018 that said that “medical cannabis and/or its synthetic extracts should not be used for the treatment of OSA due to unreliable delivery methods and insufficient evidence of effectiveness, tolerability, and safety.”
Questions poured in from participants at the start of the lecture. What are the long-term effects of cannabis use? How does medical cannabis affect older patients? Does medical cannabis “sustain the right kind of sleep?”
Hutchison laid out the historic and current medical cannabis landscapes before covering the hurdles to research.
“Cannabis is ubiquitous, as a medicine, really. And so as a health care provider, we’re asked about it, and the expectation would be that we know something about it. But yet we have no training and it’s very difficult to study,” Hutchison said, adding that regulatory and supply barriers have inhibited research. So, too, has the fact that there is one entity with a federal license in the US to provide cannabis products for research, and it is the University of Mississippi. (As Cannabis Wire has reported, this is set to change in the coming months.)
The vehicle through which cannabis is consumed presents its own issues for researchers, too. Many people prefer to smoke cannabis, but to study cannabis smoke’s effects, researchers have to take into account just how varied the smoking experience can be. In other words, “Someone may take a huge, heroic hit, or maybe someone takes a very small hit,” Hutchison said. “It’s difficult to understand how much someone is actually getting at the time.”
Additionally, Hutchinson said, “there’s also variability in the characterization of their cannabis experiences,” and whether someone has regular or very limited exposure to cannabis, which is “certainly going to impact” how they describe their experiences.
Toward the end of the session, Hutchinson leaned toward more practical thoughts for medical practitioners in the audience. For example, if a patient with insomnia visits Hutchison, she first goes for the standard care for insomnia by evaluating causes of the insomnia. She also seeks to understand if snoring or significant anxiety could be contributing to the sleep issues, and whether the patient has tried cognitive behavioral therapy.
“However, if cannabis is desired or they want something to help them and they’re not interested in using the medications that we use, then I usually recommend starting with just about 10 milligrams of CBD because that can have this anxiolytic effect,” Hutchison said. “It may be that they’re just anxious or their body is amped up, and the CBD may help to relax them and that may be all they need.”