Find out how medicinal cannabis might help to treat and manage insomnia and related sleep conditions.
Sleep condition symptoms can be varied and have a real impact on a patient’s quality of life. However, many sleep medications can have adverse side effects and a risk of dependency. Preliminary studies suggest medicinal cannabis may be an effective alternative.
What is insomnia?
Chronic insomnia disorder (insomnia) is defined by the American Academy of Sleep Medicine (AASM) as a sleep complaint that occurs when one or more of these symptoms are a problem:
- You have difficulty getting to sleep.
- You struggle to stay asleep and wake frequently during the night.
- You tend to wake too early and cannot get back to sleep.
- Your sleep is non-restorative, or of low quality.
Insomnia is only considered a disorder when it causes a significant amount of distress or anxiety, or impairs daytime activity. Chronic insomnia must last at least three months and symptoms must occur at least three times a week.
How does insomnia affect someone’s life?
Insomnia can have significant daytime consequences for patients including:
- Mood swings including irritability.
- Daytime sleepiness.
- Anxiety about sleep.
- Impaired concentration and memory.
- Impaired performance at school or work.
- Lack of motivation.
- Headaches or tension.
- Upset stomach.
- Propensity to make uncharacteristic mistakes (eg. during work or while driving).
- Difficulty engaging socially.
What are common causes of insomnia?
Primary insomnia is sleeplessness that cannot be attributed to an existing medical, psychiatric or environmental cause. Meanwhile, secondary insomnia arises as a result of another condition or external factor.
In rare cases, primary insomnia may be idiopathic, meaning it arises without a clear cause. This may begin in childhood and be a lifelong issue.
Other causes of insomnia include:
- Poor sleep hygiene.
- Drug or substance abuse.
- Mental health conditions such as depression, anxiety, schizophrenia or bipolar disorder.
- Adjustment to stress (acute insomnia).
- External factors (eg. temperature, noise, comfort).
- Alzheimer’s or Parkinson’s disease.
- Restless legs syndrome.
What are common treatments for insomnia?
Insomnia can have a life-changing impact on patients and at times it may feel impossible to manage. Rest assured there are treatment options for insomnia — although treatment is rarely as simple as medication alone.
Treatment for chronic insomnia typically has two main goals: to improve sleep quality and duration, and to reduce related daytime consequences. To this end, doctors may prescribe cognitive behavioural therapy for insomnia (CBTi). This is usually the first-line treatment for insomnia, as it does not carry many of the same health risks as sleep medications.
CBTi should be provided by a licensed psychologist with experience in this treatment. It focuses on pinpointing anxieties patients have with regards to sleep, and replacing these anxieties with healthier beliefs, attitudes and behaviours.
In addition, CBTi treatment may include:
- Sleep education and hygiene.
- Stimulus control.
- Sleep restriction and compression.
- Relaxation techniques.
In many cases, medications may be prescribed alongside CBTi. These medications may assist in helping patients fall asleep or stay asleep. Many include risk of dependence, so will typically not be prescribed for long term use.
Some medications that may be prescribed for insomnia include:
- Benzodiazepines (BDZs) such as temazepam, nitrazepam, oxazepam, flunitrazepam.
- Benzodiazepine receptor agonists (BDZRAs) such as zolpidem and zopiclone.
- Melatonin supplements.
- Calcium channel alpha-2 delta ligands like gabapentin and pregabalin.
- Dual Orexin Receptor Antagonists (DORAs) such as suvorexant. Suvorexant is the only medication for insomnia in Australia approved for use for more than three months.
In some cases, low doses of tricyclic antidepressants like amitriptyline may be prescribed for their mild sedative effect and lower risk of dependency.
How can medicinal cannabis treat insomnia?
While research is still in its early days, there is some evidence to suggest that medicinal cannabis may be an effective alternative to existing sleep medications.
Cannabidiol (CBD) and tetrahydrocannabinol (THC) for sleep conditions: This review of existing literature outlines current findings on the use of cannabis products for improving sleep outcomes. Notably, CBD may prove effective in treating insomnia, REM sleep behaviour disorder and excessive daytime sleepiness. THC may make it easier to get to sleep but could impair sleep quality long-term. Source
Sleep adequacy in patients with neuropathic pain: A study conducted by the Department of Clinical Neurosciences at the University of Calgary compared frontline medication gabapentin with synthetic cannabinoid nabilone. Sleep adequacy and the sleep problems index within the Medical Outcomes Sleep Study Scale (MOSSS) notably improved in patients treated with only nabilone. Source
Secondary insomnia associated with post-traumatic stress disorder (PTSD): The University of Colorado School of Medicine studied the effects of cannabidiol (CBD) oil in the treatment of a 10-year-old girl with PTSD. CBD was found to result in a maintained decrease in anxiety and steady improvement in the quality and quantity of the patient’s sleep. Source