What we call “primary” insomnia is sleeplessness that has no chemical or environmental causes. Patients have difficulty in getting to sleep or staying asleep. Sometimes it is an is overactive mind that doesn’t allow rest. Insomnia affects 20-30% of adults and can occur during times of stress. It can be caused by altered neurochemicals such as the “sleep” neurotransmitters (serotonin or GABA), or come about because of increased stress hormone (cortisol). Other forms of sleeplessness may occur as a result of a substance abuse or a drug withdrawal (including from marijuana). It can also be caused by a disruption of the body’s biological clock, such as a shift in time zones, jet lag or working at odd hours. Poor sleep habits often contribute to the problem as well as medical conditions such as sleep apnea, restless legs, night sweats and pain.
Insomnia and Cannabis
NOTE FOR FIRST TIME READERS: Cannabinoids – such as THC, CBD – and terpenes are the main medically active components in cannabis (aka marijuana). For more information on these components, and much more about the plant, see our section on the Science of Cannabis.
Patients who use medical cannabis for insomnia routinely report that it improves sleep. In a survey of patients in California, 71% stated that they were using cannabis to improve sleep, with 14% reporting that it was the main symptom for which they were seeking treatment. Many had tried over-the-counter sleep aids or had been given a prescription for sleeping pills. They complained that sleeping pills didn’t work very well or had a “hangover” effect the next day. Some were concerned about the side effects or potential habit-forming properties of prescription sleeping aids.
Research indicates that patients report improved sleep when using cannabis. In a 2007 study by Dr. E. Russo, a cannabis plant based extract was assessed for effects on pain. What’s interesting is that 40 – 50% of the subjects also reported “good or very good” quality when asked to rate their sleep. Most patients who use cannabis for insomnia report better sleep with less drowsiness the next day as compared with over the counter or prescription medications. In fact, these patients can reduce or eliminate their previous sleeping medicines, with fewer side effects. Ironically, many pharmaceuticals that are used to treat insomnia may actually cause sleeplessness if they are withdrawn or skipped. Cannabis does not appear to create the same sort of dependence so people can use it as needed.
For insomnia, it is important to use cannabis in a long-acting form, such as capsules, edibles or tincture, especially if patients find they’re waking up in the middle of the night. Indica strains are considered to be the best as sedatives. Preparations containing the cannabinoid CBN, even in small amounts are also effective. Dosage depends upon whether patients are weaning off of sleep medications, or have mild or severe insomnia. THC can be taken from 10 up to 50 mg, while 1 mg of CBN is all that is needed to be effective.
Nunberg H, et al. An analysis of applicants presenting to a medical marijuana specialty practice in California. Journal of Drug Policy Analysis. 2011, 4(1):1-16.
Russo E, et al. Cannabis, pain, and sleep: Lessons from therapeutic clinical trials of sativex, a cannabis-based medicine. Chemistry & Biodiverisity. 2007, 4: 1729-1743.
Bisogno T, et al. Molecular targets for cannabidiol and its synthetic analogues: effect on vanilloid VR1 receptors and on the cellular uptake and enzymatic hydrolysis of anandamide. Journal of Pharmacology. 2001, 134: 845-852.
Schierenbeck T, Riemann D, Berger M, Hornyak M. Effect of illicit recreational drugs upon sleep: cocaine, ecstasy and marijuana. Sleep Med Rev. 2008, 12(5): 381-9.
Nicholson AN, Turner C, Stone BM, Robson PJ. Effect of Delta-9-tetrahydrocannabinol and cannabidiol on nocturnal sleep and early-morning behavior in young adults. J Clin Psychopharmacol. 2004, 24(3): 305-13.