Cannabinoids and sleep


I was not looking forward to writing this, in part, due to my love-hate relationship with cannabinoids: on one hand, they show potential in many difficult-to-treat conditions; on the other hand, some psychiatric risks and this (CB receptor activation is diabetogenic).

Further, don't underestimate the complexity of cannabis plants and the endocannabinoid signaling system.

The cannabinoids (Babson et al., 2017):

-THC, the main psychoactive component of cannabis (also in drug form as Nabilone)

-CBD, a non-psychoactive component of cannabis

-Dronabinol, a highly purified synthetic (-)-trans-D9-THC. It's actually 2-3x weaker than Nabilone (which is a further testament to the complexity of this system, imo).

Nabiximols (Sativex), a roughly 1:1 combination of THC & CBD.

To be clear, the main therapeutic use of cannabinoids is anti-emetic (prevents vomiting) & appetite-stimulation in some conditions (eg, cancer, HIV). The more interesting part, imo, is some of the human studies (discussed below) on people with difficult-to-treat conditions, who also sleep poorly,  where any improvement in sleep quality inevitably improves their condition. 

This article is specifically on sleep. I'll do follow-ups on anxiety and maybe inflammation if you're interested. Let me know!

Chronic CB activation is pro-diabetogenic, but it might be worth the risk in patients with PTSD and recurring nightmares (horrific in & of itself, but this also takes a major hit on quality of life)... and who knows, the improved sleep quality may even decrease the pro-diabetogenic risks.

In healthy, young adults: expect little/no or even negative effects. 

1- This study showed THC alone had no effect on sleep and increased grogginess the following morning whereas a combination of THC and CBD decreased restorative ("stage 3") sleep.

2- This study showed slightly reduced total sleep with various doses of Dronabinol (the weaker THC synthetic analog). But this study was also in otherwise healthy adults.

BUT, in adults with sleep apnea, 2.5-10 mg Dronabinol significantly reduced sleep apnea for up to 3 weeks (Prasad et al., 2013).

Note: these are all small and short-term studies.

And in a slurry of publications on patients with PTSD, Nabilone and THC significantly reduced nightmare frequency and improved sleep quality. 

In fibromalgia patients, Nabilone improved sleep quality better than Amitriptyline (which isn't really saying that much, but this is a commonly prescribed drug) (Ware et al., 2010).

As for CBD, there are plenty of animal studies and a few case reports (in PTSD, pediatric anxiety and insomnia, REM sleep behavior disorder [something like sleepwalking], Parkinson's disease, doses ranging from 25 to 300 mg) showing beneficial effects on sleep quality... but again, no effect in otherwise healthy adults (Linares et al., 2018).

That's all for now!

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