What is insomnia?
People with insomnia have trouble sleeping. It can significantly impact daily functions, energy levels, concentration, mood, and physical well-being. In order to address insomnia and improve sleep quality, it is important to understand the underlying causes and potential treatment options.
The endocannabinoid system and its role in regulating sleep
The endocannabinoid system is made up of CB1 and CB2 receptors, which play a key role in regulating sleep. These receptors are involved in the body's circadian/diurnal light-dark cycle, which helps to regulate sleep-wake patterns.
In a systematic review of previous research, nearly half of the trials tested THC-only medicinal cannabis for the treatment of insomnia. These trials used dosages ranging from 2 to 25 mg/day, and three-quarters of the trials reported significant improvements in sleep. According to the review, compounds derived from cannabis have anxiolytic and somnolent properties, while producing very few negative side effects.
Factors that may affect sleep quality
Stress: Stressful events or thoughts can keep the mind active and prevent relaxation, leading to poor sleep quality.
Diet and exercise: A healthy diet and regular exercise can promote good sleep, while unhealthy habits such as consuming caffeine or alcohol close to bedtime or skipping exercise can disrupt sleep patterns.
Sleep environment: The conditions in which you sleep can impact sleep quality. A comfortable bed, a cool and dark room, and minimal noise and light can all contribute to better sleep.
Medical conditions: Certain medical conditions, such as sleep apnea, restless leg syndrome, and chronic pain, can disrupt sleep and lead to poor sleep quality.
Medications: Some medications, such as stimulants and certain types of antidepressants, can interfere with sleep. It is important to discuss the potential side effects of any medications with a healthcare professional.
Finally, midnight melatonin levels have been found to be a useful physiological tool for assessing sleep quality objectively. Insomniacs often have lower midnight melatonin levels compared to controls.
A tool that can be used to assess sleep duration and pattern is a Fitbit wrist activity tracker with a sleep-staging feature. Its accuracy has been tested against polysomnography in several studies.
Study on the use of medicinal cannabis for insomnia
A recent study in 2022 conducted at the National Institute of Integrative Medicine in Melbourne, Australia sought to assess the tolerability and effectiveness of a medicinal cannabis oil containing THC:CBD (10:15) on sleep in adults with insomnia. The study used a randomized crossover double-blind placebo-controlled design, and was approved by the National Health and Medical Research Council.
The inclusion criteria for the study included adults aged 25-75 years with self-reported clinical insomnia, who scored higher than 14 points on the Insomnia Severity Index (ISI). Exclusion criteria included cancer, unstable cardiac disease, psychotic disorder, schizophrenia, manic episode, seizure disorder, glaucoma, urinary retention, or pregnancy.
The study consisted of a 1-week run-in period, a 2-week intervention period, a 1-week wash-out period, and a second 2-week intervention period after crossover. During the trial, participants took 0.1 ml of active oil per day, titrating up to 1.5 ml (15 mg THC/22.5 mg CBD) over the course of 2 weeks.
The study measured saliva midnight melatonin levels, insomnia symptoms, and sleep quality using a Fitbit wrist activity/sleep tracker, as well as questionnaires including the ISI and the Pittsburgh Sleep Quality Index (PSQI).
The results of the study showed that the medicinal cannabis oil was well tolerated and significantly improved sleep quality in adults with insomnia. On the ISI, the treatment group showed a decrease in total score from 21.3 to 12.3, while the placebo group showed a decrease from 22.3 to 19.3. Similarly, on the PSQI, the treatment group showed a decrease in total score from 12.7 to 7.5, while the placebo group showed a decrease from 12.9 to 10.9.
There were also significant increases in midnight saliva melatonin levels in the treatment group compared to the placebo group.
Conclusion and limitations
Overall, the results of this study suggest that medicinal cannabis oil may be a promising treatment option for improving sleep quality in adults with insomnia. However, it is important to note that the study had some limitations, including a relatively small sample size and a short duration of treatment. Further research is needed to fully understand the potential benefits and risks of using medicinal cannabis for the treatment of sleep disorders.
In conclusion, the endocannabinoid system plays a key role in regulating sleep, and cannabis-derived compounds have been shown to have anxiolytic and somnolent properties in previous research. The results of the study discussed above suggest that medicinal cannabis oil may be a promising treatment option for improving sleep quality in adults with insomnia, although more research is needed to confirm these findings.
It is important to consider the potential risks and benefits of using medicinal cannabis for the treatment of sleep disorders and to consult with a healthcare professional before starting any new treatment.