Effects of Cannabinoids on Sleep and their Therapeutic Potential for Sleep Disorders

Abstract

The recent trend for legalization of medicinal cannabis and cannabinoid-containing products, together with their soporific effects, has led to a surge of interest of their potential therapeutic role in the management of some common sleep disorders, such as insomnia, sleep disordered breathing, and restless legs syndrome, and less common disorders such as narcolepsy and parasomnias. Although much of the pre-clinical and clinical data were derived from studies with relatively small sample sizes and limited by biases in assessment, and in clinical trials lack of allocation concealment, as a whole, the results indicate a potential therapeutic role for cannabinoids in the management of some sleep disorders. Clinical trials are underway for insomnia and obstructive sleep apnea management, but there remains a substantial need for rigorous large multi-center studies to assess the dose, efficacy, and safety of the various types of cannabinoids on sleep disorders. This review aims to summarize the modulatory effects of cannabinoids on sleep physiology and provide a critical evaluation of the research on their potential therapeutic benefit in various sleep disorders.

Altered sleep during spontaneous cannabinoid withdrawal in male mice

“…In a more recent study, 71% of participants cited improved sleep as a reason for the use of medicinal cannabis (Bonn-Miller et al , 2014). Realization of the strong hypnogenic effects of cannabis and cannabinoid drugs has led to a growing interest in their potential utility in the treatment of various sleep disorders including insomnia or nightmares associated with posttraumatic stress disorder (Kaul et al , 2021). Surprisingly, the effects of repeated or chronic cannabinoid use on sleep measures currently are not well understood.…”

“…Prior studies have shown that cannabinoid drugs can reliably alter sleep architecture in both humans and laboratory animals. Acute exposure to THC typically produces a pattern of increased sleep consolidation, increased slow-wave sleep (SWS), and decreased rapid-eye movement sleep (REM) (Kaul et al , 2021; Kesner and Lovinger, 2020). Results from studies of chronic cannabinoid exposure are variable but there is growing evidence for decreased total sleep time, decreased SWS, and a return to baseline levels of REM (Kaul et al , 2021; Kesner and Lovinger, 2020).…”

Recent cannabis use and nightly sleep duration in adults: a population analysis of the NHANES from 2005 to 2018

“…The literature examining the effects of cannabis on sleep duration, architecture, or quality in people with no sleep disturbances at baseline demonstrate overall mixed results. [5][6][7][8] Early polysomnographic studies suggest that even a single cannabis exposure can cause reduced sleep-onset latency, increased total sleep time, and less disruptions once asleep. 21 Repeated use can quickly demonstrate habituation and likely opposite effects: increased sleep-onset latency, decreased total sleep time, and greater sleep disruption.…”

“…7 8 In contrast to CBD, current evidence suggests that delta-9 tetrahydrocannabinol (THC), the other major cannabinoid present in most strains of cannabis, has stimulant and hallucinogenic properties contributing to sleep disruption. 8 With an evolving market of new cannabis strains and cannabinoid formulations, each with varying proportions of CBD and THC, the generalizability of the current literature about sleep impact is limited. Despite insomnia being one of the most cited reasons for selfmedication with cannabis or cannabinoids, the evidence base is overall inconsistent and of poor quality, as described in a recent systematic review.…”

“…While animal and in vitro studies have begun to elucidate these pathways, clinical studies with humans have typically been small and heterogeneous in design, leading to mixed results overall. [6][7][8] At the same time, sleep deprivation and insufficiency in the population has become a major public health concern. 9 Experts recommend 7-9 hours of sleep per night, yet only two-thirds meet this guideline and almost half of all American adults report daytime sleepiness nearly every day.…”