Sleep Disturbance in Heavy Marijuana Users

Bolla, Karen L; Lesage, Suzanne; Gamaldo, Charlene E.; Neubauer, David N.; Funderburk, Frank R.; Cadet, Jean Lud; David, Paula; Verdejo‐García, Antonio; Benbrook, Amy R.

doi:10.1093/sleep/31.6.901

Cited by 131 publications

(134 citation statements)

References 28 publications

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“…2,3 Smoked marijuana and oral THC facilitates falling asleep. 2,3 Acute use of THC reportedly leads to reduced sleep onset latency, increased slow wave sleep, alpha activity (intrusions), reduced eye movement density in REM sleep, and REM suppression. Chronic marijuana use may lead to long-term suppression of slow wave sleep.…”

Section: Discussionmentioning

confidence: 99%

Urine Toxicology Screen in Multiple Sleep Latency Test: The Correlation of Positive Tetrahydrocannabinol, Drug Negative Patients, and Narcolepsy

Dzodzomenyo

Stolfi

Splaingard

et al. 2015

Journal of Clinical Sleep Medicine

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of EDS or were referred for management after a diagnosis of narcolepsy was made elsewhere without urine drug screening. Our hypothesis was that tetrahydrocannabinol (THC) use can cause symptoms like EDS and may also cause false (+) MSLT consistent with narcolepsy. We also hypothesized that symptoms of narcolepsy, including EDS, cataplexy, sleep paralysis, or hypnagogic/hypnopompic hallucinations might be found in Objective: Drugs can infl uence results of multiple sleep latency tests (MSLT). We sought to identify the effect of marijuana on MSLT results in pediatric patients evaluated for excessive daytime sleepiness (EDS). Methods: This is a retrospective study of urine drug screens performed the morning before MSLT in 383 patients < 21 years old referred for EDS. MSLT results were divided into those with (1) (−) urine drug screens, (2) urine drug screens (+) for tetrahydrocannabinol (THC) alone or THC plus other drugs, and (3) urine drug screens (+) for drugs other than THC. Groups were compared with Fisher exact tests or one-way ANOVA. Results: 38 (10%) urine drug tests were (+): 14 for THC and 24 for other drugs. Forty-three percent of patients with drug screen (+) for THC had MSLT fi ndings consistent with narcolepsy, 0% consistent with idiopathic hypersomnia, 29% other, and 29% normal. This was statistically different from those with (−) screens (24% narcolepsy, 20% idiopathic hypersomnia, 6% other, 50% normal), and those (+) for drugs other than THC (17% narcolepsy, 33% idiopathic hypersomnia, 4% other, 46% normal (p = 0.01). Six percent (6/93) of patients with MSLT fi ndings consistent with narcolepsy were drug screen (+) for THC; 71% of patients with drug screen (+) for THC had multiple sleep onset REM periods (SOREMS). There were no (+) urine drug screens in patients < 13 years old. Conclusion: Many pediatric patients with (+) urine drug screens for THC met MSLT criteria for narcolepsy or had multiple SOREMs. Drug screening is important in interpreting MSLT fi ndings for children ≥ 13 years. pii: jc-00341-13 http://dx.doi.org/10.5664/jcsm.4448 E xcessive daytime sleepiness (EDS) is a frequent clinical complaint in children and adolescents seen in sleep medicine clinics. The differential diagnosis of EDS is broad and includes both narcolepsy and idiopathic hypersomnia. Diagnosis of narcolepsy and idiopathic hypersomnia is made by a clinical history followed by a standardized multiple sleep latency test (MSLT) consisting of 4-5 daytime nap opportunities conducted under a standardized protocol in which mean sleep onset latency (MSL) is calculated and the number of sleep onset rapid eye movement (REM) periods are tabulated.1 Interpretation of the MSLT fi ndings, however, can be complicated by several factors, including prior sleep deprivation, coexisting sleep disorders such as obstructive sleep apnea, prescription medications, and illicit drugs. Because of the frequency of illicit drug use, the American Academy of Sleep Medicine (AASM) standard of practice for performing an MSLT states that obtaining a mor...

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Section: Discussionmentioning

confidence: 99%

Urine Toxicology Screen in Multiple Sleep Latency Test: The Correlation of Positive Tetrahydrocannabinol, Drug Negative Patients, and Narcolepsy

Dzodzomenyo

Stolfi

Splaingard

et al. 2015

Journal of Clinical Sleep Medicine

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“…Sleep fragmentation may be a particularly pertinent objective indicator of the severity of cannabis withdrawal, as it is frequently associated with periodic leg movement, which is increased in heavy cannabis users 37 and during acute cannabis withdrawal. 12 The effects of lithium on suppressing withdrawal related nightmares and strange dreams is of interest as increased REM sleep has been documented during cannabis withdrawal, explaining the occurrence of increased dream state.…”

Section: Effects Of Lithium On Sleep Qualitymentioning

confidence: 99%

“…12,13 It should be noted that premorbid sleep patterns were not assessed in either of these studies; thus it was not clear whether these sleep disturbances were directly related to cannabis cessation. Similar observations were made by Vandrey, who also noted decreased sleep efficiency and increased sleep latency among 20 subjects in a controlled laboratory study.…”

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confidence: 97%

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The Effects of Lithium Carbonate Supplemented with Nitrazepam on Sleep Disturbance during Cannabis Abstinence

Bartlett

Johnston

Helliwell³

et al. 2015

Journal of Clinical Sleep Medicine

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Study Objectives: Sleep disturbance is a hallmark feature of cannabis withdrawal. In this study we explored the effects of lithium treatment supplemented with nitrazepam on objective and subjective measures of sleep quality during inpatient cannabis withdrawal. Methods: Treatment-seeking cannabis-dependent adults (n = 38) were admitted for 8 days to an inpatient withdrawal unit and randomized to either oral lithium (500 mg) or placebo, twice daily in a double-blind RCT. Restricted nitrazepam (10 mg) was available on demand (in response to poor sleep) on any 3 of the 7 nights. Dependent outcome measures for analysis included repeated daily objective actigraphy and subjective sleep measures throughout the 8 day detox, subjective cannabis withdrawal ratings, and detoxifi cation completion rates. S leep diffi culties and cannabis use appears to be a bi-directional relationship. Individuals often start using cannabis when they experience sleep diffi culties during stressful times, often for coping reasons 1 ; and this is a risk factor for cannabis lapse (within the fi rst 2 days out of 7) following a self-guided quit attempt.2,3 The most prevalent sleep disturbances with cannabis withdrawal include diffi culty getting to sleep, staying asleep, nightmares and strange dreams, and night sweats.4 During the withdrawal process, sleep diffi culties predict relapse to cannabis use. [5][6][7][8] There is some evidence that pharmacotherapy during cannabis abstinence attenuates withdrawal related sleep disturbances, 9 including improvements in polysomnographic measures of sleep effi ciency (but not latency) with the nonbenzodiazepine GABA(A) receptor agonist zolpidem.10 While there is a plethora of studies exploring self-reported sleep disturbances associated with cannabis withdrawal, there are very S C I E N T I F I C I N V E S T I G AT I O N Sfew that quantify sleep patterns using objective means, with the exception of the paper by Vandrey et al. 10 Poor sleep is often the last symptom to remit, and recent trials have started to specifi cally target sleep disturbances during withdrawal. Haney and colleagues conducted a small BRIEF SUMMARY Current Knowledge/Study Rationale: Sleep disturbance is the most consistent, prevalent, and severe symptom of cannabis withdrawal. However, there are currently no evidence-based medicines to assist with cannabis dependence or cannabis withdrawal. Study Impact: This formal RCT demonstrates that, contrary to positive open label clinical fi ndings, lithium carbonate does not improve cannabis withdrawal related sleep disturbances. However, the hypnotic benzodiazepine rescue medication nitrazepam signifi cantly improved multiple objective measures of sleep disturbance during cannabis withdrawal.

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“…-tetrahydrocannabinol (Δ 9 -THC), which has neural implications that are mediated through cannabinoid (i.e., CB1) receptors located in the brain [9]. One of the primary neural effects of Δ…”

mentioning

confidence: 99%

Sleep Disturbances: Implications for Cannabis Use, Cannabis Use Cessation, and Cannabis Use Treatment

Babson

Bonn‐Miller

2014

Curr Addict Rep

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Cannabis may be used, among certain individuals, for its actual and/or perceived sleep-promoting properties. Although evidence suggests that cannabis is likely beneficial for sleep initiation, over time individuals may develop tolerance to these benefits, leading to greater use in order to maintain the same sleep-inducing effects. This form of use likely contributes to the development of problematic cannabis use patterns, including cannabis use disorders. Evidence also points to sleep as an important consideration in terms of understanding cannabis withdrawal and relapse. Here, sleep disturbances have been reported as a primary symptom of withdrawal, with studies revealing that this increase in sleep disruption during discontinuation of cannabis use may be a significant risk factor for relapse. Therefore, it is likely important to consider interventions aimed at providing alternative means to cope with and/or treat sleep disturbances (e.g., behavioral or pharmacological approaches) as adjuncts to interventions for cannabis use disorders to improve treatment outcomes.

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Sleep Disturbance in Heavy Marijuana Users

Cited by 131 publications

References 28 publications

Urine Toxicology Screen in Multiple Sleep Latency Test: The Correlation of Positive Tetrahydrocannabinol, Drug Negative Patients, and Narcolepsy

Urine Toxicology Screen in Multiple Sleep Latency Test: The Correlation of Positive Tetrahydrocannabinol, Drug Negative Patients, and Narcolepsy

The Effects of Lithium Carbonate Supplemented with Nitrazepam on Sleep Disturbance during Cannabis Abstinence

Sleep Disturbances: Implications for Cannabis Use, Cannabis Use Cessation, and Cannabis Use Treatment

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