Sleep Disorders | Sleep Review
By Ian Hamilton, Associate Professor of Addiction, University of York
Sleep problems are common. In a recent study, 48% of UK adults said that poor sleep had a negative impact on their mental health. In the case of teenagers, this proportion was significantly higher at 66%.
The large number of people with sleep problems is an attractive market. Some companies have taken the opportunity to remedy the situation, including several manufacturers of cannabis products.
Changes to cannabis regulation in many countries, including the UK, have supported the boom in cannabis products as more people have access to these types of offerings – even if the cannabis compounds that can be used in sleep products in some countries are more restricted than in other. In the United States, where cannabis is perfectly legal in many states, California-based Ganja Goddess reported a more than seven-fold increase in sales for its cannabis sleep products in the first year of the COVID pandemic.
But what is the evidence that cannabis products can help people sleep better?
Cannabis and sleep
Sleep disorders are a common trait of withdrawal from cannabis use, suggesting that there may well be a link between cannabis use and sleep. But we still don’t have a clear understanding of the mechanisms in the brain that are involved in this relationship.
The effects of cannabis are due to a group of chemicals in the drug called cannabinoids. These include cannabidiol (CBD), cannabinol (CBN), and tetrahydrocannabinol (THC). THC is the psychoactive substance in cannabis. CBN and CBD don’t make you get high in the same way.
In the UK, CBD products are legally available as long as they do not contain more than 0.2% THC. Retailers and suppliers make all kinds of statements about the benefits of CBD products, including how CBD can improve sleep. There is some evidence to support these claims, but this is largely based on observational studies in animals and humans rather than randomized controlled studies that allow comparisons to be made between CBD and a placebo.
Although not legal in the UK, CBN is one of the main compounds in commercial cannabis sleep products, with more and more CBN formulations entering the market. A recent review sought to find out if CBN really did improve sleep.
The review included studies that date back to the 1940s. These mainly involved administering CBN to subjects and comparing self-reported sleep quality with participants in a control group who had not received the drug.
However, the review’s author, Jamie Corroon, noted several issues with the research to date, including the fact that the participants were more likely to be male and white. This male-centered perspective isn’t just limited to cannabis research; It is known to be a problem in research in general.
Corroon also criticized the lack of structured, evidence-based questionnaires for assessing sleep in the studies. He concluded that there is not enough published evidence to support claims that these products improve sleep, noting, “People seeking cannabis-derived sleep aids should be skeptical of manufacturers’ claims about sleep-inducing effects . “
Other factors to consider
The review mainly focused on the sleep results associated with pure medical grade CBN. This doesn’t necessarily reflect the way most people consume cannabis or cannabis products. Most either smoke a joint or take a liquid or pill when using a commercially available product.
The type of commercial product, route of administration and dose are known to affect sleep. Notably, the dose of CBN in many commercial products is lower than that tested in most of the studies in the review.
While most commercial cannabis sleep products contain less than 1% THC (if any), a cannabis joint contains hundreds of compounds, including THC. And the combination of THC with CBN is considered a sedative. Pure CBN would therefore not have the same effect as in real life when consumed with THC.
Although the review found a lack of evidence of CBN’s sedative properties, scientists have found that medicinal cannabis, which contains THC and CBD, can improve sleep for people with chronic pain. However, this benefit diminishes for people who use these products regularly as their tolerance to medical cannabis increases.
While it is useful to make a review that focuses on sleep and cannabis, it does not capture the various reasons why many people consume cannabis or products containing cannabis. Many people use cannabis to treat physical problems such as muscle and joint pain, or psychological problems such as anxiety or stress, rather than as a sleep aid. It makes sense that relieving these symptoms will improve sleep.
One example is people who experience vivid nightmares as a result of post-traumatic stress disorder (PTSD). Nabilone, a synthetic cannabinoid, has been shown to be beneficial in suppressing these types of nightmares, which could improve the quality of sleep for this group of people with PTSD. So you can see why it is difficult to unravel the effects of cannabis on sleep.
We need better research
As with many questions in research, there is no clear answer to how effective cannabis is at improving sleep. How the drug is prepared, how it is taken, and the person’s expectations are just a few of the important factors that can affect the outcome.
And as with all health products, there is a risk of side effects. For example, a recent review of medicinal cannabis products used for sleeping found a significant increase in the risk of dizziness.
What is clear is that when millions of people have a sleep problem, there will be a commercial incentive to make money selling remedies. We need more rigorous research to examine all the links between cannabis and sleep and to see if these products work.
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