Marcia’s insomnia came in the middle of the night. She’d wake up at 3 and was rarely able to get back to sleep. Ambien helped for a while. Then her doctor refused to renew her prescription, so Marcia made an appointment with a sleep therapist and went through CBT for insomnia . . . to no avail. She continued to wake up in the darkest hours. As a last resort she tried marijuana.
“Just two puffs” at bedtime enabled her to sleep uninterruptedly until 5 or 5:30 a.m. This was a surprise and a relief. But the bigger surprise came when she quit the marijuana and continued to sleep through the night.
Was she sleeping better now because she was less stressed out? I asked. Was she going to bed later and sleeping longer in the morning because she was being exposed to more sunlight in the evening? No other explanation I could come up with seemed to account for her situation. It looked like the marijuana really was what helped her sleep.
Given the numbers of people who say marijuana makes them sleepy, you might wonder if the trend toward legalizing the drug will result in doctors prescribing it for insomnia one day. Don’t hold your breath. Now legal in 21 states and the District of Columbia, medical marijuana is being used to treat people with chronic pain, multiple sclerosis, cancer and AIDS. But doctors are skeptical about its potential as a sleep aid.
The doubts are partly based on the fact that marijuana is classified as a Schedule I drug. The US Drug Enforcement Agency considers cannabis to be as dangerous as heroin, LSD, and Ecstasy. (Yes, really!) Cannabis may well be sedating, this line of thinking goes, but the risk of developing tolerance and dependency far outweighs the benefits.
Medical skepticism is also based on studies of marijuana and sleep published in the 1970s (after 1970 it got much harder to obtain cannabis for investigative purposes). All these studies were small and relatively short in duration. In most of them, the experimental subjects were not people with insomnia. But although some subjects who used it reported sleeping longer and better, THC—the chemical responsible for most of marijuana’s psychological effects—was discovered to change the nature of sleep. It tended to
- cause mild suppression of REM sleep in low doses
- increase deep sleep or total sleep time at first, an effect that disappeared following a week of use
- decrease both REM and deep sleep at high doses.
Regarding study subjects, design, length, and control of variables, though, these early studies were all over the map. They don’t tell us anything definitive about the effects of marijuana on sleep. And they certainly don’t tell us anything about its effects on people with insomnia.
Findings released last week from the University of Pennsylvania will likely foster more skepticism about marijuana’s viability as a sleep aid. Researchers looking for a relationship between sleep and marijuana use in data from a national health survey found that a history of marijuana use was associated with impaired sleep quality. The strongest association was found in adults who started using marijuana before age 15: they had about twice as many problems falling asleep and experiencing non-restorative sleep as adults who’d never used marijuana.
This study does not answer the question of whether marijuana use actually causes sleep problems. “All we can say is that there is an overlap” between marijuana use and sleep problems, lead investigator Michael Grandner told The Daily Beast on Wednesday.
Where We Go from Here
All this said, we don’t know the particulars of how the different cannabinoids in marijuana affect sleep. We don’t know enough to rule it out as a useful sleep aid in some instances. We’ll never know more unless investigators step up to the plate.
The current classification of marijuana as a Schedule I substance is clearly a deterrent to further study. Now that investigators have identified several legitimate medicinal uses for it, I’ll go along with the proposal set forth by Charles and Sandra Webb in the April issue of Hawai’i Journal of Medicine & Public Health. Cannabis should be rescheduled to a lower status, the Webbs say, “so as to reduce barriers to needed research and to humanely increase availability of cannabinoid medications to patients who may benefit.”
How does marijuana affect your sleep?