Will Marijuana Help My Insomnia?

Some people tell me marijuana helps them sleep. Just last week a friend from college—I’ll call her Marcia–mentioned she’d tried it and was happy with the result.

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.

marijuanaSome people tell me marijuana helps them sleep. Just last week a friend from college—I’ll call her Marcia–mentioned she’d tried it and was happy with the result.

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.

Medical Skepticism

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.

New Information

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?

Sleeping Pills: More Sleep or Better Sleep?

I roll my eyes when I see articles about how we humans are prone to miscalculating sleep time—in particular, people with insomnia. We tend to underestimate how long we sleep, and the conclusion is often that if we knew how long we were really sleeping, we wouldn’t complain so much.

That’s not the message of the latest of these articles, written by Derek Thompson in The Atlantic. Thompson looks at how the quest to prolong sleep ties in with the use of sleeping pills—but I think his analysis falls short.

count-sheepI roll my eyes when I see articles about how we humans are prone to miscalculating sleep time—in particular, people with insomnia. We tend to underestimate how long we sleep, and the conclusion is often that if we knew how long we were really sleeping, we wouldn’t complain so much.

That’s not the message of the latest of these articles, written by Derek Thompson in The Atlantic. Thompson looks at how the quest to prolong sleep ties in with the use of sleeping pills—but I think his analysis falls short.

Yes, We Are Unreliable

To show how unreliable we are at estimating sleep, Thompson presents data from two surveys. In one, Americans report averaging 6 hours and 45 minutes of shut-eye a night. In the other, Americans report an average of 8 hours and 42 minutes’ sleep—a whopping two-hour difference. He goes on to cite a sleep study in which New Yorker writer Elizabeth Kolbert thought she lay awake for 3 hours before finally drifting off. In reality, according to the study, she fell asleep within 10 minutes of getting in bed.

Not only are we in the dark about how much time we’re sleeping, Thompson says. The number of insomnia diagnoses and sleeping pill prescriptions has more than quintupled since 1990, yet Americans not sleeping any longer today than they were then. He concludes by suggesting that we need more accurate data about how long we’re sleeping and better drugs.

My Take

I’m all in favor of calling for better sleeping pills. The ones we’ve got now—like Ambien and Lunesta—have side effects and alter the nature of the sleep we get. But I’d like to steer the conversation away from the unreliability of our sleep estimates and the idea that prolonging sleep should be the main gauge of a drug’s effectiveness.

There are explanations for why humans—especially people with insomnia—tend to miscalculate how long we sleep. It’s easy to perceive Stage 1 sleep, the earliest and lightest stage, as wakefulness. In a retrospective study published in October 2013, Belgian investigators found that as we fall asleep, people with insomnia tend to have more high-frequency activity occurring in our brains than do normal sleepers. This suggests a higher degree of information processing, which may feel like wakefulness rather than sleep. In another recent study, German researchers found more high-frequency activity occurring in the brains of insomniacs during Stage 2 sleep.

No wonder we’re unreliable at estimating sleep time. Some of the sleep we get feels like wakefulness. So the real culprit for some of us may not be sleep length at all. It may be our poor sleep quality—an inability to shut the brain down completely and keep it offline for a sustained period of time.

In Search of Sleep Quality

There’s no definitive way to measure sleep quality today; it can’t be assessed in a sleep lab. But a recent meta-analysis of sleep studies concludes that people with insomnia get less deep sleep—associated with feelings of restoration—and less REM sleep—associated with dreams and emotional processing—than good sleepers. Maybe these are not exactly measures of sleep quality. But I’ve got a hunch they’ve got something to do with it.

What insomniacs need is not just information about how long we’re sleeping, and it may not even be that we need drugs that greatly prolong our sleep. The real problem for many of us is poor sleep quality.

Hey, Big Pharma, give us drugs to improve that.

What are your main sleep complaints? If you’ve tried sleeping pills, have they helped?

Quick Quiz on Sleep

How much do you know about sleep? See if you can answer these eight questions correctly. Check your answers at the bottom of the page.

computer-quizHow much do you know about sleep? See if you can answer these eight questions correctly. Check your answers below.

1. Most dreams occur

a)      At the beginning of the night

b)      In the middle of the night

c)       At the end of the night

2. We sleep most deeply

a)      At the beginning of the night

b)      In the middle of the night

c)       At the end of the night

3. In a sleep cycle, we move from light sleep to deep sleep and back to light sleep, and then into REM sleep. How many sleep cycles do we typically go through each night?

a)      2-3

b)      4-5

c)       6-7

4. Rapid eye movement (REM) sleep is when most dreams occur. During quiet (non-REM) sleep, the brain is mostly inactive. The 3 stages of non-REM sleep are stage 1 (very light), stage 2, and stage 3 (deep sleep). Healthy adults spend the greatest percentage of the night in

a)      Stage 2 sleep

b)      Deep sleep

c)       REM sleep

5. During deep sleep, there’s a spike in

a)      testosterone

b)      Melatonin

c)       Growth hormone

6. The pineal gland starts secreting melatonin

a)      About 2 hours before bedtime

b)      When it gets dark outside

c)       Just before we enter deep sleep

7. Which of the following is untrue? As we age,

a)      We get slightly more REM sleep

b)      We get less deep sleep

c)       Men experience more dramatic sleep stage changes than women.

8. Which is the most common sleep problem?

a)      Restless legs syndrome

b)      Insomnia

c)       Sleep apnea

 

ANSWERS

  1. C. About 80 percent of our dreams occur in the last half of the night.
  2. A. Deep sleep is discharged in the first half of the night.
  3. B. 4-5 cycles/night
  4. A. About 50 percent of the night is spent in stage 2 sleep.
  5. C. The production of growth hormone spikes during deep sleep.
  6. A. Melatonin secretion begins about 2 hours before bedtime.
  7. A. REM sleep slightly decreases as we age.
  8. B. Insomnia is the most common sleep problem.

How did you fare? Let me know if any of these answers need explaining.

Is Quality Sleep for Sale?

When it comes to sleep, I’m convinced that quality is more important than quantity. Hands down, I’ll take 5 ½ hours of sound slumber over restless dozing that stretches out for 7 hours.

So I have mixed feelings about sleeping pills. Many meds invented to give us more sleep degrade the Zzzz’s we get and can actually worsen insomnia.

pharmacyWhen it comes to sleep, I’m convinced that quality is more important than quantity. Hands down, I’ll take 5 ½ hours of sound slumber over restless dozing that stretches out for 7 hours. So I have mixed feelings about sleeping pills. Many meds invented to give us more sleep degrade the Zzzz’s we get and can actually worsen insomnia.

The case of Michael Jackson is relevant here. Propofol, the hypnotic Jackson was given by Dr. Conrad Murray for sleep, knocked Jackson out but robbed him of precious REM sleep. Sixty days of propofol injections amounted to the equivalent of Jackson being sleepless for 60 straight days, Harvard sleep specialist Charles Czeisler testified during Jackson’s wrongful death trial, according to Time Magazine online. The accumulated effects of propofol may have led to Jackson’s untimely death.

Of course, propofol is an anesthetic, not a sleeping pill. It has never been approved for the treatment of insomnia, likely because it so radically alters the nature of the sleep it provides. But sleeping pills also affect sleep quality, and it’s important to understand how.

What Does Quality Sleep Look Like?

There is no objective measure of sleep quality. But normal sleep consists of both REM sleep (when we’re dreaming) and non-REM, or quiet, sleep. Deep sleep is a key component of the non-REM sleep. Apparently we need a certain amount of both REM and non-REM sleep (particularly deep sleep) to survive.

REM Sleep Deprivation

Subjects deprived of REM sleep are moody and emotional and have memory problems. Barbiturates—sleeping pills widely prescribed through the 1970s—put people to sleep but, like propofol, deprived them of REM sleep. Nightly users who tried to stop taking drugs like Nembutal and Seconal experienced “REM rebound”—nights fraught with terrifying dreams.

REM rebound was so awful that it led people to resume taking the drug, and eventually to drug dependency and ever-increasing doses, sometimes resulting in overdose and death. This is why barbiturates are rarely prescribed for insomnia anymore.

Deprivation of Deep Sleep

Subjects deprived of deep sleep have memory and learning problems, experience compromise of various bodily systems, and typically wake up feeling unrested. Benzodiazepine drugs such as Restoril, Halcion, and Ativan—which are prescribed for insomnia today—reduce the amount of deep sleep users get. They may keep you sleeping longer, but, if you take them for prolonged periods, you wake up feeling unrefreshed.

What about the popular “Z-drugs,” zolpidem (Ambien) and eszopiclone (Lunesta)? Taken nightly, they too may result in small reductions in deep sleep, although not to extent that benzodiazepines do. And zolpidem was recently discovered to increase the occurrence of “sleep spindles”–events during non-REM sleep that, in excess, heighten users’ memory for negative events.

I’ll be the first to argue that sleeping pills have a place in the treatment of insomnia. I don’t have patience for pharmacological Puritans who insist they be avoided at all costs. Yet to use them—especially for long periods—is a little like robbing Peter to pay Paul. Keep this in mind as you’re deciding if and when to pop an Ambien.

If you’ve used sleeping pills for extended periods, what effect did they have on your sleep?

To Nap or Not?

Research shows there are many benefits to napping. But if you have chronic insomnia, they may not be such a good thing.

siesta2How I envy people who can nap! My husband, for instance, no sooner announces his intention and stretches out on the sofa than he’s down for the count. Or people I see on planes, trains, buses, and park benches. They settle down in their seats and then—bam!—their heads are lolling on their chests.

“That’s talent!” said an insomnia sufferer I interviewed for my book, and I agree. Drift into slumber amid the hubbub of people loading suitcases into luggage bins, or among strangers on a beach? I couldn’t do that in a million years. It’s rare that I can even catch a few minutes’ midday shut-eye within the quiet, protective walls of my home.

Benefits of Napping

But quite a bit of research suggests I’d be better off if I could. Not only does midday napping seem to make people more alert, but it also enhances thinking and memory. For example, in a study of medical residents, subjects that napped an average of just 8 ½ minutes were sharper and had fewer attention failures than residents who remained awake.

Longer naps appear to be even better if the aim is to consolidate memories. A study that compared three groups—subjects that napped 10 minutes, others that napped 60 minutes, and others that stayed awake—found that upon awakening the nap-takers recalled more of the information learned before the naps than did those who remained awake. The memory retention in the 10-minute nap-takers was temporary and disrupted by the learning of new information. But the 60-minute nap-takers were able to hold on to more material learned before napping despite the interference of new learning.

Napping and Insomnia

The benefits of napping sound fabulous. So why is it so hard for me and many others who suffer from insomnia to seize a few winks during the day?

The central nervous system has both alerting and inhibiting forces, and current thinking holds that on the arousal side, insomniacs are cranked up a notch too high. Even though we might feel tired and dull as mud, these overactive alerting forces make it harder for us to sleep both night and day.

Nor are naps—especially long naps—recommended for people who have trouble sleeping at night. Sleep drive, which builds higher with every waking moment and finally propels us into slumber, diminishes if we descend into deep sleep, which may occur during longer naps. So for people inclined to insomnia, the experts generally recommend cutting naps out altogether or restricting them to 30 minutes.

Recommended or ill-advised, naps are mostly out of the question for the likes of me for now. But I’m holding out hope that perhaps in my dotage I’ll be nodding off with my peers for little catnaps during the day. Aging is never a picnic, but the thought of being able to nap is a pleasant one.

Do you take naps? In what ways do they seem to help?

Medical Residents and a Midday Nap

Deep Sleep During a Daytime Nap

Memory Loss: What’s Sleep Got to Do with It?

We all know memory loss is part of aging, and that glimmerings of compromise start appearing in middle age.

A new study by sleep researchers in California suggests that age-related memory loss is caused by changes in sleep, and that remedies being developed to improve sleep may help us remember more.

memory-lossAll my friends are complaining about memory loss these days.

“Was I supposed to call you? I’m sorry. I can’t remember a thing unless I write it down.”

“It’s my Halfs-heimers. How long before I forget my name?”

All this talk about memory issues makes me feel a little less self-conscious about mine. Yes, I’m more and more prone to sounding like my mother, who gropes a lot for words. “She told me I had to—oh, you know—there’s something I have to fill out—you know—to get the money . . . She’s going to send it to me—what’s the word?” And how long before I also start repeating stories the way my mother does, who told me not once or twice but ten times that she suspected her missing checkbook fell into the trash?

Memory Loss and Sleep

We all know memory loss is part of aging, and that glimmerings of compromise start appearing in middle age. A new study by sleep researchers in California suggests that age-related memory loss is caused by changes in sleep, and that remedies being developed to improve sleep may help us remember more.

Short-term memory storage occurs in a brain region called the hippocampus. But for memories to become consolidated for long-term storage, they have to be transported to the front part of the brain, or the prefrontal cortex—a process that occurs during sleep. As people age, two things occur to interfere with this process.

  1. We lose gray matter in the prefrontal cortex, the region responsible for initiating the slow brainwaves that occur during deep sleep. Deep sleep is the kind of sleep that enables memory consolidation to occur. In turn,
  2.  We get less deep sleep—much less, in fact. While young adults spend about a quarter of their sleep time in deep sleep, the amount of deep sleep older adults get may be as little as 10 percent. So in older adults, some short-term memories in the hippocampus never get to migrate to the long-term storage area at the front of the brain.

“When we are young, we have deep sleep that helps the brain store and retain new facts and information,” said UC Berkeley sleep researcher Matthew Walker, commenting on the study in Medical News Today. “But as we get older, the quality of our sleep deteriorates and prevents those memories from being saved by the brain at night.” The result is that we have trouble remembering facts that we learned and events that occurred just a day or two before.

Remedies in the Pipeline

But hope is at hand, this same group of researchers says. Despite aged-related deterioration of the prefrontal cortex, new therapies under development now may help prevent memory loss. Weak electrical stimulation of the brain and new medications may help promote deep sleep and improve the memory of older adults.

“Can you jumpstart slow-wave sleep and help people remember their lives and memories better?” said Bryce Mander, a postdoctoral fellow in psychology at UC Berkeley and the lead author of the new study, published last month in the journal Nature Neuroscience. “It’s an exciting possibility.”

I don’t know how you feel, but I want access to these slow-wave sleep-promoting therapies RIGHT NOW.

Have you noticed that how soundly you sleep seems to affect your memory? The issue is near and dear to my heart, and I’ll share a more personal perspective in my blog on Thursday.

Boosting Slow-Wave Sleep Could Restore Memory

Disrupted Slow-Wave Sleep and Memory

A New Look at Trazodone for Sleep

Trazodone has never been approved for the treatment of insomnia. Yet it rose to the top of the bestseller charts as a medication for sleeplessness in the 1990s and enjoys great popularity still. Here’s one explanation for its appeal.

It’s been a stretch for me to accept that trazodone, a sedating antidepressant, is such a popular treatment for insomnia. Clinical trials have never shown it helps put people to sleep or keeps them sleeping longer. And even at low doses (50 mg.), the drug is known to produce cognitive and motor impairments the following day.* Trazodone has never been approved for the treatment of insomnia, yet it rose to the top of the bestseller charts as a medication for sleeplessness in the 1990s and enjoys great popularity still.

Trazodone

Confession: this is the sort of knotty paradox that keeps me awake at night.

Now, I have insomniac friends who swear by trazodone, and I know they’re not delusional. They use low-dose trazodone because it works for them, and they don’t need to understand why.

But I’m a stickler for evidence, and this gap between subjective experience and objective proof is a real sore point. So imagine my thrill at finding a paper that explains why it might be that trazodone works.

Trazodone and REM Sleep

The traditional view of insomnia holds that it’s basically a problem of non-REM (or quiet) sleep. Insomniacs may not be getting the same percent of deep sleep as good sleepers, or the problem may be in how deep sleep is discharged. Deep sleep is the restorative stuff, the kind that “knits up the raveled sleeve of care.” Alternatively, the quality of non-REM sleep may be compromised by lots of high-frequency brain activity that enables you to sense things even while you’re asleep.

But for insomniacs who struggle with frequent awakenings in the middle of the night, the problem may in fact be occurring during REM (or active) sleep, when you’re dreaming. A new analysis shows that percent-wise, people with sleep maintenance insomnia get less REM sleep and awaken more often during REM sleep than good sleepers. The hypothesis is that these insomniacs may be suffering from “REM sleep instability.”**

Despite its otherwise underwhelming characteristics as a sleep medication, trazodone does cut down on nighttime awakenings and make sleep feel easier. Unlike most other antidepressants, the drug does not suppress REM sleep. So as a sleeping pill, trazodone may have a claim to legitimacy after all.

Perhaps you’re one who knew it all along, but I was a skeptic, and this bit of news has done wonders for my sleep!

Effects of Trazodone

** REM Sleep Instability