Saintly Thoughts on Sleep Hygiene

We often hear that Americans are not getting enough sleep. Electric lights (and now screens) are usually cited as the culprits, and Thomas Edison gets blamed for saying we should all sleep less. But the Catholic saints had the same opinion. The shorter their nights were, the more time they could devote to prayer and charitable work.

I just finished reading Father Aloysius Roche’s Bedside Book of Saints, and it’s clear to me that the saints would take issue with several ideas promoted by sleep experts today, including advice for insomnia sufferers looking for a better night’s sleep.

Good sleep hygiene, while useful for insomniacs today, would not appeal to the Catholic saints

We often hear that Americans are not getting enough sleep. Electric lights (and now devices with screens) are usually cited as the culprits, and Thomas Edison gets blamed for saying we should all sleep less. But the Catholic saints had the same opinion. The shorter their nights were, the more time they could devote to prayer and charitable work.

I just finished reading Father Aloysius Roche’s Bedside Book of Saints, and it’s clear to me that the saints would take issue with several ideas promoted by sleep experts today, including advice for insomnia sufferers looking for a better night’s sleep.

 

Most Adults Need 7 to 8 Hours of Sleep a Night

I doubt the saints would agree. The story is that Saint Macarius went without sleep for 20 days at a time but lived to the ripe old age of 90. Such a steady diet of sleep deprivation would surely be the ruin of modern Americans. We hear about the nasty consequences of sleep deprivation all the time: Insulin resistance will develop and later, diabetes. Stress hormones will flood our bodies and put us at risk for heart disease. Plaques will form in our brains. Dementia will set in.

Likewise, Saint Elphide, Saint Colette, and Saint Catherine de Ricci purportedly went for long periods without sleep.

Did they suffer as a result? No, says Father Roche. Going without sleep was “a miraculous privilege akin to that of those who lived without any other nourishment than the Holy Eucharist.”

Go to Bed and Get Up at the Same Time Every Day

Saints in the contemplative orders might agree with this advice, bound as they were to rigid schedules 24/7. But not Saint Catherine of Siena. She embraced insomnia, sleeping briefly every two nights. This she called “paying the debt of sleep to the body.” As if to say, “Sleep is a bother, but at least I can dispense with it every other night.”

Make the Last Hour before Bed a “Wind-Down” Time

The need for a “wind-down” period before bed would probably have puzzled the saints. Sure, life was full of mortification and risk-taking for the boldest among them, yet they had one big advantage over most of us today, says Father Roche: their minds and hearts were in a habitual state of tranquility.

“The Saints were free from the guilty worries and anxieties which undermine the repose of the worldly,” he writes. “They had that most restful of all pillows—a good conscience.”

So there would be no need to wind down at the approach of bedtime. On the contrary, the saints often did their best to stay awake. Saint Dorotheus kept himself up making mats. Saint Jerome tried to stay awake and when he found himself nodding off, he “dashed himself upon the ground.” (Readers undergoing sleep restriction, take note!)

Make Sure Your Bed Is Comfortable

The saints would have dismissed the notion of a comfortable bed as self-indulgent. Why sleep in comfort when there were other, more righteous ways to sleep: on the ground (Saint Martin of Tours), on the straps at the bottom of a chair (Saint Dominic), or sitting upon a stone (Saint Pachomius).

Saint Charles Borromeo normally slept in a chair. He was eventually persuaded to sleep on a mattress, but it had to be made of straw. His advice for people complaining about a cold bed was rather chilly, notes Father Roche:

“The best way not to find the bed too cold is to go to bed colder than the bed is,” the saint said.

Do Not Read in Bed

The saints would definitely have disagreed with this rule of good sleep hygiene. Pious reading was exactly what one was supposed to do in bed (when not praying).

And maybe Saint Jerome’s advice will be useful for at least some insomnia sufferers looking for a better night’s sleep: “Let holy reading be always at hand,” he said. “Sleep may fall upon thee as thou lookest thereon, and the sacred page meet the drooping face.”

Q&A: During CBT, Do I Have to Stop My Sleep Meds?

A long-term user of sleeping pills wrote to Ask The Savvy Insomniac with questions about cognitive-behavioral therapy for insomnia. “Before I go through CBT, will I have to give up my sleeping pills? I’d like to get off them eventually, but every time I think of doing it I freak out.”

Recently I looked into research on insomnia sufferers going through CBT while at the same time tapering off (or reducing reliance on) sleeping pills. What I found was encouraging.

Insomnia sufferers who use sleeping pills can taper off them while undergoing cognitive-behavioral therapyA long-term user of sleeping pills wrote to Ask The Savvy Insomniac with questions about cognitive-behavioral therapy for insomnia.

“Before I go through CBT, will I have to give up my sleeping pills? I’d like to get off them eventually, but every time I think of doing it I freak out.”

Some sleep therapists ask people with insomnia to refrain from using sleeping pills while undergoing CBT, a treatment that promotes sleep-friendly practices and a positive mindset. But this rule may be hard to comply with for people who’ve used sleeping pills for months and years. So hard, in fact, that it may discourage them from trying CBT at all.

Recently I looked into research on insomnia sufferers going through CBT while at the same time tapering off (or reducing reliance on) sleeping pills. What I found was encouraging, so I’ll share it here.

Sleeping Pills? I Love Them!

My aim isn’t to convince people comfortable with their sleep meds to come off them. I use hypnotics occasionally myself, and frankly I get tired of people demonizing them as if they were on par with heroin or crack cocaine.

But some nightly users complain, even when taking sleeping pills, that their sleep isn’t very satisfying. This perception is probably related to the fact that many sleep meds, especially when taken over time, tend to change the nature of sleep. Also, studies linking long-term use of sleeping pills to increasing vulnerability to colds, depression and mortality are not reassuring. It’s easy to see why some long-term users are interested in a path to sleep that feels more “natural.”

Tapering Off Sleep Meds

If you’ve used hypnotics for a long time, it’s not a good idea to go cold turkey, say Lynda Bélanger and colleagues in a paper on hypnotic discontinuation. Stopping abruptly puts you at greater risk for withdrawal symptoms and health complications. Hypnotic drugs should be discontinued gradually, they say–ideally with guidance from a trusted physician.

No guidelines exist showing what the optimal rate of tapering is. Your doctor might propose decreasing the initial dose by 25 percent every week or every other week. But, say these Canadian researchers, the pace of the tapering “may need to be adjusted according to the presence of withdrawal symptoms and anticipatory anxiety; it can also be slowed if the person finds it too difficult to cope or feels unable to meet the reduction goal.”

CBT Assists Tapering and Improves Sleep

In most studies of sleeping pill users undergoing CBT for insomnia, CBT has helped wean them off drugs (or reduce the amount they use) and improved their sleep. Here’s a snapshot of the results:

  • CMAJ, 2003: About 77 percent of those undergoing CBT while on a drug tapering program came off their meds, vs. 38 percent on the drug tapering program only.
  • American Journal of Psychiatry, 2004: About 85 percent of those undergoing CBT while on a drug tapering program came off their meds, vs. 48 percent on the drug tapering program only. CBT groups also reported greater sleep benefits than the group doing the taper alone.
  • BMC Psychiatry, 2008: Added to a drug tapering program, CBT improved sleep quality in hypnotic users even more than it did in people who didn’t use drugs.
  • Sleep Medicine, 2014: In this novel study, adding hypnotic medication to traditional CBT improved subjects’ sleep faster than CBT alone. (By the end of therapy, the sleep of both groups had improved equally).

So if you’d like to try CBT but are anxious about stopping your sleep meds, shop around for a sleep specialist who’s willing to work with you to tailor a program suited to your needs. What’s not to like about the prospect of improving your sleep and at the same time reducing your dependence on drugs?

What concerns do you have about CBT and sleeping pills?

Sleep at College: Here’s How to Get Enough

Off to college soon (or know of someone who is)? You’re probably looking forward to interesting classes, good friends, and the freedom to live away from the prying eyes of Mom and Dad. Heady prospects, all three! But you’ll also face some challenges. Getting enough sleep may be one.

But college life doesn’t have to be disruptive to sleep. By planning ahead, you can get the sleep you need whether you’re inclined to get up early or burn the midnight oil. Here’s what you can to do get a better night’s sleep away from home.

Make sure you sleep well at collegeOff to college soon (or know of someone who is)? You’re probably looking forward to interesting classes, good friends, and the freedom to live away from the prying eyes of Mom and Dad. Heady prospects, all three! But you’ll also face some challenges. Getting enough sleep may be one.

Sleep at college was a challenge for me: growing up in a quiet home, prone to occasional bouts of insomnia, I was unprepared for life in a dormitory. The dorm was a place where rock music and partying ruled—no matter that some of us had early morning classes. Often I struggled with insomnia. That I could see, the world was divided into two tribes: early risers and night owls. Living so close together was a pain in the neck!

College life doesn’t have to be so disruptive to sleep. By planning ahead, you can get the sleep you need whether you’re inclined to get up early or burn the midnight oil. Laura McMullen in US News & World Report recently offered advice on how to sleep well at college. Here’s mine.

If You’re an Early Riser

Especially if you’re a light sleeper or one who needs a solid 8 to 9 hours, you’ll need to be prepared to deal with unwanted noise at night. You can

  • Arm yourself with silicone earplugs
  • Use a device that creates white noise. Small fans work well, as do white noise generators that can be purchased online or at stores like Best Buy. My brother swears by his SleepPhones, also available online.

A bigger challenge for early risers may be negotiating with roommates for the conditions you need to get a good night’s sleep.

  • Be up front about the situation from the start. Tell your roommates you’ve got an early class and need the place to be quiet and dark by 11 p.m. Ask them please to text rather than talk on the phone, or to wear a headphone while watching TV.
  • If friendly negotiations don’t do the trick, then request a move–the sooner, the better. Ideally you’ll know of another person looking for an early-bird roommate or someone who’s likely to be considerate of your needs. If not, interview prospective roommates about their habits at night. Given a choice of location, avoid rooms near high-traffic areas like bathrooms and stairways.

If You’re a Night Owl

Noise won’t be such a problem if you’re naturally inclined to stay up late. But you may find that your sleep preferences are out of sync with daily life on campus. Your circadian rhythms are delayed, so you’ll tend to be sound asleep when early morning classes begin and you may not feel truly alert until much later in the day. (A young night owl I know claims he doesn’t really hit his stride until 6 p.m.)

To get the sleep you need and feel alert during the day,

  • Make strategic use of bright light. Light is your friend in the morning but a foe at night. When you get up in the morning, open the curtains and turn on the lights. Spend time outside if you can. In the evening, keep lighting low. Avoid computer screens and other light-emitting devices for an hour or two before going to bed.
  • Check with your doctor about using over-the-counter melatonin supplements. Taken around dinnertime, they enable people to fall asleep earlier than normal—at midnight, for example, rather than 1 or 2 a.m. (For details, see this blog or watch this video trailer.)
  • Schedule your classes later in the day. If you slept through 8 o’clock classes in high school, chances are you’ll sleep through early morning classes at college. You may be older, but circadian rhythms remain fairly consistent.

Arrange for active days and restful nights as best you can. If you still find yourself dropping off to sleep in class, catch some shut-eye in the middle of the afternoon. Ten- to 30-minute naps can do wonders for your stamina and put you on top of your game.

Your Sleep Need? Figure It Out Yourself

You’ve heard the advice to get 8 hours of sleep a night? Now they’re saying that 7 hours is the optimal amount of sleep–which may not be very cheering for most people with insomnia. Still our nights do not measure up.

If you have persistent insomnia, and if you fall short of the recommended 7 or 8 hours, it’s natural to wonder if you’re getting enough sleep. Here’s how to get a good sense of how much sleep you really need.

calculate your sleep need by keeping track of the hours you sleep on vacationYou’ve heard the advice to get 8 hours of sleep a night? Now they’re saying that 7 hours is the optimal amount of sleep–which may not be very cheering for most people with insomnia. Still our nights do not measure up.

As if that weren’t bad enough, the web is glutted with articles showing that short sleepers are vulnerable to a host of ailments: depression, heart disease, obesity, diabetes, dementia. Yikes! It’s a wonder any of us live past 65.

If you have persistent insomnia, and if you fall short of the recommended 7 or 8 hours, it’s natural to wonder if you’re getting enough sleep.

How Much Sleep Is Enough?

Sleep need—or sleep ability—varies a lot from one person to the next. Some people feel refreshed after 5 hours while others need 9. In normal sleepers, the duration of sleep is fairly consistent from one night to the next, so it’s easy to make inferences about sleep need. A person who under favorable conditions normally falls asleep at 11 and wakes up at 6 needs an average of 7 hours’ sleep a night.

But the sleep of people with insomnia is much more variable. Insomniacs are 60 percent more likely than good sleepers to sleep poorly on any given night. After a slew of bad nights, it feels heavenly to pop off a solid 8 hours. You wake up feeling rested and ready for the day—and this might lead you to infer that you need 8 hours a night to function at your peak.

But it’s a mistake to assume that the sleep you get on a night of recovery sleep is equivalent to the amount of sleep you need every night. It’s also wrong to assume that the 4 hours you more often get will suffice. The truth lies somewhere in between.

Track Your Sleep over Time

To find the amount of sleep you need for optimal functioning, keep track of the hours you sleep for a week or two and then take the average of that. This is probably closer to your daily sleep need.

But . . . this figure may be off the mark for people with persistent insomnia. Stress can interfere with sleep and make it hard to get an accurate read on sleep need. You may be slightly but chronically low in the tank.

A Better Way to Calculate Sleep Need

Eve Van Cauter, director of the Sleep, Metabolism and Health Center at the University of Chicago, suggested a better way to figure out sleep need or capacity in last week’s USA Today. Here it is:

Wait until you’re on vacation and free of the stressors connected to the daily grind. Once you’re away, go to bed at your usual time but do not set an alarm clock. The first few days you may sleep longer than normal to make up for the sleep debt you’ve accumulated at home.

Then, once your sleep stabilizes, start keeping track of how long you sleep. This, plus or minus 15 minutes, Van Cauter says, is as good a way as there is to get a handle on your daily sleep need.

Insomnia? Travel Can Be Just the Thing

I just got back from a three-week trip to Canada, and I slept fabulously most of the time. Insomnia caught up with me just two nights out of 20. That’s as good as it gets.

Sleep doctors claim that people with insomnia often sleep better on vacation. “Of course you slept better on your trip,” I can imagine them saying sagely. “You were away from life stressors, you were away from your bed and your worries about sleep. Why wouldn’t you sleep better in places where anxiety hasn’t taken root?”

I have a different explanation for why I slept so well on the trip.

Lunenberg togetherI just got back from a three- week trip to Canada, and I slept fabulously most of the time. Insomnia caught up with me just two nights out of 20. That’s as good as it gets.

Sleep doctors claim that people with insomnia often sleep better on vacation. “Of course you slept better on your trip,” I can imagine them saying sagely. “You were away from life stressors, you were away from your bed and your worries about sleep. Why wouldn’t you sleep better in places where anxiety hasn’t taken root?”

I’ve never completely accepted this explanation for my luck with sleep on trips. “Insomnia isn’t just a matter of context,” I imagine replying to those learned doctors. “I take my anxiety about sleep with me wherever I go, thank you very much!”

I have a different explanation for why I slept so well as we traveled through Canada. It lies in my husband and travel companion, whose idea of a good vacation is dawn-to-dusk activity and who—true to his nature as a firstborn—likes to direct the show.

Traveling Together

Don’t misunderstand: Eric and I are mostly in agreement about the nature of our trips. Active vacations are the kind we prefer. For road trips we pack along hiking shoes, bicycles, and bathing suits. We’d much rather take a walk or visit a museum than simply lie on a beach.

Where we differ is in the amount of activity we like. Eric has tons of stamina and endurance, and he moves into overdrive the minute we leave home.

  • Stop at a roadside motel because we’re getting hungry and sick of driving? Why spend a night along an ugly stretch of highway when in 45 minutes we could stop in town and take a bike ride before we eat?!
  • Take the metro to the botanical garden when it’s just a few miles away from the hotel? We could as easily walk (never mind that we’ll be on our feet for the rest of the day)!
  • Relax after an afternoon hike over hors d’oeuvres and a bottle of wine? But there’s still plenty of light outside. This is the perfect time for a swim!

You get my drift. While I like to insert some R & R in between activities, Eric never winds down.

Negotiating Plans

We have words about the pace we keep from time to time. I’m a firstborn too, and relinquishing directorship of the program doesn’t come easily to me, either. Occasionally my pitch for the R & R prevails, and other times I crack open a book and let Eric work off his energy by himself.

But, traveling with a partner, you’re together 24/7, cooped up in the same car and the same hotel room and dependent on each other in so many ways. On vacation it’s harder for me to resist getting sucked into the Eric vortex, as my sister aptly describes it. I go and do and see more than I would if I were traveling on my own.

The upside to this arrangement is its hypnotic effect on my sleep. By 11 or 12 my book has fallen to the floor and I’m out cold for the rest of the night. (Insomnia? What was that about?)

The downside is the exhaustion I return to at the end of these trips. You’ve heard of having to recover from a vacation? I’m there right now.

How does going on vacation typically affect your sleep?

Q&A: Sleep Restriction: Tempted to Give Up

Jessica recently wrote with concerns about sleep restriction.

I’m on Day 6 of sleep restriction and I don’t think it’s working. The first 3 nights were miserable. I kept looking at the clock and thinking, just 4 more hours to sleep, just 3 more, just 2 . . . I had so much anxiety I hardly slept at all!

Am I just going to have to resign myself to insomnia for the rest of my life? Honestly I’m on the verge of giving up.

coffee-in-bedJessica recently wrote to Ask The Savvy Insomniac with concerns about sleep restriction.

I’m on Day 6 of sleep restriction and I don’t think it’s working. The first 3 nights were miserable. I kept looking at the clock and thinking, just 4 more hours to sleep, just 3 more, just 2 . . . I had so much anxiety I hardly slept at all!

But on the 4th night I passed out and overslept my alarm in the morning. I FELT GREAT. And I’m like, sleep restriction rocks! But . . . the next night was terrible. I barely got 2 hours, and the same thing happened again last night. Today I feel so bad I called in to work—something I never do unless I’m sick.

Now I’m wondering if it’s worth the punishment.  Am I just going to have to resign myself to insomnia for the rest of my life? Honestly I’m on the verge of giving up.

An Erratic Sleep Pattern

I can so relate to Jessica’s plight. The sleep pattern she describes was mine for several decades. Terrible sleep for 3 to 5 nights in a row, followed by a night where I conked out so completely I could sleep through ear-splitting thunder.

Mornings after super long nights felt great. But nothing is comforting about this kind of sleep pattern. Lurching from one bad night to the next, never knowing when I was finally going to pop off a good one, raised my anxiety sky high. I wanted good sleep to be regular. I wanted it to be dependable.

With Restriction, a Payoff

My first week of sleep restriction was pretty close to hell. Like Jessica, I had 3 really bad nights before I was sleepy enough to fall asleep at the bedtime I’d chosen. But sleep restriction also required getting up at a fixed time every morning. This rule contradicted one of the most ingrained notions I had about my sleep, namely, that on the rare nights when I could sleep, I’d better let myself sleep as long as possible—because I never knew when I’d get another chance.

So when the alarm rang at 5 a.m., the temptation was simply to roll over and go back to sleep. It felt like the middle of the night. It felt like I needed more sleep. Why deny myself something my body evidently needed?

By that time I was far enough along in my research to understand the theory behind sleep restriction; I understood the forces driving my insomnia well enough to know that letting myself sleep late was probably a road to nowhere. So I mustered up my willpower and hauled myself out of bed and into the day–and the next day, and the next.

Wasted is how I felt after those short nights, and definitely lame in the head. But I held fast to my sleep window, recalculating my time in bed at the end of each week. And in time my sleep became deeper, longer and more dependable. Amazing gifts for a guerrilla sleeper like me.

Rest for Success

Not every insomniac will benefit from sleep restriction. But research suggests many can. Set yourself up to be one of them by

  • choosing to go through treatment at a time when you’re not too busy with other things.
  • avoiding clocks after bedtime. Looking at the clock creates anxiety, and that’s something you want to avoid.
  • setting appropriate bed and wake times and observing them to the letter.

What problems have you encountered during sleep restriction?

Insomnia and Me: Squaring Off in Middle Age

I had my life organized so my insomnia was under control. I’d accepted—not very gracefully—the fact that I was going to have to get vigorous exercise not just 3 or 4 days a week but EVERY SINGLE DAY. This was part of the dues I personally was going to have to pay to be a member of the Recovering Insomniacs Club.

The exercise routine I came up with wasn’t bad. But then calamity struck.

SwimmingI had my life organized so my insomnia was under control. I’d accepted—not very gracefully—the fact that I was going to have to get vigorous exercise not just 3 or 4 days a week but EVERY SINGLE DAY. This was part of the dues I personally was going to have to pay to be a member of the Recovering Insomniacs Club.

The exercise routine I came up with wasn’t bad. Every day I forced myself to drop whatever I was doing at 5 p.m. to take a bike ride or head down to the basement for a session on the elliptical trainer. Sleep was more dependable as a result.

I even started looking forward to the workouts. Sometimes it took effort to warm up. But the surge of energy that usually came after 5 or 10 minutes, when my muscles were limbered up and working in sync, felt great. Not to mention the blissed-out feeling I had when I stopped. The extra slice out of my day wasn’t really such a big price to pay for holding insomnia at bay.

Trouble Strikes

Then I started having pain in my left knee. All weight-bearing activities that involved bending at the knee should be avoided for a few months, the orthopedist said.

“Oh, great,” I said to the doctor. “So now I can’t ride a bike?”

“Not until your knee gets better,” he said (a touch too cheerfully, I thought). “No jogging either, but the elliptical trainer might be OK.” Swimming was really the way to go, the doctor added–especially strokes with a flutter kick.

Swimming? Flutter kick? My heart sank. An hour-long schlep there and back to the pool in rush hour traffic? Changing into and out of a bathing suit every day? Showering and then washing and drying my hair in a locker room? The added expense? Why this, in God’s name, and why now?!

The grinding of my knee as I galloped along on the elliptical trainer made it clear that my Old Faithful was no longer an option. The facts were plain to see: I was going to have to become the fish I used to be in childhood. Otherwise my sleep was down the tubes.

A New Routine

I fumed over this turn of events for about a week. Then grudgingly I packed up my suit and towel, launched myself into rush hour traffic (listening to NPR to keep the road rage in check), and started swimming laps.

Swimming was OK. The water was cold at first but exhilarating by the end of the first lap. After 3 months, when I realized my knee problem was probably permanent, I started swimming at a wellness center newly opened up near my house.

Call it denial or a kind of middle-ager’s Stockholm Syndrome, but now I’ve decided I actually like swimming laps and look forward to it (if not to the 12-minute drive). Swimming in the lake outside my husband’s family cottage is even better. This photo was taken over Memorial Day, when the water was bracing. My sleep continues to be pretty good.

Swimming isn’t my first choice of exercise (and I certainly never chose my insomnia). But Stephen Stills got one thing right: If you can’t be with the one you love, love the one you’re with.

What sleep challenges have you experienced or did you experience in middle age?

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?