7. Kesner AJ, Lovinger DM. Cannabinoids, endocannabinoids and sleep. Front Mol Neurosci. 2020;13:125. doi:10.3389/fnmol.2020.00125
For example, the PACE trial, which evaluated the use of the synthetic cannabinoid dronabinol in the treatment of OSA, was conducted as a phase 2 trial and may soon be expanded to include more efficacy data. 6 Other research, such as that using natural cannabis products for restless legs syndrome, consists of case reports.
In an article published in Sleep Medicine Reviews, Suraev et al conducted a systematic analysis of 12 clinical studies and 14 preclinical studies investigating the use of cannabinoids in the management of sleep disorders. 3 They concluded that while the existing data are insufficient to support the routine clinical use of cannabinoids for this purpose, preliminary “evidence provides the rationale for future [randomized] controlled trials of cannabinoid therapies in individuals with sleep apnea, insomnia, post-traumatic stress disorder-related nightmares, restless legs syndrome, rapid eye movement sleep [behavior] disorder, and narcolepsy.”
Eye on the Future
Sleep medicine is very complex with a variable interplay of neurologic, respiratory, psychiatric, and social factors. Cannabinoids may certainly have an effect on 1 or more of these systems in any individual.
What are the implications for the use of cannabinoids in the management of sleep disorders?
Additionally, there appears to be crosstalk between the endocannabinoid system and other cellular pathways such as the orexigenic system, which plays an important part in sleep-wake disorders such as narcolepsy.
The perception of cannabis products being natural and therefore safer than other pharmaceutical agents used for treating sleep disorders can lead to potential harm because any agent has risks when used inappropriately.
It is unlikely that dramatic scientific advances can be made while cannabis retains its schedule I designation by the US Drug Enforcement Agency. While cannabis is increasingly used for both recreational as well as self-medicinal purposes, clinical use remains underdeveloped and relies more on patient experiences in a trial-and-error fashion than on the evidence base with which most clinicians are accustomed.
Cannabis also helps with my anxiety. I have severe anxiety that is treated with pharmaceuticals. By integrating medical cannabis into my treatment plan, I’ve been able to reduce the amount of pharmaceuticals that I take to treat my anxiety. Since there are often worse side effects from pharmaceuticals than cannabis, I take that as a win.
Like any medication, I have to be careful with my cannabis dosage. I use other medications in addition to my medical cannabis. Cannabis can interfere with one of these medications, so I try to watch my intake. Cannabis use can decrease the efficiency of certain antidepressants, which I take to control my cataplexy.
I grew up watching That 70s Show, where that the majority of cannabis users are depicted as young, dumb, and healthy. As a disabled adult, these expectations have since flown out the window. I’ve met a plethora of different people who utilize medical cannabis. Some of these people you might never have guessed, especially if you grew up in a post-‘war-on-drugs’-world, like me.
Medical cannabis assists in my ability to achieve a deeper and more peaceful sleep state with my narcolepsy condition. I have a reduction in anxiety, which makes normally disturbing hallucinations just a temporary discomfort.
Different strains affect me differently
I’ve also found that different strains help me with different narcolepsy symptoms. For example, cannabis “sativa” strains help give me energy usually. These can be used as a last resort defense against sleep attacks. When it works, it works well.
Sometimes if I use too much cannabis or simply the wrong strain, my cataplexy will be worsened for a number of hours. This was scary at first, but I’ve been able to avoid it from happening too much by utilizing a few different strategies. One of them is very simple – just don’t smoke too much!
I have also found that the right levels of cannabis in my system can actually decrease the frequency and length of my hallucinations at night. I am unsure if this is because I am achieving a deeper sleep or another reason. All I know is that it works for me.
Carefully managing my dosage
On the other hand, cannabis “indica” strains help me achieve deeper sleep. If I were to smoke an “indica” strain during the day, I would find myself napping too much. I use “indica” strains at night. These strains are also higher in CBD, which is a moderate sleep aid.
There is still a heavy stigma attached to the use of medical cannabis, despite it being legal in the U.S. in 36 states. 1