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  • The Science of Medical Cannabis and How it Can Help Your Sleep

    The Science of Medical Cannabis and How it Can Help Your Sleep

    Sleep is a naturally recurring state in which the body alternates between two distinct modes: rapid eye movement (REM) sleep and non-REM sleep. Sleep is characterized by altered consciousness, relatively inhibited sensory activity, reduced muscle activity, inhibition of nearly all voluntary muscles during REM sleep, and reduced interactions with surroundings1,2 

    A benefit commonly associated with cannabis is improved sleep, with many people routinely using cannabis as a sleep aid6–8 

    In Aurora’s recent patient-reported outcomes study, 13% of patients reported a sleep disorder as the primary medical condition for which they were seeking medical cannabis treatment for9.  A significant improvement in sleep was reported, with 93% of these patients self-reporting improvements in their sleep after 6 weeks of medical cannabis treatment9.  

    If you’re curious about the science of medical cannabis and how it can help your sleep, this article can help answer any questions you might be having.  

    How can a Lack of Sleep Hurt your Health? 

    Sleep helps restore and maintain mood, memory and cognitive function and it plays a significant role in the endocrine and immune systems function1,2. The brain does remain active during sleep which is thought to play a role in memory consolidation3.   

    Sleep disturbances or impairments can often be a downstream effect of other medical ailments. It is common for sleep issues to occur in individuals who have been diagnosed with chronic pain, diabetes, neurological disorders, cardiovascular disorders, mood disorders, etc4,5.  

    CBD vs. THC - What's Better for Sleep Disorders? 

    When deciding which cannabis products will help with your sleep issues, it is important to consider the THC:CBD ratio of the product and its format.  

    THC  

    In Aurora’s recently published patient-reported outcomes study, out of all patients who rated cannabis as helpful for their sleep disorders, 38% selected high THC products, 25% selected high CBD products and 16.7% selected balanced THC:CBD products9. This means that high THC products were most commonly reported by these patients as being helpful for improving sleep9 

    CBD  

    However, CBD-focused studies have reported that patients find CBD products helpful in improving sleep and insomnia. For instance, Moltke and Hindocha found that 37% of their surveyed patient cohort endorsed CBD for enhancing sleep, and 24.6% endorsed it for helping their self-perceived insomnia10. Additionally, 48.2% reported that CBD helped them to fall asleep quicker10.   

    THC and CBN  

    Alternatively, there is emerging evidence that THC in combination with CBN may be an effective sleep aid. CBN (cannabinol) is one of many minor cannabinoids found in cannabis.  

    CBN and THC together can be helpful in improving many aspects of sleep such as11,12: 

    •  Falling asleep quicker 
    •  
    Staying asleep for longer 
    •  
    Improved overall quality of sleep and feeling more refreshed upon waking 

    However, the research on CBN alone so far has shown no effect on sleep13. 

    Cannabis May Help You Fall Asleep Faster if Timed Correctly

    If you are looking to use cannabis as a sleep aid, pay attention to when you take your product. The right timing depends on the product format you are going to be consuming.  

    If you go with an inhalation product, you will only need to take your cannabis product within minutes of when you want to sleep24This is because when you inhale cannabis, the effects peak around 30 minutes and wear off by 6 hours post consumption24.  

    If you choose an oral product (like a gummy or capsule), the peak effects can take up to 4 hours to occur with the onset of effects occurring between 30 minutes to 2 hours24 

    Using an oral product may take a bit more trial error to get the timing correct (you will want to take your product 1-2 hours before your bedtime), but its effects will last longer (up to 12 hours or longer) than if you were to inhale cannabis24
     

    What Are the Types of Cannabis Products I Could Use to Help Me Sleep? 

    When choosing a product format, it is essential to think about how long you want it to take until you feel the product’s effects and how long you want the effects to last.  

    There is no perfect answer to this question, it depends on your preference, experience with THC, and sleeping goals. From Aurora’s patient reported outcome study, patients who were using cannabis to help their sleep disorders preferred cannabis oils the most. Their second preference was softgels and third was using a vaporizer9. 

    If you are new to cannabis, you may have to do some trial and error on cannabinoid ratios and product formats before you find the product that is best for you. Here are some suggestions to help you get started. We recommend you consult with your healthcare provider to ensure the product you choose is right for you. 

    Smoking Dried Cannabis Flowers 

    If you want a quick onset of effects so you can take your medical cannabis close to your bedtime, you will want to look for dried flower formats you can vape or smoke and/or vape products.  

    Edibles or Capsules 

    If you are looking for a longer duration of effects and don’t mind taking your product a bit farther in advance from bedtime, you will want to look for oral products such as capsules, gummies, oils etc. Although it might take you longer to get the timing correct, the effects will last longer (up to 12 hours or more) than inhalation products.  

    Remember, if you choose an orally ingested product to help you sleep at night, the effects can take up to 2 hours to feel, so you will need to plan accordingly. 

    THC:CBD Ratio  

    In terms of what THC:CBD ratio you are looking for, consider your experience and comfortability with THC. You might want to go with a high CBD, balanced THC:CBD (equal levels of THC and CBD), or high THC product.  

    There is a large amount of scientific evidence that THC  is the most effective at helping with sleep (even at low potencies). So if you are comfortable with THC, you may want to start there.  

    Potential Side Effects of Using Cannabis 

    The adverse events reported from the use of cannabis (or cannabinoids in combination) have been deemed mild-moderate in severity14,25,26. Commonly reported adverse events are:  

    1. Dry mouth27 
    2. Dizziness26,28–31 
    3. Gastrointestinal issues14,25,26 
    4. Nervous system disorders14,29  
    5.  Drowsiness

    How to Get Medical Cannabis for Sleep in Canada 

    If you have questions about using medical cannabis as a sleep aid, reach out to your healthcare practitioner. They are best suited to help you understand how cannabis may support your health.  

    If you are not comfortable speaking with your primary physician about cannabis, or your primary physician is not familiar with cannabis, there are many healthcare practitioners who specialize in medical cannabis that you could speak to. Aurora’s clinic partner, Canadian Cannabis Clinics, offers free virtual appointments and will assist you in getting started on your medical cannabis journey. You can book an appointment here.

      

     

     

     

    References: 

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    2. Brain Basics: Understanding Sleep | National Institute of Neurological Disorders and Stroke.
    3. Walker MP,Stickgold R. Sleep-dependent learning and memory consolidation. Neuron. 2004;44(1):121-133. 
    4. SL A, TK G, CJ L, AW T, RD M, NP S, DA G-C, RJ A. Prevalence and comorbidity of sleep conditions in Australian adults: 2016 Sleep Health Foundation national survey.Sleep Heal. 2018;4(1):13-19. 
    5. DD, G G. Medical comorbidity of sleep disorders. Curr Opin Psychiatry. 2011;24(4):346-354. 
    6. Lee CM, Neighbors C, Woods BA. Marijuana motives:Young adults’ reasons for using marijuana. Addict Behav. 2007;32(7):1384-1394. 
    7. Bachhuber M, Arnsten JH, Wurm G. Use of Cannabis to Relieve Pain and Promote Sleep by Customers at an Adult Use Dispensary.J Psychoactive Drugs. 2019;0(0). 
    8. Walsh Z, Callaway R, Belle-Isle L, Capler R, Kay R, Lucas P, Holtzman S. Cannabis for therapeutic purposes: Patient characteristics, access, and reasons for use.Int J Drug Policy. 2013;24(6):511-516. 
    9. Cahill SP, Lunn SE, Diaz P, Page JE. Evaluation of Patient Reported Safety and Efficacy of CannabisFrom a Survey of Medical Cannabis Patients in Canada. Front Public Heal. 2021;9:626853. 
    10. Moltke J, Hindocha C. Reasons for cannabidiol use: a cross-sectional study of CBD users, focusing on self-perceived stress, anxiety, and sleep problems.J Cannabis Res. 2021;3(1):5. 
    11. Gannon WE,Bronfein W, Jackson DS, Holshouser K, Artman BE, Schestepol M, Treacy DJ, Rudnic EM. Novel Formulation of THC and CBN in a Repeat-Action Tablet Improves Objective and Subjective Measurements of Sleep. Am J Endocannabinoid Med I. 3(1):12-18. 
    12. JH W, KJ M, T R, K M, N M, MJ R, DR H, PR E. Treating Insomnia Symptoms with Medicinal Cannabis: A Randomized, Cross-Over Trial of the Efficacy of a Cannabinoid Medicine Compared with Placebo.Sleep. June 2021. 
    13. KarniolIG, Shirakawa I, Takahashi RN, Knobel E, Musty RE. Effects of delta-9-tetrahydrocannabinol and cannabinol in man. Pharmacology. 1975;13:502-512. 
    14. Ware MA, Wang T, Shapiro S, Collet J-P, COMPASS study team A, Esdaile JM, Gordon A, Lynch M, Moulin DE, O’Connell C. Cannabis for the Management of Pain: Assessment of Safety Study (COMPASS).J Pain. 2015;16(12):1233-1242. 
    15. Ware MA, Wang T, Shapiro S, Robinson A,Ducruet T, Huynh T, Gamsa A, Bennett GJ, Collet J-P. Smoked cannabis for chronic neuropathic pain: a randomized controlled trial. CMAJ. 2010;182(14):E694-701. 
    16. Vigil JM, Stith SS, Adams IM, Reeve AP. Associations between medical cannabis and prescription opioid use in chronic pain patients: A preliminary cohort study. Vrana KE, ed.PLoS One. 2017;12(11):e0187795. 
    17. Boehnke KF,Litinas E, Clauw DJ. Medical Cannabis Use Is Associated With Decreased Opiate Medication Use in a Retrospective Cross-Sectional Survey of Patients With Chronic Pain. J Pain. 2016;17(6):739-744. 
    18. Lucas P, Walsh Z. Medical cannabis access, use, and substitution for prescription opioids and other substances: A survey of authorized medical cannabis patients.Int J Drug Policy. 2017;42:30-35. 
    19. Boehnke KF, Scott JR,Litinas E, Sisley S, Williams DA, Clauw DJ. Pills to pot: observational analyses of cannabis substitution among medical cannabis users with chronic pain. J Pain. 2019;20(7):830-841. 
    20. CorroonJM, Mischley LK, Sexton M, Sexton M. Cannabis as a substitute for prescription drugs - a cross-sectional study. J Pain Res. 2017;10:989-998. 
    21. Lucas P, Boyd S, Milloy M-J, Walsh Z. Cannabis Significantly Reduces the Use of Prescription Opioids and Improves Quality of Life in Authorized Patients: Results of a Large Prospective Study.Pain Med. 2020;00(0):1-13. 
    22. AS L, LL H, K S, RR. Effect of Inhaled Lavender and Sleep Hygiene on Self-Reported Sleep Issues: A Randomized Controlled Trial. J Altern Complement Med. 2015;21(7):430-438. 
    23. S K, M G, WE M, HP V, HJ M, A D, SS. Silexan, an orally administered Lavandula oil preparation, is effective in the treatment of “subsyndromal” anxiety disorder: a randomized, double-blind, placebo controlled trial. Int Clin Psychopharmacol. 2010;25(5):277-287. 
    24. Minister of Health HC, Health Canada.Health Effects of Cannabis.; 2017. 
    25. SerpellM, Ratcliffe S, Hovorka J, Schofield M, Taylor L, Lauder H, Ehler E. A double-blind, randomized, placebo-controlled, parallel group study of THC/CBD spray in peripheral neuropathic pain treatment. Eur J Pain. 2014;18(7):999-1012. 
    26. Johnson JR, Burnell-Nugent M,Lossignol D, Ganae-Motan ED, Potts R, Fallon MT. Multicenter, Double-Blind, Randomized, Placebo-Controlled, Parallel-Group Study of the Efficacy, Safety, and Tolerability of THC:CBD Extract and THC Extract in Patients with Intractable Cancer-Related Pain. J Pain Symptom Manage. 2010;39(2):167-179. 
    27. BellnierT, Brown GW, Ortega TR. Preliminary evaluation of the efficacy, safety, and costs associated with the treatment of chronic pain with medical cannabis. Ment Heal Clin. 2018;8(3):110-115. 
    28. Abrams DI, Jay CA, Shade SB, Vizoso H, Reda H, Press S, Kelly ME, Rowbotham MC, Petersen KL. Cannabis in painful HIV-associated sensory neuropathy: A randomized placebo-controlled trial.Neurology. 2007;68(7):515-521. 
    29. HoggartB, Ratcliffe S, Ehler E, Simpson KH, Hovorka J, Lejčko J, Taylor L, Lauder H, Serpell M. A multicentre, open-label, follow-on study to assess the long-term maintenance of effect, tolerance and safety of THC/CBD oromucosal spray in the management of neuropathic pain. J Neurol. 2015;262(1):27-40. 
    30. Stott CG, White L, Wright S, Wilbraham D, Guy GW. A phase I study to assess the effect of food on the single dose bioavailability of the THC/CBDoromucosal spray. Eur J Clin Pharmacol. 2013;69(4):825-834. 
    31. UeberallMA, Essner U, Mueller-Schwefe GH. Effectiveness and tolerability of THC:CBD oromucosal spray as add-on measure in patients with severe chronic pain: analysis of 12-week open-label real-world data provided by the German Pain e-Registry. J Pain Res. 2019;12:1577-1604. 
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