The potential of medical cannabis for insomnia

We all have trouble sleeping from time to time. Restless nights are at least a semi-common occurrence for most people, but if you find yourself battling through weeks or months-long issues surrounding sleep, there may be more at play.The most up-to-date statistics show that almost 1 in 5 people in the UK aren’t getting enough sleep (7 to 9 hours is recommended for adults). It is hard to put a firm figure on just how many people suffer from insomnia as the definition isn’t always black and white, but there are some potentially surprising numbers we can look at.

• In the UK, around 22% of the adult population has difficulty falling asleep every night. And on top of that, another 15% struggle with getting to sleep at least once a week. That's 37% of the population that is affected by sleep-related issues on at least a weekly basis, if not more regularly. 
• Only 40% of people say that they never have difficulty sleeping.

What is insomnia exactly?

Insomnia is a bit of a strange condition, as the definition changes depending on who you ask. In general, though, it is a set of symptoms that can make it difficult to fall asleep or stay asleep throughout the night, or to get decent quality sleep in general.

There are two forms of insomnia that are generally recognised:

• Short-term insomnia  — This kind of insomnia typically occurs due to severe stress, anxiety, or changes in surroundings, and typically persists for several days to a few weeks.
• Chronic or long-term insomnia – Chronic insomnia is characterised by difficulty falling or staying asleep for more than three months and is not attributed to any underlying medical condition.

While there are some conventional pharmaceutical options available for the treatment of insomnia, these options come with a range of possible side effects and are usually only a temporary fix. Most pharmaceutical treatments available (sleep aids) are only recommended for short-term use (less than 2 weeks of continuous use), leaving insomniacs in a bit of a bind when it comes to finding an effective and healthy long-term solution.

Medical cannabis became a reality here in the UK on the 1st of November 2018. With this change came the possibility of using cannabis as a natural sleep aid, and one that can be implemented into a treatment plan for longer periods than most conventional sleeping pills.

Cannabis has a long-recorded history of medicinal usage stretching back more than 5000 years, with the first recorded usage coming from China in 2800 BC. One of the more common issues that it has historically helped with is sleep, so let's look at what the current science has to say about cannabis as an aid for insomnia.

How cannabis affects sleep

To understand how cannabis helps in any medicinal application, we first have to look into how it interacts with the human body.

The endocannabinoid system

Humans (and all other mammals) have an endocannabinoid system (ECS), which is made up of specialised receptors (CB1 and CB2), endocannabinoids that interact with these receptors, and enzymes that break down the endocannabinoids once they have done their job.

What are endocannabinoids?

Endocannabinoids are simply cannabinoids produced by the human body. Cannabis (and some other plants) also produce cannabinoids, referred to as phytocannabinoids, which also have the ability to interact with the CB1 and CB2 receptors (among other bodily systems). This is why cannabis can have such a profound effect on the human body and mind.

The ECS is responsible for a huge range of bodily functions, both psychological and physical. From influencing hunger and emotions to aiding in the regulation of vital bodily functions like digestion and breathing, and (unsurprisingly for people who have experience with cannabis) influencing sleep, the ECS is thought to be a major player in maintaining homeostasis, or balance, throughout the human body.

Researchers have so far isolated over one hundred phytocannabinoids from cannabis. Most of these are found in minuscule amounts, with the two major players being THC (tetrahydrocannabinol) and CBD (cannabidiol).

Both interact with the ECS in different ways, and so they produce different, sometimes contrasting, effects when consumed.

The effect of THC on sleep

THC is the phytocannabinoid that produces the psychotropic (intoxicating) effect associated with cannabis, but it also has a variety of potential medicinal applications.

THC has been shown to have a strong interaction with the CB1 receptor and binds in a weaker way with CB2. This is the reason researchers believe it offers not only the 'high', but also why it allows for such a profound effect on sleep and a range of bodily functions.

Research suggests that, at low doses, THC can induce a sedative effect and can help to reduce the time it takes to fall asleep while also increasing sleep duration. But as the dose rises, so does the disturbance to these benefits. At higher doses, that sedative effect disappears and turns into a feeling of stimulation.

And, as we see with more conventional sleep aids, THC may not be suited to long-term administration for the betterment of sleep. As this study from 2021 points out, THC can help almost all areas of sleep in the short term, but once tolerance has been built up, the benefits drop off. With long-term usage, there is a reduction of rapid eye movement (REM) sleep and slow wave sleep (SWS), which can potentially cause issues with mental and physical health.

So, for now at least, it seems like when taken alone, THC may be best in small doses and for short-term use. Let’s see where the research takes us in the coming years. 

The effect of CBD on sleep

Unlike THC, CBD only binds very weakly to both the CB1 and CB2 receptors, or at least that's what the research is suggesting. While there has been a meteoric rise in the popularity and understanding of CBD in the past decade or so, the research is still lacking in terms of its effect on sleep in some respect.

What we do know is that when CBD is consumed, it is able to boost serotonin levels. This may help promote better sleep, as serotonin is linked to the regulation of sleep and is the precursor for melatonin. Melatonin is the hormone that is responsible for helping us drift off to sleep, so boosting serotonin levels may help us fall asleep easier, and have a positive impact on our sleep.

Another 2018 study, titled “Effectiveness of Raw, Natural Medical Cannabis Flower for Treating Insomnia under Naturalistic Conditions” found that CBD was a better choice for insomnia symptomatic reduction than THC, but that both cannabinoids did produce beneficial sleep results.

CBD has zero intoxicating effects, and has not been shown to have a negative impact on sleep as the dose rises, or that a tolerance is built up over time in the same way as THC. This makes it an ideal choice for long-term administration, and researchers have even been exploring the idea of using CBD in conjunction with THC to take advantage of the benefits both have to offer.

Terpenes that may help induce sleep, and the entourage effect

Gone are the days when cannabis can be thought of as being either a Sativa or Indica strain, and that's all. We now know that cannabis and other hemp-based products are comprised of a massive variety of different compounds, and it’s this variety that helps to create the 'entourage effect'. 

What is the entourage effect?

It's the theory that when all these different compounds (cannabinoids, terpenes, and flavonoids) work together, they create a more powerful overall effect than if one were to take a single compound alone.

Up until quite recently, the whole Indica/Sativa split was what dominated the cannabis industry, and while it is still used (to a certain extent, especially in the recreational market), it's far from being as accurate as it once was thought to be.

What researchers now believe is that Indica dominant strains may offer more sedation and relaxation, but this is due to them having higher concentrations of terpenes that promote relaxation.

That is not to say that Sativa strains – which are more commonly associated with an uplifting, energizing, and euphoric experience – don't also come with the same sedating terpenes, it's just that they are most likely to contain higher levels of energizing terpenes.

Terpenes?

Terpenes are aromatic compounds found in cannabis and other plants and have a vast range of potential effects. Some terpenes may work as anti-inflammatories, while others work as anti-depressants, and some offer sedative qualities. The terpenes most often regarded as being sedative include myrcene, beta-caryophyllene, linalool, limonene, and terpinolene.

Choosing the right cannabis product for insomnia

All the currently available research points to products containing the above-listed terpenes, along with low doses of THC and higher doses of CBD, to potentially be the best choice for treating insomnia. Such products should also have a high terpene content, as this is important in inducing sleep.

If you are looking to add medicinal cannabis to your insomnia treatment, speak with your doctor or health practitioner to get the best advice on prescription and dosage. Not all doctors in the UK are licensed to prescribe medical cannabis. Here at Releaf, we offer online consultations and can provide you with a Medical Cannabis Card, allowing the easiest access to this new treatment option. For more information regarding how to receive a Medical Cannabis Card for insomnia, check out this post.

Other tips for managing insomnia

There are many changes that you can make right now to help promote better sleep.

Lifestyle changes such as cutting out daytime naps, switching to a more comfortable bed, having your bedroom at a more comfortable temperature, reducing noise disturbances, limiting screen time to one hour before bed, and having a consistent routine can all help improve sleep quality.

Exercising regularly, reducing stress levels, and meditation are also great avenues to explore for better sleep.

Finally, if you feel like your insomnia is beyond self-help measures, speak with your doctor about other treatments that may be available to you. Cognitive Behavioural Therapy (CBT) has been proven to work very well for insomnia, and it may be worth exploring this avenue.

The wrap up

Insomnia is a real and debilitating issue, but there are steps that can be taken to help manage it. Releaf understands the importance of medical cannabis in treating various medical conditions. With our tailored monthly packages, specialist consultations for medical cannabis, and a unique medical cannabis card for protection, you can access the treatment you need without worrying about the stigma.