Cannabis and the various extracts derived from the plant have been successfully utilized to assist with a variety of sleep disorders, including sleep disruption, sleep apnea, and insomnia. The main reason for this is that cannabis medicines can be mildly sedative, besides the exception of CBD, which can be wake promoting, especially later in the day. The endocannabinoid system is well known to regulate sleep.  Research has discovered that successful treatment of sleep issues with cannabis medicines is largely dose and delivery method dependent.
Insomnia is typically characterized by an inability to maintain sleep or fall asleep. Sleep disorders often are part of more serious medical conditions, especially pain syndromes, and some mental health problems. Conventional treatments of other medical conditions rarely brings relief to insomnia, and usually the treatment (e.g., medication for depression or ADHD) makes this sleep problem even worse.
The theory is that medical marijuana, especially when utilized as a tincture or oral form, would show up as superior to other pharmacologic or non-pharmacologic interventions. Insomnia is usually one of the top reasons cited by medical cannabis patients for its use, next to depression, anxiety, and pain. For more, see our articles on Depression, Anxiety, and Pain.
Tetrahydrocannabinol (THC) creates residual sedation, while cannabidiol (CBD) tends to be wake-promoting. Although, CBD is potent for bringing a reduction to anxiety, which can make it much easier to fall asleep, without those racing thoughts, or feelings. It is highly likely that the essential oils (in the form of terpenes) unique to each cannabis strain can also affect the cannabis's ability to sedate, so highly stimulating cannabis strains are not ideal. See our Ultimate Guide to Terpenes.
Sleep disorders are conditions where the cannabinoid profile or the medicine, along with the size and timing of the actual dose, are importantly vital to a successful outcome and relief of the problem. Almost all recreational users of cannabis note the residual sedative properties of cannabis that come about around ninety minutes after dosing, as the drug’s initial stimulation gives way to sleepiness. THC shows up as initially stimulating, whereby later, its metabolites are more sedative, which means that people could vaporize or smoke cannabis about an hour before bedtime to let these sedative tetrahydrocannabinol metabolites accumulate.
The Indian Ayurvedic medical tradition recognizes the sleep-inducing qualities of cannabis, in which it is characterized as nidrajanan (sleep-inducing). This ancient tradition is reflected in a 1991 survey of Indian cannabis users in the city of Varansi, where 90 percent of the participants found that cannabis was helpful and effective for sleep. Historically, the use of cannabis to treat sleep disorders has been closely associated with its ability to reduce pain and discomfort. William O’Shaughnessy, an Irish physician working in colonial India in the 19th century, noted the effectiveness of cannabis as a sedative for the treatment of rheumatism and pain. When THC was initially isolated in 1964, the earliest research discovered that it shortened the amount of time it took patients to fall asleep and suppressed deep sleep. In the late 1990s, a review was published that claimed that tetrahydrocannabinol adversely altered brainwave patterns during sleep studies and left most patients with hangover effects (headaches, exhaustion).  Although, this was strongly contradicted in a 2007 review on the use of Sativex, where it was found to be very potent for assisting with pain-induced insomnia in 13 different studies.
If someone wakes in the middle of the evening, a dose of oral medicinal cannabis consumed an hour prior to bed can be more valuable in assisting with keeping the person asleep. However, overmedicating with cannabis can produce intense psychoactivity, which can make falling asleep very challenging, and can interfere with normal sleep cycles. People who have medical conditions or who are taking medications that can cause insomnia usually experience improved sleep when utilizing cannabis safely, but excessive THC use can reduce restful, normal sleeping patterns.
Unlike other pharmacological treatments, edible cannabis effects last for between 2 to 5-hours, with limited or no residual effect in the morning upon waking, given that the dose was reasonable and the person is efficiently hydrated. Oral cannabis consumption does require sufficient attention to time the dose to accommodate the time it takes to absorb and take action (most people will find that roughly one hour before bedtime is appropriate), with smoked and tincture, or vaporized cannabis, the effect is immediate and rapid, but the effects last for a shorter time. The safety profile of medical cannabis is superior to the benzodiazepine and nonbenzodiazepine GABA-agonists, with far less potential for dependence or withdrawal symptoms. Cannabis doesn’t cause any rebound insomnia or anxiety when discontinued, and there isn’t any risk of fatal intentional or accidental overdose.
Out of 39 studies of cannabinoids, most featured oral dosing of pharmaceutical tetrahydrocannabinol (called dronabinol or nabilone), using highly variable regimens. There are eleven nabiximol (Sativex) studies that examine its effects on sleep. Not surprisingly, these study outcomes were very inconsistent due to the regimens of the study participants being so inconsistent. The researchers drew the following conclusions:
“Recreational cannabis may interrupt normal sleep cycles, does not consistently increase time spent asleep or reduce number of awakenings, and it “may leave an impression of non-restful sleep.”
“When medical cannabis was used by patients with a medical condition known to disturb sleep, however, there was “some consistency across studies that showed improved sleep with reduced nighttime disturbances.”
“When objective, validated-outcome measures were used to evaluate the effect of medical cannabis on patients, the effects on sleep were “relatively inconsistent.” Studies that used THC/CBD combinations tended to show more consistently positive results.”
The only controlled studies of CBD (through an oral spray) alone, discovered that it was superior to placebo, but inferior to a THC oral spray alone or a combination CBD/THC oral spray. The medical research seems to show that overall, CBD plays a role as a “modulator” or the therapeutic effect of tetrahydrocannabinol. Observational reports show that CBD can assist when a patient is excessively fatigued, but well-rested patients often find CBD too stimulating.
For those with significant insomnia problems, it is unrealistic to assume that everything can be solved with medicinal cannabis alone, regardless of the delivery method, strain, ratio, or dose. Attention to creating healthy sleep hygiene habits, and nonpharmacologic treatments, are still very important. It is recommended to try using a high-CBD non-psychoactive tincture during the day to reduce any general background levels of stress, however, avoid using CBD after 5pm, as it can be wake-promoting.
Studies based in the laboratory have shown that the endocannabinoid system is of vital importance in regulating the onset of sleep, alongside the quality and duration of sleep. Animal studies have revealed that the endocannabinoid anandamide and its pharmacologic mimic, THC, is consistent with laboratory studies showing a role for medical cannabis for treatment of sleep disorders.   For more information, read our article The Endocannabinoid System Explained.
Medical disclaimer: this information contained in this article is for informational purposes only and does not constitute medical advice. Prior to making changes to your lifestyle or treatment plan, always consult with your doctor. It is recommended that all hemp plant derived THC free broad spectrum CBD isolate products are verified for purity and potency by a third party lab using CO2 extraction to maximise the entourage effect. The best CBD oil can be made from hemp or cannabis, it largely depends on the quality of the growing and processing components.
If someone is waking during the night, oral cannabis, with it’s longer onset of effects, can be most valuable. Special care must be taken not to overmedicate, due to the stimulating and psychoactive effects of high doses of cannabis could be wake-promoting and make sleep impossible.
Oral cannabis preparations are very effective for increasing the quality of rest and sleep, and they can give longer-lasting analgesic effects for pain. Consuming cannabinoids, such as CBD gummies, orally does require an amount of patience and planning to get the desired dose right and create even relief over time. Swallowed medicines generally take 45 minutes to an hour to be felt. Whereas, inhaled forms take effect immediately, and sublingual (under the tongue) or sprays take effect within about 20 minutes.
If insomnia is created because of pain, anxiety, depression or PTSD, please view our articles on Pain, Anxiety, Depression, and PTSD, as they are more dedicated to those specific concerns. Insomnia is typically one of the most frequent adverse side effects of antidepressants. Depressed people, or those with PTSD, who may be doing well with their antidepressants but have sleep issues that are not relieved, may wish to research whether their antidepressants are causing their sleep problems. As always, do not change the dose or use of any medication without the supervision of your doctor.
Anxiety or rumination (repetitive thoughts about problems, negative self-judgements, or worrying without resolution) can interfere with getting adequate restful sleep. Tetrahydrocannabinol is effective for anxiety or rumination at 1 to 5 mg when taken sublingually (or swallowed) for more potent effect and soporific effect).
Observational reports have noted that cannabidiol (CBD) can make a sleep-deprived patient sleepy, but becomes wake-promoting once the person has caught up on rest or if CBD is taken after 5pm. Generally, after a few days of daytime use, the antianxiety effects of CBD ten dto help in creating more calm so one can fall asleep easier, resolving the issue.
THC consumed orally is ideal for sleep: 5 to 7.5 mg THC, swallowed one hour prior to bed or when bed rest is needed. Swallowing THC increases its soporific and analgesic effects and extends the period of action.
Smoked or vaporized cannabis is generally valuable for sleep problems when taken one hour before bedtime on waking during the night. Products made by CO2 extraction can be of better quality.
Cannabis strains high in the terpene, myrcene, are of value, which include the “Purple” strains that also produce linalool are often recommended to assist with sleep disorders, namely due to the calming and sedative effects of these terpenes.  Other strains containing the terpenes myrcle and linalool include Purps, Grape Ape, and Kush strains such as Bubba Kush, and Hindu Kush.
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