From the Guidelines
Cannabis is not recommended as a first-line treatment for sleep disorders due to limited and mixed scientific evidence supporting its use for sleep. The most recent and highest quality study, 1, published in 2021, recommends cognitive behavioral therapy for insomnia (CBT-I) as the treatment of choice for chronic insomnia disorder, with a strong recommendation based on a systematic review of the clinical trial literature. While some people report that cannabis helps them fall asleep faster, cannabis products, particularly those high in THC (tetrahydrocannabinol), may initially improve sleep onset but can disrupt sleep quality over time, reduce REM sleep, and lead to tolerance where higher doses are needed for the same effect. Key considerations for treating sleep disorders include:
- CBT-I as the primary intervention
- Behavioral therapies, such as stimulus control and relaxation therapy, as potentially useful interventions with minimal undesirable effects
- Conventional sleep medications prescribed by a healthcare provider, if necessary
- Avoiding sleep hygiene as a single-component therapy due to lack of evidence for its efficacy Cannabis use can also lead to dependence, morning grogginess, and may worsen certain mental health conditions, making it essential for individuals considering cannabis for sleep to consult with a healthcare provider, especially since regulations vary by location and many products lack standardization in terms of potency and composition, as noted in 1.
From the Research
Cannabis and Sleep Disorders
- The use of cannabis for sleep disorders is a topic of increasing interest, with some studies suggesting potential therapeutic benefits 2, 3, 4.
- However, the current evidence base is limited, and more research is needed to fully understand the effects of cannabis on sleep disorders 2, 5.
- Some studies have found that cannabinoids, such as THC and CBD, may have a positive impact on sleep quality, particularly in individuals with insomnia, post-traumatic stress disorder, and other sleep disorders 6, 3.
Therapeutic Efficacy and Safety
- The therapeutic efficacy and safety of cannabis for sleep disorders are unclear, with some studies suggesting potential benefits and others raising concerns about the risk of bias and adverse effects 2, 5.
- Regular cannabis use has been associated with withdrawal, which can alter sleep patterns, and clinicians should be aware of the potential effects of cannabis on the metabolism of other medications 5.
- More high-quality evidence is needed to guide clinicians in their recommendations for the use of cannabis for sleep disorders 5.
Specific Sleep Disorders
- Some studies have found that cannabinoids may be effective in reducing symptoms of insomnia, post-traumatic stress disorder-related nightmares, and restless legs syndrome 6, 3.
- However, the evidence is not yet conclusive, and more research is needed to fully understand the potential benefits and risks of cannabis for these conditions 2, 5.
- Cannabinoids may also have a positive impact on sleep quality in individuals with obstructive sleep apnea, although more research is needed to confirm this finding 3.