What is the effect of marijuana (cannabis) on sleep?

Effects of Marijuana on Sleep

Marijuana has complex effects on sleep that can include short-term improvements in sleep onset but long-term disruption of sleep architecture and potential withdrawal-related insomnia, making it an unreliable and potentially harmful option for managing sleep disorders. 1, 2

Acute Effects on Sleep

• Initial sleep promotion: Cannabis may initially decrease the time to fall asleep and increase total sleep time in some users 3
• Sedative effects: THC (the main psychoactive component) can produce sedative effects that some users perceive as helpful for sleep 4
• Reduced REM sleep: Cannabis use typically suppresses REM sleep, which is essential for cognitive function and memory consolidation 2

Long-Term and Withdrawal Effects

• Sleep architecture disruption: Chronic cannabis use alters normal sleep cycles and can lead to poor sleep quality over time 2
• Withdrawal insomnia: Cannabis withdrawal commonly causes significant insomnia, which can lead to:
  • Increased anxiety and mood disturbances
  • Potential suicidal ideation in severe cases
  • Relapse to cannabis use to manage withdrawal symptoms 2
• Sleep quality deterioration: Regular users often experience worse sleep quality despite subjective beliefs that cannabis improves their sleep 2, 4

Clinical Considerations

Risk Factors and Vulnerable Populations

• Mental health conditions: Cannabis use can worsen psychiatric symptoms and sleep disturbances in those with mental health disorders 1, 5
• Adolescents and young adults: Particularly vulnerable to cannabis-related sleep disruption and neurodevelopmental effects 1
• Older adults: May experience more pronounced sedation, obtundation, and cardiovascular effects 1
• Perioperative concerns: Cannabis use affects anesthesia requirements and is associated with:
  • Reduced postoperative sleep quality
  • Greater postoperative pain
  • Increased risk of cardiovascular complications 1

Specific Sleep Disorders

• Insomnia: Limited evidence for long-term benefit; may worsen chronic insomnia despite initial improvement 2
• Sleep apnea: Some preliminary evidence for potential benefit, but insufficient high-quality research 2
• Parasomnias and restless legs syndrome: Minimal to no evidence of benefit 2

Clinical Recommendations

1. Screen for cannabis use disorder: Symptoms include withdrawal insomnia, irritability, and headaches 1
2. Consider alternative evidence-based sleep interventions: Cognitive behavioral therapy for insomnia (CBT-I) has stronger evidence than cannabis
3. For patients using cannabis for sleep:
   • Monitor for withdrawal symptoms if discontinuing use
   • Be aware that perceived benefits may diminish over time
   • Educate about potential long-term negative effects on sleep architecture

Common Pitfalls

• Misattribution of benefits: Patients often attribute improved sleep to cannabis when evidence suggests minimal to negative effects for most sleep disorders 2
• Overlooking withdrawal: Failure to recognize that sleep problems may be caused by cannabis withdrawal rather than the condition the patient is self-treating 2
• Marketing claims: Claims about specific cannabinoids (like CBN) for sleep have insufficient evidence to support them 6
• Ignoring drug interactions: Cannabis can interact with medications affecting sleep, including sedatives and hypnotics 1

In summary, while cannabis may initially seem to help with sleep onset, the evidence suggests it disrupts normal sleep architecture and can lead to dependence and withdrawal insomnia. For most patients with sleep disorders, evidence-based alternatives should be considered before cannabis use.