Cannabis, Cannabinoids, and Sleep: a Review of the Literature
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Purpose of Review
The current review aims to summarize the state of research on cannabis and sleep up to 2014 and to review in detail the literature on cannabis and specific sleep disorders from 2014 to the time of publication.
Preliminary research into cannabis and insomnia suggests that cannabidiol (CBD) may have therapeutic potential for the treatment of insomnia. Delta-9 tetrahydrocannabinol (THC) may decrease sleep latency but could impair sleep quality long-term. Novel studies investigating cannabinoids and obstructive sleep apnea suggest that synthetic cannabinoids such as nabilone and dronabinol may have short-term benefit for sleep apnea due to their modulatory effects on serotonin-mediated apneas. CBD may hold promise for REM sleep behavior disorder and excessive daytime sleepiness, while nabilone may reduce nightmares associated with PTSD and may improve sleep among patients with chronic pain.
Research on cannabis and sleep is in its infancy and has yielded mixed results. Additional controlled and longitudinal research is critical to advance our understanding of research and clinical implications.
KeywordsCannabis Cannabinoids Sleep Insomnia Sleep apnea
Compliance with Ethical Standards
Conflict of Interest
James Sottile and Danielle Morabito declare that they have no conflict of interest.
Kimberly A. Babson has received personal fees from Insys Therapeutics.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 1.Marijuana (Cannabis): Substance Abuse and Mental Health Services Administration; 2016 [Available from: https://www.samhsa.gov/atod/marijuana.
- 2.• Bonn-Miller MO, Boden MT, Bucossi MM, Babson KA. Self-reported cannabis use characteristics, patterns and helpfulness among medical cannabis users. Am J Drug Alcohol Abuse. 2014;40(1):23–30. This study examined medical cannabis patients' demographic profiles, reported reasons for using cannabis, and patterns of use. PubMedCrossRefGoogle Scholar
- 4.Grotenhermen F, Russo E. Cannabis and cannabinoids: pharmacology, toxicology, and therapeutic potential. New York: Haworth Press Inc; 2002.Google Scholar
- 31.Tringale R, Jensen C. Cannabis and insomnia. Depression. 2011;4(12):0–68.Google Scholar
- 35.• Belendiuk KA, Babson KA, Vandrey R, Bonn-Miller MO. Cannabis species and cannabinoid concentration preference among sleep-disturbed medicinal cannabis users. Addict Behav. 2015;50:178. This article documented the preferred cannabis strain and cannabinoid concentration among a group of medical cannabis users reporting use of cannabis for insomnia and nightmares. PubMedCrossRefGoogle Scholar
- 36.• Ogeil R, Phillips JG, Rajaratnam SM, Broadbear JH. Risky drug use and effects on sleep quality and daytime sleepiness. Hum Psychopharmacol Clin Exp. 2015;30(5):356–63. This study investigated sleep disturbance among a sample of problematic alcohol and cannabis users and found impaired sleep quality to be a larger problem than excessive daytime sleepiness. CrossRefGoogle Scholar
- 41.• Calik MW, Radulovacki M, Carley DW. Intranodose ganglion injections of dronabinol attenuate serotonin-induced apnea in Sprague-Dawley rat. Respir Physiol Neurobiol. 2014;190:20–4. This study examined the effect of synthetic cannabinoid injections into the nodose ganglion of rats and found that this treatment reduced symptoms of OSA. PubMedCrossRefGoogle Scholar
- 42.• Farabi SS, Prasad B, Quinn L, Carley DW. Impact of dronabinol on quantitative electroencephalogram (qEEG) measures of sleep in obstructive sleep apnea syndrome. J Clin Sleep Med. 2014;10(1):49–56. This study investigated dronabinol's effect on delta and theta wave activity and ultradian rhythms as measured by polysomnography. PubMedPubMedCentralGoogle Scholar
- 43.• Calik MW, Radulovacki M, Carley DW. A method of nodose ganglia injection in Sprague-Dawley rat. J Vis Exp. 2014(93):e52233. This article describes a technique for localized injection into the nodose ganglia of rats to prevent central nervous system alteration and isolate peripheral nervous system activity. Google Scholar
- 44.• Calik MW, Carley DW. Intracerebroventricular injections of dronabinol, a cannabinoid receptor agonist, does not attenuate serotonin-induced apnea in Sprague-Dawley rats. J Negat Results Biomed. 2016;15:8. This study examined the effect of central nervous system injections of a synthetic cannabinoid and determined that the drug's ability to reduce apneas is a result of peripheral rather than central nervous system activation. PubMedPubMedCentralCrossRefGoogle Scholar
- 45.• Chagas MH, Eckeli AL, Zuardi AW, Pena-Pereira MA, Sobreira-Neto MA, Sobreira ET, et al. Cannabidiol can improve complex sleep-related behaviours associated with rapid eye movement sleep behaviour disorder in Parkinson's disease patients: a case series. J Clin Pharm Ther. 2014;39(5):564–6. This article documented cannabidiol's effect in reducing REM sleep behavior disorder symptoms among a sample of patients with Parkinson's disease. PubMedCrossRefGoogle Scholar
- 47.• Cameron C, Watson D, Robinson J. Use of a synthetic cannabinoid in a correctional population for posttraumatic stress disorder-related insomnia and nightmares, chronic pain, harm reduction, and other indications: a retrospective evaluation. J Clin Psychopharmacol. 2014;34(5):559–64. This study examined the use of Nabilone in a correctional facility and found that the drug reduced nightmares associated with PTSD. PubMedPubMedCentralCrossRefGoogle Scholar
- 48.• Roitman P, Mechoulam R, Cooper-Kazaz R, Shalev A. Preliminary, open-label, pilot study of add-on oral Delta9-tetrahydrocannabinol in chronic post-traumatic stress disorder. Clin Drug Investig. 2014;34(8):587–91. This article provided prelimary evidence suggesting that THC may be effective in reducing nightmares and improving sleep quality among patients with PTSD. PubMedCrossRefGoogle Scholar
- 49.• Jetly R, Heber A, Fraser G, Boisvert D. The efficacy of nabilone, a synthetic cannabinoid, in the treatment of PTSD-associated nightmares: a preliminary randomized, double-blind, placebo-controlled cross-over design study. Psychoneuroendocrinology. 2015;51:585–8. This article provided preliminary evidence suggesting that Nabilone may be effective in reducing nightmares associated with PTSD. PubMedCrossRefGoogle Scholar
- 51.• Dzodzomenyo S, Stolfi A, Splaingard D, Earley E, Onadeko O, Splaingard M. Urine toxicology screen in multiple sleep latency test: the correlation of positive tetrahydrocannabinol, drug negative patients, and narcolepsy. J Clin Sleep Med. 2015;11(2):93–9. This study investigated the relationship between positive urine screen for THC and presence of excessive daytime sleepiness and narcolepsy among a pediatric patient population. PubMedPubMedCentralGoogle Scholar
- 52.Association AP. Diagnostic and statistical manual of mental disorders (5th ed.). Washington 2013.Google Scholar
- 53.• Ford ES, Cunningham TJ, Giles WH, Croft JB. Trends in insomnia and excessive daytime sleepiness among U.S. adults from 2002 to 2012. Sleep Med. 2015;16(3):372–8. This study examined prevalence of insomnia and daytime sleepiness based on National Health Interview survey data. PubMedPubMedCentralCrossRefGoogle Scholar
- 54.• Shannon S, Opila-Lehman J. Cannabidiol oil for decreasing addictive use of marijuana: a case report. Integr Med (Encinitas). 2015;14(6):31–5. This case study investigated cannabidiol's effect on problematic cannabis use, anxiety, and sleep disturbance and found benefits for all three conditions. Google Scholar
- 57.• Weaver TE, Calik MW, Farabi SS, Fink AM, Galang-Boquiren MT, Kapella MC, et al. Innovative treatments for adults with obstructive sleep apnea. Nat Sci Sleep. 2014;6:137–47. This article provided a review of novel treatment approaches for OSA including surgical, mechanical, and pharmacotherapy treatments. PubMedPubMedCentralCrossRefGoogle Scholar
- 62.• Betthauser K, Pilz J, Vollmer LE. Use and effects of cannabinoids in military veterans with posttraumatic stress disorder. Am J Health Syst Pharm. 2015;72(15):1279–84. This study investigated the use of cannabinoids by military veterans with PTSD and found that cannabis use was associated with a decrease in nightmares associated with PTSD. PubMedCrossRefGoogle Scholar
- 63.• Lynch ME, Ware MA. Cannabinoids for the treatment of chronic non-cancer pain: an updated systematic review of randomized controlled trials. J NeuroImmune Pharmacol. 2015;10(2):293–301. This article provided a literature review of research investigating the use of cannabinoids in treating chronic pain. PubMedCrossRefGoogle Scholar
- 65.• Ferguson G, Ware M. Review article: sleep, pain and cannabis. Journal of Sleep Disorders & Therapy. 2015;4(2):191. This paper reviewed the state of current research on cannabis, chronic pain, and sleep. Google Scholar
- 66.• Roth T. Effects of excessive daytime sleepiness and fatigue on overall health and cognitive function. J Clin Psychiatry. 2015;76(9):e1145. This article described the negative health effects of excessive daytime sleepiness and discussed psychometric scales used to measure excessive daytime sleepiness. PubMedCrossRefGoogle Scholar
- 67.• Murillo-Rodriguez E, Sarro-Ramirez A, Sanchez D, Mijangos-Moreno S, Tejeda-Padron A, Poot-Ake A, et al. Potential effects of cannabidiol as a wake-promoting agent. Curr Neuropharmacol. 2014;12(3):269–72. This study examined the effects of cannabidiol as a wakefulness promoting drug. PubMedPubMedCentralCrossRefGoogle Scholar