Cannabis, Cannabinoids, and Sleep: a Review of the Literature

  • Kimberly A. Babson
  • James Sottile
  • Danielle Morabito
Sleep Disorders (P Gehrman, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Sleep Disorders

Abstract

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.

Recent Findings

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.

Summary

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.

Keywords

Cannabis Cannabinoids Sleep Insomnia Sleep apnea 

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Marijuana (Cannabis): Substance Abuse and Mental Health Services Administration; 2016 [Available from: https://www.samhsa.gov/atod/marijuana.
  2. 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
  3. 3.
    Pacher P, Batkai S, Kunos G. The endocannabinoid system as an emerging target of pharmacotherapy. Pharmacol Rev. 2006;58(3):389–462.PubMedPubMedCentralCrossRefGoogle Scholar
  4. 4.
    Grotenhermen F, Russo E. Cannabis and cannabinoids: pharmacology, toxicology, and therapeutic potential. New York: Haworth Press Inc; 2002.Google Scholar
  5. 5.
    Cousens K, DiMascio A. (−) Delta 9 THC as an hypnotic. An experimental study of three dose levels. Psychopharmacologia. 1973;33(4):355–64.PubMedCrossRefGoogle Scholar
  6. 6.
    Pivik RT, Zarcone V, Dement WC, Hollister LE. Delta-9-tetrahydrocannabinol and synhexl: effects on human sleep patterns. Clin Pharmacol Ther. 1972;13(3):426–35.PubMedCrossRefGoogle Scholar
  7. 7.
    Feinberg I, Jones R, Walker JM, Cavness C, March J. Effects of high dosage delta-9-tetrahydrocannabinol on sleep patterns in man. Clin Pharmacol Ther. 1975;17(4):458–66.PubMedCrossRefGoogle Scholar
  8. 8.
    Barratt ES, Beaver W, White R. The effects of marijuana on human sleep patterns. Biol Psychiatry. 1974;8(1):47–54.PubMedGoogle Scholar
  9. 9.
    Feinberg I, Jones R, Walker J, Cavness C, Floyd T. Effects of marijuana extract and tetrahydrocannabinol on electroencephalographic sleep patterns. Clin Pharmacol Ther. 1976;19(6):782–94.PubMedCrossRefGoogle Scholar
  10. 10.
    Chait LD. Subjective and behavioral effects of marijuana the morning after smoking. Psychopharmacology. 1990;100(3):328–33.PubMedCrossRefGoogle Scholar
  11. 11.
    Freemon FR. The effect of chronically administered delta-9-tetrahydrocannabinol upon the polygraphically monitored sleep of normal volunteers. Drug Alcohol Depend. 1982;10(4):345–53.PubMedCrossRefGoogle Scholar
  12. 12.
    Karacan I, Fernandez-Salas A, Coggins WJ, Carter WE, Williams RL, Thornby JI, et al. Sleep electroencephalographic-electrooculographic characteristics of chronic marijuana users: part I. Ann N Y Acad Sci. 1976;282:348–74.PubMedCrossRefGoogle Scholar
  13. 13.
    Pranikoff K, Karacan I, Larson EA, Williams RL, Thornby JI, Hursch CJ. Effects of marijuana smoking on the sleep EEG. Preliminary studies JFMA. 1973;60(3):28–31.PubMedGoogle Scholar
  14. 14.
    Budney AJ, Vandrey RG, Hughes JR, Thostenson JD, Bursac Z. Comparison of cannabis and tobacco withdrawal: severity and contribution to relapse. J Subst Abus Treat. 2008;35(4):362–8.CrossRefGoogle Scholar
  15. 15.
    Babson KA, Boden MT, Bonn-Miller MO. The impact of perceived sleep quality and sleep efficiency/duration on cannabis use during a self-guided quit attempt. Addict Behav. 2013;38(11):2707–13.PubMedCrossRefGoogle Scholar
  16. 16.
    Babson KA, Boden MT, Harris AH, Stickle TR, Bonn-Miller MO. Poor sleep quality as a risk factor for lapse following a cannabis quit attempt. J Subst Abus Treat. 2013;44(4):438–43.CrossRefGoogle Scholar
  17. 17.
    Copersino ML, Boyd SJ, Tashkin DP, Huestis MA, Heishman SJ, Dermand JC, et al. Cannabis withdrawal among non-treatment-seeking adult cannabis users. Am J Addict. 2006;15(1):8–14.PubMedCrossRefGoogle Scholar
  18. 18.
    Haney M. Self-administration of cocaine, cannabis and heroin in the human laboratory: benefits and pitfalls. Addict Biol. 2009;14(1):9–21.PubMedCrossRefGoogle Scholar
  19. 19.
    Vandrey R, Smith MT, McCann UD, Budney AJ, Curran EM. Sleep disturbance and the effects of extended-release zolpidem during cannabis withdrawal. Drug Alcohol Depend. 2011;117(1):38–44.PubMedPubMedCentralCrossRefGoogle Scholar
  20. 20.
    Budney AJ, Moore BA, Vandrey RG, Hughes JR. The time course and significance of cannabis withdrawal. J Abnorm Psychol. 2003;112(3):393–402.PubMedCrossRefGoogle Scholar
  21. 21.
    Crowley TJ, Macdonald MJ, Whitmore EA, Mikulich SK. Cannabis dependence, withdrawal, and reinforcing effects among adolescents with conduct symptoms and substance use disorders. Drug Alcohol Depend. 1998;50(1):27–37.PubMedCrossRefGoogle Scholar
  22. 22.
    Vandrey R, Budney AJ, Kamon JL, Stanger C. Cannabis withdrawal in adolescent treatment seekers. Drug Alcohol Depend. 2005;78(2):205–10.PubMedCrossRefGoogle Scholar
  23. 23.
    Vandrey RG, Budney AJ, Hughes JR, Liguori A. A within-subject comparison of withdrawal symptoms during abstinence from cannabis, tobacco, and both substances. Drug Alcohol Depend. 2008;92(1–3):48–54.PubMedCrossRefGoogle Scholar
  24. 24.
    Bolla KI, Lesage SR, Gamaldo CE, Neubauer DN, Wang NY, Funderburk FR, et al. Polysomnogram changes in marijuana users who report sleep disturbances during prior abstinence. Sleep Med. 2010;11(9):882–9.PubMedPubMedCentralCrossRefGoogle Scholar
  25. 25.
    Sanford AE. Cannabinoids and hamster circadian activity rhythms. Brain Res. 2008;1222:141–8.PubMedCrossRefGoogle Scholar
  26. 26.
    Vaughn LK, Denning G, Stuhr KL, de Wit H, Hill MN, Hillard CJ. Endocannabinoid signalling: has it got rhythm? Br J Pharmacol. 2010;160(3):530–43.PubMedPubMedCentralCrossRefGoogle Scholar
  27. 27.
    Perron RR, Tyson RL, Sutherland GR. Delta9-tetrahydrocannabinol increases brain temperature and inverts circadian rhythms. Neuroreport. 2001;12(17):3791–4.PubMedCrossRefGoogle Scholar
  28. 28.
    Nicholson AN, Turner C, Stone BM, Robson PJ. Effect of Delta-9-tetrahydrocannabinol and cannabidiol on nocturnal sleep and early-morning behavior in young adults. J Clin Psychopharmacol. 2004;24(3):305–13.PubMedCrossRefGoogle Scholar
  29. 29.
    Carlini EA, Cunha JM. Hypnotic and antiepileptic effects of cannabidiol. J Clin Pharmacol. 1981;21(8–9 Suppl):417S–27S.PubMedCrossRefGoogle Scholar
  30. 30.
    Zuardi AW. Cannabidiol: from an inactive cannabinoid to a drug with wide spectrum of action. Rev Bras Psiquiatr. 2008;30(3):271–80.PubMedCrossRefGoogle Scholar
  31. 31.
    Tringale R, Jensen C. Cannabis and insomnia. Depression. 2011;4(12):0–68.Google Scholar
  32. 32.
    Hsiao YT, Yi PL, Li CL, Chang FC. Effect of cannabidiol on sleep disruption induced by the repeated combination tests consisting of open field and elevated plus-maze in rats. Neuropharmacology. 2012;62(1):373–84.PubMedCrossRefGoogle Scholar
  33. 33.
    Chagas MH, Crippa JA, Zuardi AW, Hallak JE, Machado-de-Sousa JP, Hirotsu C, et al. Effects of acute systemic administration of cannabidiol on sleep-wake cycle in rats. J Psychopharmacol. 2013;27(3):312–6.PubMedCrossRefGoogle Scholar
  34. 34.
    Gorelick DA, Goodwin RS, Schwilke E, Schroeder JR, Schwope DM, Kelly DL, et al. Around-the-clock oral THC effects on sleep in male chronic daily cannabis smokers. Am J Addict. 2013;22(5):510–4.PubMedPubMedCentralCrossRefGoogle Scholar
  35. 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. 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
  37. 37.
    Shannon S, Opila-Lehman J. Effectiveness of cannabidiol oil for pediatric anxiety and insomnia as part of posttraumatic stress disorder: a case report. Perm J. 2016;20(4):108–11.PubMedPubMedCentralGoogle Scholar
  38. 38.
    Carley DW, Paviovic S, Janelidze M, Radulovacki M. Functional role for cannabinoids in respiratory stability during sleep. Sleep. 2002;25(4):391–8.PubMedCrossRefGoogle Scholar
  39. 39.
    Jumpertz R, Wiesner T, Bluher M, Engeli S, Batkai S, Wirtz H, et al. Circulating endocannabinoids and N-acyl-ethanolamides in patients with sleep apnea—specific role of oleoylethanolamide. Exp Clin Endocrinol Diabetes. 2010;118(9):591–5.PubMedCrossRefGoogle Scholar
  40. 40.
    Prasad B, Radulovacki MG, Carley DW. Proof of concept trial of dronabinol in obstructive sleep apnea. Front Psychiatry. 2013;4:1.PubMedPubMedCentralGoogle Scholar
  41. 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. 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. 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. 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. 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
  46. 46.
    Fraser GA. The use of a synthetic cannabinoid in the management of treatment-resistant nightmares in posttraumatic stress disorder (PTSD). CNS Neurosci Ther. 2009;15(1):84–8.PubMedCrossRefGoogle Scholar
  47. 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. 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. 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
  50. 50.
    Ware MA, Fitzcharles MA, Joseph L, Shir Y. The effects of nabilone on sleep in fibromyalgia: results of a randomized controlled trial. Anesth Analg. 2010;110(2):604–10.PubMedCrossRefGoogle Scholar
  51. 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. 52.
    Association AP. Diagnostic and statistical manual of mental disorders (5th ed.). Washington 2013.Google Scholar
  53. 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. 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
  55. 55.
    Gorelick DA, Goodwin RS, Schwilke E, Schwope DM, Darwin WD, Kelly DL, et al. Tolerance to effects of high-dose oral delta9-tetrahydrocannabinol and plasma cannabinoid concentrations in male daily cannabis smokers. J Anal Toxicol. 2013;37(1):11–6.PubMedCrossRefGoogle Scholar
  56. 56.
    Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol. 2013;177(9):1006–14.PubMedPubMedCentralCrossRefGoogle Scholar
  57. 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
  58. 58.
    Veasey SC, Panckeri KA, Hoffman EA, Pack AI, Hendricks JC. The effects of serotonin antagonists in an animal model of sleep-disordered breathing. Am J Respir Crit Care Med. 1996;153(2):776–86.PubMedCrossRefGoogle Scholar
  59. 59.
    McCarter SJ, Boswell CL, St Louis EK, Dueffert LG, Slocumb N, Boeve BF, et al. Treatment outcomes in REM sleep behavior disorder. Sleep Med. 2013;14(3):237–42.PubMedPubMedCentralCrossRefGoogle Scholar
  60. 60.
    Aurora RN, Zak RS, Auerbach SH, Casey KR, Chowdhuri S, Karippot A, et al. Best practice guide for the treatment of nightmare disorder in adults. J Clin Sleep Med. 2010;6(4):389–401.PubMedPubMedCentralGoogle Scholar
  61. 61.
    Raskind MA, Peterson K, Williams T, Hoff DJ, Hart K, Holmes H, et al. A trial of prazosin for combat trauma PTSD with nightmares in active-duty soldiers returned from Iraq and Afghanistan. Am J Psychiatry. 2013;170(9):1003–10.PubMedCrossRefGoogle Scholar
  62. 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. 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
  64. 64.
    Russo EB, Guy GW, Robson PJ. Cannabis, pain, and sleep: lessons from therapeutic clinical trials of Sativex, a cannabis-based medicine. Chem Biodivers. 2007;4(8):1729–43.PubMedCrossRefGoogle Scholar
  65. 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. 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. 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

Copyright information

© Springer Science+Business Media New York (outside the USA) 2017

Authors and Affiliations

  • Kimberly A. Babson
    • 1
  • James Sottile
    • 2
  • Danielle Morabito
    • 1
  1. 1.National Center for PTSD-Dissemination & Training DivisionVA Palo Alto Health Care SystemMenlo ParkUSA
  2. 2.Palo Alto UniversityPalo AltoUSA

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