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A cross-sectional survey of the prevalence and patterns of using cannabis as a sleep aid in Canadian cancer survivors

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Abstract

Purpose

Poor sleep is one of the most common side effects of cancer. It can persist for years beyond treatment and negatively impact quality of life and health. Cannabis is increasingly used to manage cancer treatment-related symptoms, including sleep. This study investigated the use and perceived effects of cannabis as a sleep aid in Canadian cancer survivors.

Methods

Adult Canadian cancer survivors (N = 1464) were recruited via the Angus Reid Institute and completed an online, cross-sectional survey including the Insomnia Severity Index and questions about cannabis use for sleep. Standard descriptive statistics, such as means, standard deviations, and ranges were produced for measured variables to assess the ways cancer survivors use cannabis for sleep. Frequencies were tabulated for categorical and ordinal variables.

Results

On average, participants (Mage = 61.1 years; Women = 50%: Men = 48%) received their cancer diagnosis 12.5 years prior. Of participants, 23.5% (n = 344) currently use cannabis as a sleep aid, with reported benefits including relaxation, reduced time to fall asleep, fewer nocturnal awakenings and improved sleep quality. Two thirds (68.3%, n = 235) only began using cannabis for sleep after their cancer diagnosis. Over a third of participants (36.3%, n = 125) use cannabis as a sleep aid every day. Among the 344, the most common other reasons for using cannabis were pain (31.4%, n = 108), recreational use (24.4%, n = 84), and anxiety (12.5%, n = 43).

Conclusions

Given the prevalence and potential impact, research is needed to examine the actual efficacy of cannabis as a sleep aid.

Implications for cancer survivors

It is important that cancer survivors have information on methods to help their sleep to avoid impairments to quality of life and health.

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Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

References

  1. Nunn CL, Samson DR, Krystal AD. Shining evolutionary light on human sleep and sleep disorders. Evol Med Public Health. 2016;2016(1):227–43.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Hung CM, et al. Risk of dementia in patients with primary insomnia: a nationwide population-based case-control study. BMC Psychiatry. 2018;18(1):38.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Bertisch SM et al. Insomnia with objective short sleep duration and risk of incident cardiovascular disease and all-cause mortality: sleep heart health study. Sleep. 2018;41(6):zsy047.

  4. Bin YS, Marshall NS, Glozier N. The burden of insomnia on individual function and healthcare consumption in Australia. Aust N Z J Public Health. 2012;36(5):462–8.

    Article  PubMed  Google Scholar 

  5. Lallukka T, et al. Joint associations of sleep duration and insomnia symptoms with subsequent sickness absence: the Helsinki Health Study. Scand J Public Health. 2013;41(5):516–23.

    Article  PubMed  Google Scholar 

  6. APA. The diagnostic and statistical manual of mental disorders. 5th ed. Washington, DC: American Psychiatric Association; 2013.

  7. Mullan F. Seasons of survival: reflections of a physician with cancer. N Engl J Med. 1985;313(4):270–3.

    Article  CAS  PubMed  Google Scholar 

  8. Al Maqbali M, et al. Prevalence of sleep disturbance in patients with cancer: a systematic review and meta-analysis. Clin Nurs Res. 2022;31(6):1107–23.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Harrold EC, et al. Prevalence of insomnia in an oncology patient population: an Irish tertiary referral center experience. J Natl Compr Canc Netw. 2020;18(12):1623–30.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Palesh O, et al. Prevalence, putative mechanisms, and current management of sleep problems during chemotherapy for cancer. Nat Sci Sleep. 2012;4:151–62.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Reynolds-Cowie P, Fleming L. Living with persistent insomnia after cancer: a qualitative analysis of impact and management. Br J Health Psychol. 2021;26(1):33–49.

    Article  PubMed  Google Scholar 

  12. Strollo SE, et al. Cancer-related problems, sleep quality, and sleep disturbance among long-term cancer survivors at 9-years post diagnosis. Sleep Med. 2020;65:177–85.

    Article  PubMed  Google Scholar 

  13. Lis CG, Gupta D, Grutsch JF. The relationship between insomnia and patient satisfaction with quality of life in cancer. Support Care Cancer. 2008;16(3):261–6.

    Article  PubMed  Google Scholar 

  14. Colten HR, Altevogt BM, I.o.M. Sleep disorders and sleep deprivation: an unmet public health problem. Washington: National Academics Press; 2006.

    Google Scholar 

  15. Zhou ES, et al. Cancer patient’s attitudes of using medicinal cannabis for sleep. J Psychosocial Oncolocy. 2021;40(3):397–403.

    Article  Google Scholar 

  16. Rosenberg R, Citrome L, Drake CL. Advances in the treatment of chronic insomnia: a narrative review of new nonpharmacologic and pharmacologic therapies. Neuropsychiatr Dis Treat. 2021;17:2549–66.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Brandt J, Leong C. Benzodiazepines and Z-Drugs: an updated review of major adverse outcomes reported on in epidemiologic research. Drugs R D. 2017;17(4):493–507.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Jacobs GD, et al. Cognitive behavior therapy and pharmacotherapy for insomnia: a randomized controlled trial and direct comparison. Arch Intern Med. 2004;164(17):1888–96.

    Article  PubMed  Google Scholar 

  19. Suraev A, et al. Cannabidiol (CBD) and Delta(9)-tetrahydrocannabinol (THC) for chronic insomnia disorder (‘CANSLEEP’ trial): protocol for a randomised, placebo-controlled, double-blinded, proof-of-concept trial. BMJ Open. 2020;10(5):e034421.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Qaseem A, et al. Management of chronic insomnia disorder in adults: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2016;165(2):125–33.

    Article  PubMed  Google Scholar 

  21. Williams J, et al. Cognitive behavioral treatment of insomnia. Chest. 2013;143(2):554–65.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Squires LR, et al. Systematic review and meta-analysis of cognitive-behavioural therapy for insomnia on subjective and actigraphy-measured sleep and comorbid symptoms in cancer survivors. Sleep Med Rev. 2022;63:101615.

    Article  PubMed  Google Scholar 

  23. Howell D, et al. A pan-canadian practice guideline and algorithm: screening, assessment, and supportive care of adults with cancer-related fatigue. Curr Oncol. 2013;20(3):e233-46.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Zhou ES, et al. Evaluation and treatment of insomnia in adult cancer survivorship programs. J Cancer Surviv. 2017;11(1):74–9.

    Article  PubMed  Google Scholar 

  25. Thomas A, et al. Where are the behavioral sleep medicine providers and where are they needed? A geographic assessment. Behav Sleep Med. 2016;14(6):687–98.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Cheung JMY, et al. To drug or not to drug: a qualitative study of patients’ decision-making processes for managing insomnia. Behav Sleep Med. 2018;16(1):1–26.

    Article  PubMed  Google Scholar 

  27. Zachariae R, et al. Internet-delivered cognitive-behavioral therapy for insomnia in breast cancer survivors: a randomized controlled trial. J Natl Cancer Inst. 2018;110(8):880–7.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Zhou ES, Recklitis CJ. Internet-delivered insomnia intervention improves sleep and quality of life for adolescent and young adult cancer survivors. Pediatr Blood Cancer. 2020;67(9):e28506.

    Article  PubMed  Google Scholar 

  29. Amidi A, et al. Changes in sleep following internet-delivered cognitive-behavioral therapy for insomnia in women treated for breast cancer: a 3-year follow-up assessment. Sleep Med. 2022;96:35–41.

    Article  PubMed  Google Scholar 

  30. Choi S, Huang BC, Gamaldo CE. Therapeutic uses of cannabis on sleep disorders and related conditions. J Clin Neurophysiol. 2020;37(1):39–49.

    Article  PubMed  Google Scholar 

  31. Andre CM, Hausman JF, Guerriero G. Cannabis sativa: the plant of the thousand and one molecules. Front Plant Sci. 2016;7:19.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Kesner AJ, Lovinger DM. Cannabinoids, endocannabinoids and sleep. Front Mol Neurosci. 2020;13:125.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Hawley P, Gobbo M, Afghari N. The impact of legalization of access to recreational cannabis on Canadian medical users with cancer. BMC Health Serv Res. 2020;20(1):977.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Webster EM, et al. Prescribed medical cannabis in women with gynecologic malignancies: a single-institution survey-based study. Gynecol Oncol Rep. 2020;34:100667.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Abdel-Rahman O. Cannabis use among canadian adults with cancer (2007–2016): results from a national survey. Expert Rev Pharmacoecon Outcomes Res. 2021;21(5):1025–9.

    Article  PubMed  Google Scholar 

  36. Martell K, et al. Rates of cannabis use in patients with cancer. Curr Oncol. 2018;25(3):219–25.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Moltke J, Hindocha C. Reasons for cannabidiol use: a cross-sectional study of CBD users, focusing on self-perceived stress, anxiety, and sleep problems. J Cannabis Res. 2021;3(1):5.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Babson KA, Sottile J, Morabito D. Cannabis, cannabinoids, and sleep: a review of the literature. Curr Psychiatry Rep. 2017;19(4):23.

    Article  PubMed  Google Scholar 

  39. De Feo G, et al. Multinational association of supportive care in cancer (MASCC) guidelines: cannabis for psychological symptoms including insomnia, anxiety, and depression. Support Care Cancer. 2023;31(3):176.

    Article  PubMed  Google Scholar 

  40. Edwards D, Filbey FM. Are sweet dreams made of these? Understanding the relationship between sleep and cannabis use. Cannabis Cannabinoid Res. 2021;6(6):462–73.

    Article  PubMed  PubMed Central  Google Scholar 

  41. McLennan A, et al. Health care provider preferences for, and barriers to, cannabis use in cancer care. Curr Oncol. 2020;27(2):e199–205.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Donovan KA, et al. Cannabis consumption in young adults with cancer: descriptive study. BMJ Support Palliat Care. 2022. https://doi.org/10.1136/bmjspcare-2021-003353.

  43. Walsh JH et al. Treating insomnia symptoms with medicinal cannabis: a randomized, crossover trial of the efficacy of a cannabinoid medicine compared with placebo. Sleep. 2021;44(11):zsab149.

  44. Kuhathasan N, et al. The use of cannabinoids for insomnia in daily life: naturalistic study. J Med Internet Res. 2021;23(10):e25730.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Pivik RT, et al. Delta-9-tetrahydrocannabinol and synhexl: effects on human sleep patterns. Clin Pharmacol Ther. 1972;13(3):426–35.

    Article  CAS  PubMed  Google Scholar 

  46. Suraev AS, et al. Cannabinoid therapies in the management of sleep disorders: a systematic review of preclinical and clinical studies. Sleep Med Rev. 2020;53:101339.

    Article  PubMed  Google Scholar 

  47. Belendiuk KA, et al. Cannabis species and cannabinoid concentration preference among sleep-disturbed medicinal cannabis users. Addict Behav. 2015;50:178–81.

    Article  PubMed  Google Scholar 

  48. Barratt ES, Beaver W, White R. The effects of marijuana on human sleep patterns. Biol Psychiatry. 1974;8(1):47–54.

    CAS  PubMed  Google Scholar 

  49. Fallon MT, et al. Sativex oromucosal spray as adjunctive therapy in advanced cancer patients with chronic pain unalleviated by optimized opioid therapy: two double-blind, randomized, placebo-controlled phase 3 studies. Br J Pain. 2017;11(3):119–33.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Zylla DM, et al. A randomized trial of medical cannabis in patients with stage IV cancers to assess feasibility, dose requirements, impact on pain and opioid use, safety, and overall patient satisfaction. Support Care Cancer. 2021;29(12):7471–8.

    Article  PubMed  Google Scholar 

  51. von Elm E, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007;370(9596):1453–7.

    Article  Google Scholar 

  52. Morin CM. Insomnia: Psychological Assessment and Management. New York: Guilford; 1993.

    Google Scholar 

  53. Bastien CH, Vallieres A, Morin CM. Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Med. 2001;2(4):297–307.

    Article  PubMed  Google Scholar 

  54. Morin CM, et al. The Insomnia Severity Index: psychometric indicators to detect insomnia cases and evaluate treatment response. Sleep. 2011;34(5):601–8.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Savard J, et al. Randomized study on the efficacy of cognitive-behavioral therapy for insomnia secondary to breast cancer, part I: Sleep and psychological effects. J Clin Oncol. 2005;23(25):6083–96.

    Article  PubMed  Google Scholar 

  56. Ford DE, Kamerow DB. Epidemiologic study of sleep disturbances and psychiatric disorders. An opportunity for prevention? JAMA. 1989;262(11):1479–84.

    Article  CAS  PubMed  Google Scholar 

  57. Grotenhermen F. Pharmacokinetics and pharmacodynamics of cannabinoids. Clin Pharmacokinet. 2003;42(4):327–60.

    Article  CAS  PubMed  Google Scholar 

  58. Eadie L, et al. Duration of neurocognitive impairment with medical cannabis use: a scoping review. Front Psychiatry. 2021;12:638962.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Velzeboer R et al. Cannabis dosing and administration for sleep: a systematic review. Sleep. 2022;45(11):zsac218.

  60. Arboleda MF, et al. Medical cannabis in supportive cancer care: lessons from Canada. Support Care Cancer. 2020;28(7):2999–3001.

    Article  PubMed  Google Scholar 

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Acknowledgements

Rachel Lee is a trainee in the Cancer Research Training Program of the Beatrice Hunter Cancer Research Institute, with funds generously provided by the Canadian Cancer Society’s JD Irving, Limited - Excellence in Cancer Research Fund. Dr. Sheila Garland is supported by a Canadian Cancer Society Emerging Scholar Award (Survivorship) (grant #707146).

Funding

This project was funded by a Seed Grant from Memorial University of Newfoundland.

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Authors and Affiliations

Authors

Contributions

Conceptualization, S.G.; methodology, R.L, S.G., J.D., and N.H.; validation, R.L, S.G., J.D., and N.H.; formal analysis, R.L.; investigation, R.L.; resources, R.M, S.G., J.D., and N.H.; data curation, R.L.; writing—original draft preparation, R.L.; writing—review and editing, S.G., J.D., and N. H.; visualization, R.L.; supervision, S.G.; project administration, R.L. and S.G.; funding acquisition, R.L. and S.G. All authors have read and agreed to the published version of the manuscript.

Corresponding author

Correspondence to Sheila N. Garland.

Ethics declarations

The authors have no relevant financial or non-financial interests to disclose.

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Interdisciplinary Committee on Ethics in Human Research at Memorial University of Newfoundland file #20222467-SC.

Consent to participate

Informed consent was obtained from all individual participants included in the study. Identifying information was removed so that data were anonymous.

Competing interests

The authors declare no competing interests.

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Lee, R.M., Donnan, J., Harris, N. et al. A cross-sectional survey of the prevalence and patterns of using cannabis as a sleep aid in Canadian cancer survivors. J Cancer Surviv (2023). https://doi.org/10.1007/s11764-023-01474-2

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