Sleep difficulties affect approximately 20% of people, especially those with medical conditions such as chronic pain syndromes or mental illnesses such as anxiety, depression, or psychotic disorders induced by illicit drugs. Cannabis use is on the rise with an impressive record of inducing symptoms of mental and physical illnesses and disrupting sleep-wake cycles. A 58-year-old Caucasian female with a history of bipolar type 1 disorder, generalized anxiety disorder, insomnia, chronic pain syndrome, migraine headaches, and cannabis dependence is seen for a routine 3-month visit. Per her report, she has increased anxiety, depression, and insomnia for the past 2 months. Also, she has become more paranoid and is having visual hallucinations when she has been unable to sleep for several days. The patient admits to daily cannabis use of at least 1 g but has increased her intake to about 1 ½ g per day but without success in helping her anxiety to diminish and sleep to ensue. She is being treated with venlafaxine, gabapentin, Robaxin, oxcarbazepine, ibuprofen, and sumatriptan as needed. Based on this patient’s physical exam and mental history and toxicology screening, this patient has cannabis-induced sleep disturbance resulting in diminished sleep quality, increased anxiety, increased depressive symptoms, and the presence of visual hallucinations. The patient requires treatment in a substance use facility for cannabis withdrawal monitoring while managing sleep, controlling for anxiety, and depression.
- Sleep disturbances