Cannabis for sleep disorders

In which cases can medical cannabis be considered as a therapy option?

Healthy sleep at night is essential for a person's physical and mental well-being. However, problems falling asleep and staying asleep are widespread. According to a health report, around 80 percent of working individuals in Germany suffered from poor sleep in 20171. But what are sleep disorders actually? And how are they treated? Can medical cannabis help with sleep disorders?

Sufficient and restful sleep is absolutely essential for good health. During sleep, many important processes take place in our body. For example, growth hormones are released, which help our muscles, bones and organs regenerate. Our immune system is also strengthened during sleep, and our metabolism produces more proteins to replenish our energy stores. At the same time, the metabolism ensures that unusable metabolic products are removed.

A disturbed sleep rhythm and the resulting lack of sleep can have serious health consequences. Especially if the sleep problems occur over a longer period of time. Possible symptoms of sleep deficiency are2:


  • Decreased ability to concentrate and react.
  • forgetfulness
  • Lack of drive
  • headaches
  • Mood swings


If the sleep problems take a chronic course, you should definitely have this clarified by a doctor. Under certain conditions, medical cannabis may also be a treatment option for sleep disorders.

Criteria for the prescription of medical cannabis

The "Cannabis as Medicine" law makes it possible for doctors of any specialty (except dentists and veterinarians) to prescribe cannabis as medicine on a narcotic prescription under certain conditions.

These conditions include the presence of a serious illness that is classified as treatment-resistant, for which no standard therapy is available, or for which the side effects of standard therapy are unacceptable. According to medical assessment, there must also be a chance that the symptoms will improve with medical cannabis.

Forms and causes of sleep disorders

Not all sleep disturbances need to be treated. In short-term stressful situations, for example the day before an exam, many people complain about sleep that is not very restful. Late-night coffee can also make it difficult to get a good night's rest. However, if the sleep problems occur over a longer period of time or repeatedly, the result is a permanent lack of sleep.

The American Academy Of Sleep Medicine has categorized these disorders and according to the International Classification of Sleep Disorders (ICSD) classification system, they are divided into six main categories3:

  • Insomnia → Sleeplessness
  • Sleep-related breathing disorders → e.g., sleep apnea, where there are recurrent pauses in breathing during sleep
  • Hypersomnias/daytime sleepiness of central origin, not caused by circadian rhythm disturbance (e.g., sleep-wake rhythm), sleep-related breathing disorders, or other reasons for disturbed nighttime sleep → increased need for sleep
  • Disturbances of circadian rhythms and sleep-wake cycles.
  • Parasomnias → behavioral abnormalities during sleep phases, e.g., sleepwalking
  • Sleep-related movement disorders → e.g. restless legs syndrome.

Possible causes of sleep problems

The causes of sleep problems can be diverse and usually various factors play a role here.  General worries, stress or unfavorable sleeping conditions can prevent us from sleeping, but mental illnesses such as depression, anxiety, psychosis or schizophrenia can also be the cause.  Other diseases such as rheumatic and hormonal diseases, cancer, restless legs, heart and lung diseases, Parkinson's disease, dementia and many others can lead to sleep disorders, especially when chronic pain is present2.

In addition, there are a number of medications that can lead to sleep disturbances, including corticosteroids such as prednisolone, diuretics, blood pressure medications, cancer cytostatics, etc.  Discontinuation of medications such as sleeping pills can also lead to long-lasting sleep problems2.

How is the diagnosis made?

If you suspect you are suffering from a sleep disorder, please first visit your family doctor. A detailed medical history plays an important role. What medications are the patients taking? What is the medical history? Is there any substance use, e.g. alcohol dependence?  All of this can help in making a diagnosis. It can also be helpful to keep a sleep diary before the doctor's visit and to take it with you to the consultation.

A medical examination of the body may also be necessary in the diagnosis, or blood samples sent to the laboratory for examination. (For example, to measure hormone levels if thyroid disease is suspected). Electrocardiography (ECG) and electroencephalography (EEG) may also be helpful in diagnosis. In the case of a very pronounced sleep disorder, it is usually also useful to examine the sleep process in a sleep laboratory2.

Sleep disorder – what to do?

Doctors differentiate between acute and chronic sleep disorders. A chronic illness is said to exist if the complaints persist at least three times a week for more than a month4.

In many cases, improved sleep hygiene can help with mild sleep problems5. This refers to changes in habits that often lead to more restful sleep. For example, experts advise sufferers to always go to bed at the same time, to avoid coffee and alcohol in the evening, to avoid naps and to learn relaxation techniques. It can also help to avoid watching TV and using a cell phone immediately before going to bed.

Medication for sleep disorders

Depending on the cause and severity of the sleep disorder, however, changing habits may not be enough to improve sleep quality.

One option for patients is to turn to a natural remedy for sleep disorders. Valerian is one of the best-studied and most widely used natural remedies for sleep disorders. However, the evidence for improvement of sleep by valerian in scientific studies is quite mixed6. Hops, the main ingredient in beer, are also thought to have a sedative effect7.

Prescription medications for sleep disorders

If a severely pronounced disturbance of sleep is present, the change of sleeping habits or the intake of herbal remedies usually reaches its limits. If the level of suffering is very high and no other treatment (e.g., cognitive behavioral therapy) can help, doctors can prescribe medications to help people fall asleep. However, since these have a high dependence potential and do not eliminate the cause of the sleep disorder, such sleeping pills should only be used temporarily8.

These sleeping pills include benzodiazepines and the so-called Z-substances (benzodiazepine receptor agonists). Both drugs are strong sleep and sedative agents that can shorten the time it takes to fall asleep and improve the quality of sleep. However, they are not free of side effects. Particularly problematic is that they impair concentration, attention and driving ability – sometimes even the next day8.

Contrary to their actual purpose, other groups of drugs are also repeatedly used as sleeping pills. Experts use "off-label use" to take advantage of the side effects of drugs that are approved for other symptoms. In the case of sleep problems, for example, antidepressants that are actually used for depression and anxiety disorders are prescribed for relief8.

Cannabis for sleep disorders

Cannabis has been used as a natural sleep aid for centuries9. A look at recent studies also shows that cannabinoids from medical cannabis can have a sleep-inducing effect10. This is most likely due to an interaction with the endocannabinoid system, which is part of our nervous system and is involved in the control of various processes, such as pain perception and emotions, but also in the function of the immune system and even in the sleep-wake rhythm11.

The body also produces its own cannabinoids (endocannabinoids), which interact with the same receptors as cannabinoids from cannabis. For example, the endocannabinoid anandamide binds to cannabinoid receptor 1 (CB1), which is part of the ECS. Systemic administration of anandamide promotes sleep, and this effect can be prevented by blocking CB1. Thus, cannabis may promote sleep by interacting with the CB1 receptor11.

Studies on medicinal cannabis as a sleep aid.

In a study involving 23 subjects with chronic insomnia, one group received a medicinal cannabinoid extract containing THC, cannabidiol (CBD), and cannabinol (CBN) for two weeks and another group received a placebo (placebo). In this study, the patients who received the extract reported that the time to fall asleep was shortened and the duration of sleep was prolonged12.

Another study focused on the effects of medical cannabis on the quality of life and health of patients. The participants interviewed reported that the use of medical cannabis improved health satisfaction, quality of life and sleep, among other things13.

Regarding the use of medical cannabis, however, it must also be said that although there is an acute effect on sleep, tolerance can occur with regular use, so that the effect decreases over time. Discontinuing sleep medications and medicinal cannabis can also disrupt sleep. Therefore, it is especially important that you consult with physicians who specialize in the use of medical cannabis11.

Cannabidiol (CBD) to help you sleep

Cannabidiol (CBD) is the second best-known cannabinoid from the cannabis plant after THC and does not cause any intoxicating effects.  Most studies on the effects of cannabinoids on sleep have focused on the effects of pure THC or preparations high in THC. However, interest in the effects of products containing only CBD is increasing11.

Many people who use nonprescription CBD products report that they help them fall asleep15. However, the products cannot be compared to medical CBD because they are not pharmaceutical grade, so the content and purity can vary greatly15.

There are few results from clinical trials on the effect of pure CBD on sleep, and the results are inconsistent. Therefore, further research is needed to determine if CBD alone has a positive effect on sleep11,16.

How can Canify Clinics help?

Canify Clinics is here to help you get closer to your goal: We want to help you regain your quality of life. To do this, it is important to keep bureaucratic hurdles to a minimum and to adapt appointments and tasks to your everyday life. This means that the symptoms of your disease must not prevent you from taking care of your health. To make your path to medical cannabis easier, Canify Clinics works on the principle of telemedicine.

After you register on our website without any obligation, our doctors will review your records and contact you in a timely manner to discuss the next steps. If treatment with medical cannabis is an option for you, an appointment with one of our cooperating physicians will follow. The follow-up appointments can take place from the comfort of your own home, in the video appointment you discuss everything important with your doctor. Only once per calendar year is there an appointment in person – we will be happy to help you prepare for this.

FAQ

What can be done against sleep disorders?

People who suffer from insomnia should pay attention to their sleeping habits and always go to bed at the same time. Before that, caffeine and alcohol should be avoided as much as possible. Learning relaxation techniques can also be helpful. Natural remedies may be an option, and in more severe cases, sleeping pills may be prescribed for a temporary period.

What is the reason for sleep disorders?

There are usually several factors that interfere with restful sleep. Sometimes it is external factors such as an incorrect mattress or too much noise in the environment. In other cases, stress, worry and anxiety can be the cause. The consumption of caffeine, alcohol or drugs can also disrupt sleep, as can certain medications such as diuretic drugs – and blood pressure medications. Other possible causes can be mental or physical illnesses.

What diseases cause sleep disorders?

The causes of sleep disorders can be varied. Mental illnesses such as anxiety or depression can be a reason, but so can organic diseases. For example, diseases such as rheumatism, heart and lung diseases or restless legs syndrome can be causative. Chronic pain can also rob you of sleep. It is therefore all the more important to have the causes clarified by a doctor.

Disclaimer and legal information

This article is for information purposes only and does not replace medical advice from a doctor. The content is not intended to motivate self-diagnosis or self-treatment, nor to induce independent changes in medical treatment. Canify Clinics does not make any recommendations or promote any diagnostic methods or treatments. If you wish to change your treatment, this should always be discussed with a doctor. Furthermore, Canify Clinics cannot guarantee the accuracy, timeliness and balance of the content. Therefore, neither the authors of the texts nor Canify Clinics accept any liability for damages resulting from the independent use of the information described here.

References

1. DAK-Gesundheitsreport 2017, „Müdes Deutschland: Schlafstörungen steigen deutlich an

2. Gesundheitsportal NetDoktor, M Feichter, Medizinredakteurin und Biologin, 2022, „Schlafstörungen

3. American Academy of Sleep Medicine. International Classification of Sleep Disorders, 3rd ed, American Academy of Sleep Medicine, 2014.

4. Universitätsmedizin der Johannes Gutenberg-Universität Mainz, „Chronische Schlafstörungen

5. Helios Kliniken GmbH, Helios Gesundheit, „Schlafhygiene

6. Verma, K., Singh, D. & Srivastava, A. The Impact of Complementary and Alternative Medicine on Insomnia: A Systematic Review. (2022) doi:10.7759/cureus.28425.

7. Benkherouf, A. Y., Eerola, K., Soini, S. L. & Uusi-Oukari, M. Humulone Modulation of GABAA Receptors and Its Role in Hops Sleep-Promoting Activity. Front Neurosci 14, (2020).

8. Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen (IQWiG), gesundheitsinformation.de, 2021, „Schlafprobleme und Schlafstörungen (Insomnie)

9. Zuardi, A. W. History of cannabis as a medicine: A review. Revista Brasileira de Psiquiatria vol. 28 153–157 (2006).

10. Bilbao, A. & Spanagel, R. Medical cannabinoids: a pharmacology-based systematic review and meta-analysis for all relevant medical indications. BMC Med 20, (2022).

11. Kesner, A. J. & Lovinger, D. M. Cannabinoids, Endocannabinoids and Sleep. Front Mol Neurosci 13, 125 (2020).

12. Walsh, J. H. et al. Treating insomnia symptoms with medicinal cannabis: a randomized, crossover trial of the efficacy of a cannabinoid medicine compared with placebo. Sleep 44, (2021).

13. Schlienz, N. J. et al. A Cross-Sectional and Prospective Comparison of Medicinal Cannabis Users and Controls on Self-Reported Health. Cannabis Cannabinoid Res 6, 548–558 (2021).

14. 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 3, (2021).

15. Hazekamp, A. The Trouble with CBD Oil. Med Cannabis Cannabinoids 1, 65–72 (2018).

16. Henson, J. D., Vitetta, L. & Hall, S. Tetrahydrocannabinol and cannabidiol medicines for chronic pain and mental health conditions. Inflammopharmacology 2022 30:4 30, 1167–1178 (2022).