Cannabis Shows Potential In Combating Insomnia And Anxiety

Insomnia is a sleep disorder that affects millions of people worldwide, making it difficult to fall or stay asleep, and harming physical and mental health and quality of life. Current treatments, such as cognitive behavioral therapy and medications, don't always work well in the long term. Recent research suggests that cannabis-based medications may improve sleep quality and reduce anxiety symptoms in patients with insomnia, but larger, long-term studies are still needed to confirm their effectiveness and safety.

Insomnia is one of the most common sleep disorders. It occurs when a person has difficulty falling asleep, wakes up several times during the night, or wakes up very early in the morning and is unable to return to sleep. To be considered a clinical problem, these difficulties must occur at least three times a week for more than three months, even when the person has adequate sleep conditions.

Approximately one-third of the population experiences symptoms of insomnia at some point in their lives, and about 10% of adults worldwide suffer from persistent insomnia. Beyond discomfort, insomnia can have serious health consequences, such as an increased risk of developing mental illness, cardiovascular problems, reduced quality of life, and decreased productivity at work.

The cause of insomnia is complex and involves several factors. One of the main ones is so-called "hyperarousal," which means the body and mind remain in a state of alert even when they should be relaxing for sleep. This can alter the normal structure of sleep, reducing important phases such as deep sleep and rapid eye movement sleep.

Changes in the biological clock, which regulates sleep and wake cycles, can also contribute. Furthermore, imbalances in brain chemicals, such as gamma-aminobutyric acid (a neurotransmitter that helps with relaxation), play a significant role in this disorder.

The human body has a system called the endocannabinoid system, which helps regulate various functions, including sleep. This system is made up of natural substances produced by the body itself, their receptors in the brain, and enzymes that control its function.

Research shows that this system directly participates in the initiation and maintenance of sleep. Therefore, scientists have begun investigating whether cannabis-based medications, which act on these same receptors, could have a positive effect on treating insomnia.

The most commonly recommended treatment for insomnia is currently cognitive behavioral therapy, a type of psychotherapy that helps modify habits and thoughts that disrupt sleep. However, access to this type of treatment is still limited. 

The most commonly used medications are those that enhance the action of gamma-aminobutyric acid, such as benzodiazepines and so-called "Z-drugs." These drugs work in the short term, but prolonged use can cause dependence and side effects. Other medications, such as melatonin, have a safer profile, but their effectiveness in many cases remains uncertain.

Recently, so-called orexin antagonists have also emerged, which act on another brain system linked to wakefulness, but they are not yet widely available.

Cannabis-based medications contain substances such as tetrahydrocannabinol (THC) and cannabidiol (CBD). THC has similar effects to some natural substances in the body that promote sleep, while CBD can balance the effects of THC and increase the availability of these natural substances.

Initial studies show that these medications can improve sleep quality in people with insomnia, including human and animal studies. Some studies suggest that combinations with more CBD than THC may be more effective and safer.

Despite these promising results, there is still little large-scale research definitively confirming the benefits of medicinal cannabis for insomnia. Many studies were conducted with a small number of patients, for a short period of time, or with people who had other health problems in addition to insomnia.

Furthermore, there are doubts about the effects of prolonged use, as stopping use can cause worsening sleep.

In a recent study conducted in the United Kingdom with more than 100 patients diagnosed with insomnia, treatment with medicinal cannabis resulted in significant improvements in sleep quality, reduced anxiety, and improved overall well-being.

The reported side effects were mild, and no serious cases were recorded. Still, scientists emphasize that more clinical studies, longer in duration and with more participants, are needed to evaluate the true benefits and safety of this treatment.

In short, insomnia is a public health problem that affects millions of people. Current treatments help, but they have limitations. Medicinal cannabis appears to be a promising option that can offer relief for many patients, but it still needs further study before being widely recommended.

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UK Medical Cannabis Registry: A clinical outcomes analysis for insomnia 

Arushika Aggarwal, Simon Erridge, Isaac Cowley, Lilia Evans, Madhur Varadpande, Evonne Clarke, Katy McLachlan, Ross Coomber, James J. Rucker,

Mark W. Weatherall, and Mikael H. Sodergren

PLOS Ment Health 2(8): e0000390. https://doi.org/10.1371/journal.pmen.0000390

Abstract: 

Insomnia affects approximately 10% of adults globally. Current treatments have their limitations, and there is growing evidence on the therapeutic potential of cannabis-based medicinal products for insomnia. This study aimed to assess changes in sleep-specific and general patient-reported outcome measures (PROMs) in individuals prescribed cannabis-based medicinal products for insomnia and to assess the incidence of adverse events. A case series was analysed with patients diagnosed with primary insomnia from the UK Medical Cannabis Registry (UKMCR). The primary outcome examined changes in the Single-Item Sleep Quality Scale (SQS), Generalised Anxiety Disorder-7 (GAD-7), and EuroQol-5 Dimension-5 Level (EQ-5D-5L). Changes in PROMs were assessed from baseline to 1-, 3-, 6-, 12- and 18-months. Adverse events were classified according to the CTCAE version 4.0. The inclusion criteria were met by 124 participants. SQS scores showed improvement from baseline (2.66 ± 2.41) to 1- (5.67 ± 2.65; p < 0.001), 3- (5.41 ± 2.69; p < 0.001), 6- (4.80 ± 2.89; p < 0.001), 12- (4.24 ± 3.01; p < 0.001) and 18-months (3.81 ± 2.90; p < 0.001). GAD-7 scores improved from baseline to 1-, 3-, 6-, 12- and 18-months (p < 0.050). There were also improvements in EQ-5D-5L dimensions of usual activities, pain/discomfort, anxiety/depression, and index values (p < 0.001). Eleven (8.87%) participants reported a total of 112 (90.32%) adverse events, but none were disabling or life-threatening. The study demonstrated improvements in subjective sleep quality and other captured PROMs in insomnia patients treated with cannabis-based medicinal products. Although the treatment was generally well-tolerated, randomised controlled trials are needed to confirm the effectiveness and safety of cannabis-based medicinal products