While cannabis has been used for medicinal properties for thousands of years, a hefty and ill-timed period of prohibition also resulted in a paucity of clinical research. However, as an increasing number of countries and jurisdictions around the world – including many European countries, 36 US states and Washington DC in the US – continue to legalise the use of medical cannabis, research into the potential of the plant’s derivates is growing.
One of these areas of research is in sleep quality and sleep conditions. Evidence gathered in a study by Altman and colleagues showed that cannabis reportedly helped participants to fall asleep 15 minutes earlier and stay asleep for two hours longer. However, further research is still required to better understand the objective and subjective effects of cannabis on sleep.
A recent study aimed to assess the effect of a repeat-action tablet containing 10mg tetrahydrocannabinol (THC) and 5mg cannabinol (CBN) on sleep quality, sleep duration, and awakenings in medical cannabis users. The participants reported using medical cannabis for a number of conditions, including sleep/insomnia (69%), pain (40%), and generalised anxiety disorder (29%).
Methods of the Study
The researchers recruited 41 medical cannabis patients (certified by the Maryland Medical Cannabis Commission) who had reported having trouble staying asleep. A total of 35 participants completed the study.
All participants were provided with a SleepScore Max device and a number of repeat action THC/CBN tablets. Prior to the start of the study period, all 41 participants also reviewed and signed informed consent forms and met all eligibility criteria. Of the 41 participants, one failed to register a sleep-tracking system account and two withdrew from the study – one due to a pre-existing medical condition and one cited technological difficulty with the app. Three more participants did not submit complete data.
The repeat-action tablets, containing a 10mg dose of THC and 5mg of CBN, released half of this dose immediately after consumption and the remaining half between 2-3 hours later.
The SleepScore Max device was used to measure participants’ sleep unobtrusively and objectively at home. The system provides ‘standard annotated 30-second epoch sleep-stage data” and commonly used sleep metrics, including time taken to fall asleep (sleep onset latency), number of awakenings, start and end of sleep sessions, and total sleep time.
To measure compliance with sleep tracking, compliance to repeat-action dosage during the product-use period, and to measure perceived sleep quality, daily questionnaires were sent to participants each morning throughout the six-week study.
Results of the Study
Participants used the SleepScore Max device prior to the use of the cannabinoid repeat-action tablet in order to provide date for comparison. There were 594 nights of tracked sleep before the use of the cannabis product and 426 tracked nights during which participants were using the product.
The data revealed that the measurements indicative of staying asleep did not change when the repeat-action tablet was introduced. The effects of the preparation for wake after sleep onset, number of awakenings, sleep efficiency, and sleep maintenance were not significant and there was also no significant changed observed in time to fall asleep.
On the other hand, participants’ average length of time in bed increased by 22 minutes which may have resulted in a healthier amount of sleep. Self-reported data collected from the daily questionnaire suggested that the repeat-action dosage helped participants to experience better sleep. Overall sleep quality of the participants increased by 18% with sleep quality rating increasing from 57.36 before product use to 67.90 during product use.
This study unexpectedly coincided with the COVID-19 pandemic which the researchers note may have led to health and lifestyle changes in patients which could have an impact upon results. Further, the increase in sleep time found in the study example is in line with national data which shows that, on average, people spent more time in bed and slept longer during COVID-19 restrictions than pre-pandemic.
The researchers conclude that the oral product containing THC and CBN were “directly associated with both improved objective and perceived sleep quality and duration in a sample of patients taking medical cannabis”. There were, however, no significant changes observed in the objective sleep measurements specific to remaining sleep despite participant perception of improvements, including reports of longer time in bed and total sleep time records.