In this blog post for Medical Cannabis Awareness Week 2021, we devolve into the topic of insomnia and sleep in medical cannabis consumers.
As research into the medicinal and therapeutic potential of cannabis continues to pick up the pace, a growing number of people across the world report using cannabis-based medicines – including whole-plant products – to aid sleep. Sleep quality is an important aspect of a healthy life; however, research consistently shows that a significant proportion of the population suffers from poor sleep and sleep conditions such as insomnia.
Insomnia is characterised as having trouble getting to and/or staying asleep or having non-restorative sleep. It is one of the most common reasons someone might see their GP. In fact, it is estimated that approximately 30% of adults report ‘some insomnia problems over the past year’ and around 10% of adults suffer from chronic insomnia.
Furthermore, insomnia is considered a recurring or ongoing condition: for example, longitudinal studies show that almost 70% of individuals reporting insomnia symptoms continue to report symptoms a year later, and 50% continue to report symptoms a year later.
Insomnia is one of the most reported reasons for using medical cannabis. However, few clinical studies have focused on sleep quality as a primary outcome, with most of the evidence in this area being driven by clinical trials that used cannabinoids for the treatment of other conditions, including chronic pain or multiple sclerosis.
Current Evidence of the Potential of Cannabis for Insomnia
A previous study involved the observation of 95 medical cannabis users who used the products for a variety of conditions. The results of this review showed that users tended to prefer Cannabis Indica products to aid with sleep and sedation, as well as to treat insomnia. Another recent naturalistic study examined cannabis use for insomnia in a sample of 409 participants. This study identified significant reductions in symptom severity; however, these findings were limited by recorded data on different cannabis products and patient demographics.
To help address the current gaps in the evidence to support the use of medical cannabis for insomnia, a recent retrospective study aimed to investigate the perceived effectiveness of cannabinoid-based products for insomnia in a large, naturalistic sample of Canadian participants.
Design and Methods of the Study
Researchers used anonymous archival data obtained from the medicinal cannabis-tracking app Strainprint – a Canadian app with a large database of both medical and recreational cannabis users (>90 million data points and 2 million reported patient outcomes). Strainprint allows its users to record medical conditions, symptoms being treated, methods of ingestion, doses, emotive effects, pre- and post-medication ratings and cannabis product constituents by batch for each tracked session.
App users are initially prompted to enter demographics and to rate the severity of their symptoms on an 11-point scale (0=least severe, 10=most severe). The app also collects data on the product name and batch of cannabis used as well as the product form (flower, oil, capsule, edible, vape pen, or concentrate), route of administration (vape, oil, smoke, edible, pill, tincture, spray, concentrate, dab bubble, dab portable, oral, topical, or transdermal), and dose (drops, mg, ml, or puffs) for that specific session. Users are then later prompted with a push notification (8 hours later for sleep symptoms) to enter a post-medication symptom severity score on the same 11-point numeric scale.
The data utilised for this review included all tracked sessions between February 2017 and February 2020, consisting of a sample of 991 Canadian medical cannabis users with insomnia who used the app across 24,189 tracked sessions.
Results of the Study
The evidence collected from this sample of medicinal cannabis users who tracked their insomnia symptoms before and after cannabis use suggests “significant improvements in insomnia symptoms, with no gender differences in perceived efficacy”. The researchers note that this study, through its utilisation of advancing technologies, offers a unique perspective on a health management self-monitoring tool that examines data on a population scale.
Before cannabis use, the mean tracked symptom severity rating for insomnia was 7.35, compared to a mean symptom severity rating of 3.20 after use – representing an improvement of over 50%.
Preferred products and cannabinoid ratios
The data showed that cannabis flowers and oils were the most commonly used products. There were no significant differences in reported efficacy among product forms.
Interestingly, all strains of cannabis were reported to be beneficial for the management of insomnia symptoms to some extent; however, strains that were higher in tetrahydrocannabinol (THC) were more often reported as efficacious than cannabidiol (CBD) and CBD-dominant strains. The researchers note that this finding was in line with the results of previous studies which identified THC-dominant and hybrid strains as the most frequently for insomnia.
The researchers conclude that, while the findings of this review mirror promising results demonstrated in other studies that assessed the efficacy of cannabis products for sleep improvement and insomnia, there remains a lack of placebo-controlled trials that have examined the effects of the drug, using validated sleep measures or objective sleep outcomes.
Furthermore, current evidence on the potential risks, harms and side effects of the use of cannabis-based products for sleep-related conditions remains limited. Nonetheless, the results of this review “suggest that individuals using medicinal cannabis to manage insomnia symptoms report significant symptom reduction after use”.
The authors of this review recommend that future clinical trials should “focus on the benefits and potential harms through the use of validated objective and subjective measures” to better understand the potential of cannabinoids for the management of insomnia symptoms.