Medical cannabis and insomnia in older adults with chronic pain: a cross-sectional study

BMJ Support Palliat Care. 2020 Dec;10(4):415-420. doi: 10.1136/bmjspcare-2019-001938. Epub 2020 Jan 20.


Objectives: Medical cannabis (MC) is increasingly being used for treatment of chronic pain symptoms. Among patients there is also a growing preference for the use of MC to manage sleep problems. The aim of the current study was to examine the associations between use of whole plant cannabis and sleep problems among chronic pain patients.

Methods: A total of 128 individuals with chronic pain over the age of 50 years were recruited from the Rambam Institute for Pain Medicine in Haifa, Israel. Of them, 66 were MC users and 62 were non-users. Regression models tested the differences in sleep problems between the two groups. Furthermore, Pearson correlations between MC use measures (dose, length and frequency of use, number of strains used, tetrahydrocannabinol/cannabidiol levels) and sleep problems were assessed among MC users.

Results: After adjustment for age, sex, pain level and use of sleep and anti-depressant medications, MC use was associated with less problems with waking up at night compared with non-MC use. No group differences were found for problems with falling asleep or waking up early without managing to fall back asleep. Frequent MC use was associated with more problems waking up at night and falling asleep.

Conclusions: MC use may have an overall positive effect on maintaining sleep throughout the night in chronic pain patients. At the same time, tolerance towards potential sleep-inducing properties of MC may occur with frequent use. More research based on randomised control trials and other longitudinal designs is warranted.

Keywords: chronic pain; insomnia; medical cannabis; sleep.

MeSH terms

  • Aged
  • Chronic Pain* / complications
  • Chronic Pain* / drug therapy
  • Cross-Sectional Studies
  • Drug Tolerance
  • Female
  • Humans
  • Male
  • Medical Marijuana* / therapeutic use
  • Middle Aged
  • Sleep Initiation and Maintenance Disorders* / drug therapy
  • Sleep Initiation and Maintenance Disorders* / etiology
  • Socioeconomic Factors


  • Medical Marijuana