Cannabinoids, Insomnia, and Other Sleep Disorders

Isobel Lavender; Iain S McGregor; Anastasia Suraev; Ronald R Grunstein; Camilla M Hoyos

doi:10.1016/j.chest.2022.04.151

Cannabinoids, Insomnia, and Other Sleep Disorders

Chest. 2022 Aug;162(2):452-465. doi: 10.1016/j.chest.2022.04.151. Epub 2022 May 7.

Authors

Isobel Lavender¹, Iain S McGregor², Anastasia Suraev¹, Ronald R Grunstein³, Camilla M Hoyos⁴

Affiliations

¹ Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia; Faculty of Science, School of Psychology, University of Sydney, Sydney, NSW, Australia; Lambert Initiative for Cannabinoid Therapeutics, University of Sydney, Sydney, NSW, Australia; Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia.
² Faculty of Science, School of Psychology, University of Sydney, Sydney, NSW, Australia; Lambert Initiative for Cannabinoid Therapeutics, University of Sydney, Sydney, NSW, Australia; Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia.
³ Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Royal Prince Alfred Hospital, Sydney, NSW, Australia.
⁴ Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia; Faculty of Science, School of Psychology, University of Sydney, Sydney, NSW, Australia; Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia. Electronic address: camilla.hoyos@sydney.edu.au.

PMID: 35537535
DOI: 10.1016/j.chest.2022.04.151

Abstract

Sleep disturbances are often cited as a primary reason for medicinal cannabis use, and there is increasing clinical interest in the therapeutic potential of cannabinoids in treating sleep disorders. Burgeoning evidence suggests a role of the endocannabinoid system in regulating the circadian sleep-wake cycle, highlighting a potential avenue for developing novel therapeutics. Despite widespread use of cannabis products as sleep aids globally, robustly designed studies verifying efficacy in sleep-disordered populations are limited. Although some study outcomes have suggested cannabinoid utility in insomnia disorder and sleep apnea, most studies to date are limited by small sample sizes, lack of rigorously controlled study designs, and high risk of bias. This critical review summarizes the current evidence for the use of cannabinoids as a treatment for sleep disorders and provides an overview of endocannabinoid modulation of sleep-wake cycles, as well as the sleep-modulating effects of plant-derived cannabinoids such as delta-9-tetrahydrocannbinol, cannabidiol, and cannabinol. The review also discusses practical considerations for clinicians regarding cannabinoid formulations, routes of administration, respiratory concerns, dosing, potential side effects, drug interactions, and effects relevant to driving, tolerance, and withdrawal. Although current interest in, and uptake of, medicinal cannabis use for sleep disorders may have surpassed the evidence base, there is a strong rationale for continued investigation into the therapeutic potential of cannabinoids.

Keywords: cannabidiol; cannabinol; medicinal cannabis; sleep disorders; tetrahydrocannabinol.

Publication types

Review
Research Support, Non-U.S. Gov't

MeSH terms

Cannabinoids* / pharmacology
Cannabinoids* / therapeutic use
Cannabis*
Endocannabinoids / pharmacology
Humans
Medical Marijuana* / pharmacology
Medical Marijuana* / therapeutic use
Sleep
Sleep Initiation and Maintenance Disorders* / drug therapy

Substances

Cannabinoids
Endocannabinoids
Medical Marijuana