Nadav Spiegelman

The Effects of Cannabinoids on Sleep
Bhanu Prakash Kolla
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Our comprehensive review of the effects of cannabis products on normal sleep and sleep disorders, relevant to primary care providers and other clinicians evaluating and treating patients who use these types of products, shows that cannabis products have minimal to no effects on sleep disorders and may have deleterious effects in some individuals
A total 818 abstracts were reviewed by authors BK and MPM
No funding was received for this work.
Sleep disturbances are a hallmark symptom of cannabis withdrawal. [31]( Sleep difficulty during attempts to discontinue use of cannabis is reported by 67% to 73% of adults.[5](,[32](,[33]( Furthermore, sleep difficulty has been consistently rated as one of the most severe symptoms of cannabis withdrawal. [34](
In humans, cannabis can result in an increase in stage 3 non-rapid eye movement or slow wave sleep (SWS), but this has not been shown in all studies as described below, and the effects on rapid eye movement (REM) sleep are variable.[4](,[5]( SWS and REM sleep are considered the deep stages of sleep. Some studies have shown a quicker onset to sleep, subjectively decreased insomnia and nightmares, and increased sleep quality, which appears to decline with chronic use.[5](,[24](,[37](
Sleep difficulties are commonly cited as a reason that people use medical cannabis. In 1 study, the sales of over the counter (OTC) sleep aids significantly fell once cannabis dispensaries opened in Colorado. [38]( However, the evidence supporting its use is weak. There is only 1 randomized controlled trial (RCT) conducted in otherwise healthy patients with insomnia by Cousens and DiMascio, [39]( and the remainder are observational studies. In the study by Cousens and DiMascio, [39]( THC resulted in a decrease in the sleep onset latency, but it was associated with a “hangover effect” the next morning. In addition, patients experienced temporal disorganization. [39](
In summary, it is challenging to know the effects of cannabis products on insomnia due to significant variations in cannabinoids that are currently available
similar to most previous reviews, our comprehensive review showed that there is little to no convincing evidence to show that cannabis products lead to significant or meaningful improvements in sleep disorders, including insomnia and RLS