In a model of maternal separation, sleep reduction has been related to the endocannabinoid system through the expression of CB1 in the prefrontal cortex and hypothalamus while oleamide improved sleep in adult rats (Reyes Prieto et al., 2012).
The administration of 2-AG restores sleep in the same model of maternal separation but not in wild type rats, proving the role of the endocannabinoid system in sleep processes (Pérez-Morales et al., 2014).
Activation of CB1 receptors in the endopeduncular nucleus can induce sleep while their blockade promotes insomnia-type symptoms in rats (Méndez-Díaz et al., 2013).
CB1 receptors mediated sleep effects caused by Anandamide in a rat model with in vivo microdialysis (Murillo-Rodriguez et al., 2003).
In a in vitro study, CBD, but not THC, was able to regulate genes responsible for the circadian rhythm in microglia and authors suggest that these findings are consistent to clinical observations of cannabis treating insomnia (Lafaye et al., 2019).
Anandamide may interact with oleamide processes to induce sleep.
CBD would act as an inhibitor of Anandamide uptake through TPRV1 receptor, suggesting a role in sleep (Bisogno et al., 2001; Mechoulam et al., 1997).
In a EEG experiment with rats, administration of a synthetic CB1 antagonist showed arousal-enhancing properties, suggesting again a role of the endocannabinoid system in sleep (Santucci et al., 1996).
Administration of a synthetic inhibitor of Anandamide uptake showed increased sleep in rats and enhanced c-Fos expression in sleep related brain areas (Murillo-Rodríguez et al., 2008).
Administration of THC in people with insomnia showed decreased time to fall asleep compared to controls (Cousens & DiMascio, 1973).
In a different study, administration of smoked cannabis containing THC also showed benefits to fall asleep and increased stage 4 sleep (Schierenbeck et al., 2008).
The effects of CBD in sleep appear to be related to a reduction of anxiety-induced REM sleep instead of sleep regulation processes (Hsiao et al., 2012).
Medical cannabis users have reported use of cannabis to treat multiple medical symptoms.
Symptoms with higher reports of cannabis use are pain, anxiety and insomnia (Walsh et al., 2013).
In two different studies, subjects with high scores of PTSD reported benefits of using cannabis to cope with PTSD-related insomnia (Bonn-Miller et al., 2010).
Nabiolone, a cannabinoid approved drug, showed also benefits to treat sleep problems related to PTSD (Cameron et al., 2014).
In a study focusing on sleep disorders and cannabis use, 81 participants reported use of cannabis to treat insomnia and 14 participants reported use of cannabis to reduce nightmares (Belendiuk et al., 2015).
A cannabinoid dependent study showed that subjects reported residual effects during daytime after the administration of THC before sleeping.
CBD would eliminate those residual effects but subjects reported sleepiness after CBD administration (Nicholson et al., 2004).
A review addressing cannabis properties to help sleep disorders concluded that CBD might help to treat insomnia (Babson et al., 2017).
A decrease in sales for over-the-counter sleep AIDS has been associated to the opening of recreational cannabis dispensaries in Colorado, suggesting that cannabis is somehow used to treat sleep problems (Doremus et al., 2019).
Patients who suffer chronic pain and use medical cannabis to manage their symptoms, reported less problems with waking up at night than non-users. However, frequent use of medical cannabis could also induce sleep problems (Sznitman et al., 2020)
In a case series report, participants reporting por sleep showed improvement on sleep scales during the first month of treatment with CBD (25mg before sleep time) (Shannon et al., 2019).
Rats showed increased NREM sleep during the first hour of sleep after vaporizing cannabis containing 23mg of THC (Mondino et al., 2019).
A 10 year old patient with PTSD showed an improvement on quantity and quality of sleep after CBD oral treatment (25mg/day) (Shannon & Opila-Lehman, 2016).
Two systematic reviews and metanalyisis on the efficacy of the treatment of insomnia using cannabinoids (100mg to 6000mg of either THC or CBD) concluded that there is not enough scientific evidence to lead to evidence-based practice. This is due to the heterogeneity of the studies done until the date (Bhagavan et al., 2020; Suraev et al., 2020).
A study including 409 participants suffering insomnia, were asked for their self-perceived insomnia before and after cannabis use using a mobile app. Results showed that both THC and CBD use reduce insomnia, being CBD the most effective (Vigil et al., 2018).
Patients of Multiple Sclerosis reported that CBD help them with their symptoms, including insomnia (Guarnaccia et al., 2021).
A study of self-perceived benefits of CBD use shows that 42% of the 387 participants used CBD (less than 50mg/day) to deal with sleep problems (Moltke & Hindocha, 2021).
For more information, please read a reviews on the topic by Gates et al. (2014) and Choi et al. (2020).
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