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Close-up of pharmacist dispensing diazepam tablets into pill bottle (Photo by Universal Images Group via Getty Images)

health | 01.01.2022

The Low-Down on Prescription Pills vs. Cannabis as a Sleep Aid

People have longed used cannabis as a sleep aid. But is it actually a safer and better alternative to over-the-counter drugs?

Since as far back as the early 1970s, researchers have been investigating cannabis’ potential to alleviate sleeping problems. In the United States, according to Harvard Medical School, sleep disorders are among the most common medical conditions experienced in the country. And if you regularly miss out on a good night’s sleep, it can lead to a host of other medical problems ranging from weight gain and heart disease to a reduced life expectancy.

Roughly 50 to 70 million adults in the United States suffer from sleep problems, according to the American Sleep Association, the most common sleeping disorder being insomnia, which about 30 percent of U.S. adults will experience at some point in their lives. 

These types of sleeping disorders and their related symptoms are among the most common reasons Americans seek access to medical cannabisHowever, cannabis’ Schedule I status under the Controlled Substances Act has resulted in a scarcity of cannabis research and conflicting findings on how cannabis may best be used as a sleep aid, if at all.

One double-blind, placebo-controlled study from 2004, for example, found that 15 milligrams of THC appeared to act as a sedative, while 15 milligrams of cannabidiol (CBD) had the opposite effect by increasing wakefulness during sleep. However, a 2017 review of the scientific literature on cannabis’ effect on sleep suggests that CBD actually has the opposite effect, and may, in fact, offer therapeutic benefits for those afflicted with insomnia.

Another important potential effect of THC on sleep is its impact on the rapid-eye-movement stage of the sleep cycle or REM sleep. This stage of the sleep cycle is characterized by vivid dreams, a deeply sedated state, and is considered an important sleep-stage for memory consolidation. In 2008, one study found that THC leads to a reduction in REM sleep.

The impacts of reduced REM sleep have been debated, as, on the one hand, this sleep stage is important for the brain’s cognitive functioning, but on the other hand, reducing vivid dreams may be beneficial for certain patient populations.

Some research, for example, suggests that nightmares affect roughly 71 to 96 percent of those with PTSD. For this reason, some have suggested that cannabis could be a helpful sleep aid for those with PTSD who are haunted by vivid, traumatizing nightmares. But again, until more research is conducted, it remains uncertain whether this effect of THC on sleep is more useful or detrimental to the health of patient populations.

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Photo by Adriana Duduleanu/EyeEm/Getty Images

As cannabis becomes an increasingly popularized form of medicine—now available to roughly 95 percent of the U.S. population in some form, according to at least one report—researchers will almost certainly continue to explore cannabis’ potential effects on sleep, and whether it can be used as a sleep aid. And while current findings are mixed, some researchers still see cannabis as a better alternative to other popular sleep aid medications, like benzodiazepines.

Benzodiazepines are most commonly used to treat anxiety (many will likely recognize brand names like Xanax and Valium). These drugs are also frequently used as sleep aids for those with insomnia or other sleeping conditions. However, they come with a risk of overdose and addiction.

Research has shown that people who use benzodiazepines and other sleep-aid drugs in too large quantities or lengths of time can easily form dependencies. These drugs are especially dangerous because it can be difficult to identify when the use of these drugs turns into a dependency, which can manifest after only a few weeks. In the United States, one 2008 research paper found that 5.2 percent of U.S. adults (18 to 80 years old) used benzodiazepines. The study also found that these drugs are predominantly used by women.

Recently, Dr. Josh Kaplan, a professor of behavioral neuroscience at Western Washington University who specializes in medicinal cannabis, spoke at a pop-up panel on cannabis’ effects on sleep in Toronto for the cannabis company Dosist. As Kaplan tells Herb, cannabis can have therapeutic benefits for those with sleeping problems by helping to shut down the brain’s arousal system to allow for an easier transition into sleep as well as to help people stay asleep for longer. And while Kaplan has stated that more research is necessary, he also believes that cannabis can present a safer alternative to sleep aids like benzodiazepines.

“The problem with some of these other sleep-aids is that over time they’re not very well tolerated by the brain and body,” said Kaplan. They can negatively impact the liver and kidneys over time, he said, in comparison with cannabis, which people tend to tolerate “very well at all different age levels including the elderly.” 

That doesn’t mean there are no risks associated with cannabis use. Cannabis has been shown to have a small potential for addiction. But, for now, it appears this risk relative to the risks of more serious sleep-aids are negligible—and the benefits, potentially life-changing.

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