ASK WELL
Is Cannabis Good or Bad for Sleep?
Here’s what the experts want you to know.
Credit...Joyce Lee for The New York Times
By
Hannah Seo
- Published March 7, 2023Updated June 20, 2023
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Q: I take forever to fall asleep and wake frequently throughout the night. I’ve heard cannabis can help — is that true?
Few things can throw off your day more than a night of bad sleep. Insufficient sleep can worsen mood, sap energy and has even been linked with a range of health issues including
dementia,
depression,
heart disease and
a weakened immune system.
Between 2013 and 2020, according to the Centers for Disease Control and Prevention,
more than a third of adults in the United States reported getting less than the recommended seven hours of sleep each night. And in 2020, a
Department of Health and Human Services study found, about 8 percent of adults reported that they regularly took sleep medications to help them fall or stay asleep. Some of those people,
studies suggest, may be smoking, vaping or consuming cannabis products such as marijuana to help with their sleep.
So we asked some experts, including cannabis and sleep researchers, a sleep psychologist and a cannabis pharmacist, to explain cannabis’s effects on sleep and how its various chemical compounds influence those effects.
Will cannabis help me sleep?
In a
survey published in 2022 of more than 27,000 medical marijuana users in the United States and Canada, nearly half cited sleep as a physical health reason for its use.
But it’s tricky to explain exactly how cannabis affects sleep because the studies that have been done are limited, and their results are often mixed, said Vyga Kaufmann, an assistant professor of psychology and neuroscience at the University of Colorado Boulder.
The two main active compounds in cannabis — tetrahydrocannabinol (or THC, which is largely responsible for getting people high) and cannabidiol (or CBD, which does not cause a high) — seem to affect sleep in different ways, said Cinnamon Bidwell, a clinical psychologist and assistant professor of cognitive science also at the University of Colorado Boulder.
For instance, limited studies have found that
low doses of THC can improve sleep and
high doses can worsen it, whereas
the inverse is true
of CBD. This makes studying cannabis and sleep challenging, Dr. Bidwell said — especially because different cannabis products may have varying ratios of the compounds.
That being said, researchers from
one review of 26 studies that was published in 2020 reported that there was “promising preliminary evidence” that cannabinoid therapies, including THC and CBD, should be investigated as possible treatments for sleep issues like insomnia, sleep apnea, restless legs syndrome and nightmares related to post-traumatic stress disorder.
Cannabis’s effects on sleep and sleepiness can also be influenced by how you take it, said Dr. Ashima Sahni, a pulmonologist and sleep specialist at the University of Illinois College of Medicine. Oral forms, like pills or edibles, will take longer to kick in than inhaled forms, she said, but their effects on sleep will last longer throughout the night. Inhaled cannabis, via vaping or smoking, will yield faster results, but they won’t last as long. Of course, Dr. Sahni added, vaping and smoking can come with certain health concerns including
damage to the lungs and
inflamed airways.
There is also some evidence that cannabis might indirectly help with sleep by alleviating
chronic pain and
anxiety — the
two top concerns motivating new patients to try medical cannabis, said Rahim Dhalla, a pharmacist specializing in medical cannabis in Ottawa, Canada, who has studied patient experiences with cannabis for sleep. Though research in this area is “limited” and “the data are kind of all over the place,” Dr. Kaufmann said.
What to consider before trying cannabis for sleep
In her clinical experience, Dr. Bidwell said that people who use cannabis products for sleep seem to be the most satisfied with them when they use them every now and then but not every day. This is because using THC too frequently can lead to a tolerance or dependency, she said, which can reverse the benefits of cannabis on sleep.
“As you start taking it more chronically, you fall into this trap that, for the same amount of effect, you have to go up in the quantity,” Dr. Sahni added. And eventually, you might get to a point where it doesn’t work at all.
At the same time, you might become so dependent on it that you have to keep taking it to stave off withdrawal symptoms. In such people with marijuana addictions, Dr. Bidwell said, stopping its use can result in symptoms like anxiety, irritability, nausea and even unsettling dreams that can disrupt sleep. “That’s one of the main reasons they go back to using it, or why they can’t fully quit,” she said, “because of how hard it is to sleep as part of that withdrawal.”
And some people who use too much THC can report a “
weed hangover” the next morning, which can include symptoms like fatigue, headache and dry eyes and mouth. Using CBD, however, does
not seem to lead to a tolerance or dependency.
In Dr. Kaufmann’s clinical experience, many of her patients want to try cannabis for sleep because they are wary of sleep medications. But she urges them to try
some lifestyle strategies first: such as going to bed and waking up at the same times every day, reducing screen-time before bed, cutting out afternoon caffeine, getting daily exercise and keeping your bedroom cool, clean and comfortable.
For her patients with insomnia, Dr. Kaufmann recommended trying cognitive behavioral therapy for insomnia, or CBT-I — a kind of talk therapy designed to help change the way you think about sleep. It’s “the gold standard intervention for insomnia that has the longest lasting effects,” she said, and patients usually aren’t even aware that it’s a possible treatment for them.
A major consideration for anyone curious about marijuana is that
it’s not legal everywhere in the United States. But even if you live in a state where it is legal, you should ask yourself some questions before trying cannabis for sleep, Dr. Dhalla said: Are you taking any medications that could possibly interact with it? (The
blood thinner warfarin and several epilepsy drugs are of particular concern with cannabis products.) Would you like something you can use everyday or only as needed? If you’re looking for an everyday sleep aid, he said, cannabis is not your best bet.
Dr. Bidwell said that if you’re set on trying it, start with the lowest dose possible to see how you react. Dr. Sahni also cautioned that because these products are poorly regulated, it’s difficult to know exactly what you’re getting and whether it’s safe.
The bottom line is that we need more research, Dr. Kaufmann said. We want people to feel satisfied with their sleep, she said — so if cannabis is working for you, great. But if you’ve never done it and you’re looking for help with sleep, it should not be the first thing you turn to.
Audio produced by Kate Winslett.
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