Committee Blog: Redefining Sleep Therapy – The Role of Cannabis in Decreasing Dependence on Conventional Sleep Medications

Reviewed by NCIA’s Scientific Advisory Committee

Introduction

Insomnia affects nearly 30% of adults, leading many to rely on medications like benzodiazepines and sleep aids that can cause dependency and cognitive side effects. With growing interest in natural alternatives, cannabis has emerged as a potential option.

Cannabis contains compounds like THC and CBD, that interact with the brain’s endocannabinoid system-specifically CB1 receptors that play a role in regulating sleep and wake cycles. Low doses of THC may help with falling asleep and increasing deep sleep, while higher doses of CBD can reduce anxiety and promote relaxation. Lower THC:CBD ratios are typically recommended for insomnia.

While research is still emerging, real-world data is helping fill the gaps. Management Science Associates recently analyzed how cannabis use affected sleep medication use among patients with insomnia—offering new insights into its potential as a safer, more natural alternative.

Methods

This analysis included 81 adults aged 18 and over, diagnosed with insomnia disorders based on ICD-10 codes, who have purchased cannabis products through medical cannabis dispensaries in Minnesota from 2016 to 2022.

Using MSA’s patented HIPAA compliant de-identification technology, we linked each patient’s electronic health records (EHRs) with medical cannabis dispensary transaction records while protecting patient privacy. 

We investigated the trends of cannabis products use in patients with insomnia, according to demographics, and quantified changes in sleep medication use over time, using the Defined Daily Dose (DDD) established by the World Health Organization (WHO) to obtain a ratio that reflects the patient’s daily medication intake in a standard measure. We analyzed the differences in medication use before and after cannabis use, and describe the characteristics of patients who experienced a reduction in sleep medication use.

Results: Cannabis in Correlation with Insomnia 

1. Demographics: Most insomnia patients participating in our study fall within the middle-aged bracket. Almost 50% of the participants were aged 35-50 years, closely followed by 44.4% within the 51–64-year age group.
   
   
2. Product preference overall: Over half of the patients with insomnia (51%) preferred cannabis products with a THC ratio of 19:1.
3. Most patients with insomnia were using cannabis products in Vape, Tablets and capsule forms.
4. Reduction in Sleep Medication use of 27%: The average DDD Ratio of Sleep Medications before cannabis use was 2.38, and after starting using Cannabis it was 1.75. The percentage reduction in DDD ratio from Before to After:  26.7%
5. Reductions in Sleep Medication Usage Observed Post-Cannabis Use Across Age GroupsPatients using cannabis experienced notable decreases in sleep medication use, with the most substantial improvements seen in individuals aged 50 and older. Specifically, in those over 65 years old we observed a 60% reduction. Meanwhile, the 51-64 age group showed a 39% reduction, and those aged 35-50 observed a 25% decrease in sleep medication prescriptions. Patients 35-50 years old were using higher doses of Sleep medications than other age groups.  Patients over 65 years old exhibited a more pronounced reduction in DDD ratios compared to other age groups, this suggests that older patients might benefit more significantly from cannabis use in terms of reducing their sleep medication intake.
6. Reduction by Type of sleep medication: In our analysis, we observed a significant reduction in the use of various sleep medications among patients who began using cannabis, with benzodiazepines showing a particularly notable decrease of approximately 50% of the daily dose. The group of patients that experienced a reduction of sleep medication during cannabis use were mostly using Benzodiazepines, among which the most used were Alprazolam, Lorazepam, Diazepam, and Clonazepam. Benzodiazepines are well-known for their efficacy in treating insomnia but come with risks such as tolerance, dependence, and withdrawal symptoms. The use of benzodiazepines after starting cannabis decreased by 50.17%, highlighting cannabis’s potential as a viable alternative or supplement to traditional sleep medication regimens. The substantial reductions observed here suggest that cannabis might serve as an effective alternative or adjunct therapy, potentially helping to mitigate these risks.
   
7. Reduction by THC:CBD ratio: Although most patients with insomnia in this study were using cannabis products with a ratio of 19:1, the THC:CBD ratios that were most effective to reduce sleep medication use were 4:1, 20:1, and 1:1.
8. Milligrams of THC: Cannabis products with higher amount of mg of THC were correlated with higher daily dose of sleep medications. This supports previous literature about the effect of THC on insomnia, where lower contents of THC being most effective to alleviate insomnia are reported. 
9. Product Form and Reduction of Sleep Medication: Patients who were using cannabis in capsules experienced the most reduction in sleep medication use. Capsules can have a higher bioavailability, meaning more cannabis enters the bloodstream compared to tablets, which could make them more effective. Gummies were most used by patients using high dosages of sleep medications at baseline.

Conclusion

These preliminary findings suggest that cannabis has the potential to reduce the use of traditional sleep medications, particularly among older adults. The preference for specific forms of cannabis in patients using high doses of sleep medications, and the use of capsules in patients who reduced its use, highlight important considerations for patient preferences and adherence. As we continue this research, we aim to further elucidate the mechanisms behind these trends and refine our understanding of how cannabis can be optimized for managing insomnia and sleep disturbances.

Discussion

Our results from this exploratory analysis suggest medical cannabis could reduce the reliance on traditional sleep medications among patients with insomnia. This finding is particularly important given the adverse effects associated with long-term use of conventional sleep aids, such as tolerance, dependence, and cognitive impairment, especially in older adults. The observed reductions in sleep medication use across various age groups underscore the potential of cannabis as an effective alternative to manage insomnia symptoms. Further research is needed to find the significance of these associations among different age cohorts. Notably, the most substantial reductions were seen in patients over 65 years old, indicating that older adults might benefit the most from cannabis therapy in terms of decreasing their sleep medication intake.

The varying impact of different THC:CBD ratios in reducing sleep medication use highlights the importance of personalized medicine. Ratios like 4:1 and 1:1 were particularly effective, suggesting that specific cannabinoid profiles may better address the symptoms of insomnia in certain populations. This aligns with previous research indicating that both THC and CBD play distinct roles in modulating sleep, with THC primarily influencing sleep latency and duration, and CBD offering anxiolytic and sedative effects at higher doses.

Furthermore, the preference for certain cannabis product forms, such as capsules, in patients who reduced sleep medication use, points to the need for considering product bioavailability in treatment plans. The higher bioavailability of capsules compared to other forms like tablets may lead to more effective symptom relief, thereby reducing the need for conventional medications. This aspect of cannabis therapy could be crucial for optimizing treatment outcomes and enhancing patient adherence. These findings support previous studies about the potential of cannabis as a valuable tool in managing insomnia and call for further research to understand the mechanisms underlying these effects.

Next Steps

Longitudinal studies in large and diverse populations are essential to evaluate the long-term safety and effectiveness of cannabis, particularly in terms of dependency, cognitive function, and overall sleep quality. The development of comprehensive clinical guidelines informed by high-quality evidence will be crucial in integrating cannabis into insomnia treatment safely and effectively. By continuing to explore these avenues, we aim to refine our understanding of cannabis’s role in sleep therapy, ultimately providing more tailored treatment options for patients suffering from insomnia.

If you are interested in learning more or getting involved with MSA by being a prominent leader in cannabis research, we’d love to hear from you. Additionally, as a cannabis operator, you’d receive valuable insights into your cannabis business. You can reach out to Madeline Grant at mgrant@msa.com to schedule an introductory call. 

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