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Medical Cannabis Can Improve Sleep and Combat Nightmares in PTSD, Study Finds

By Alexander Beadle

Published: Sep 27, 2022   
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Medical cannabis may help to prevent nightmares in individuals with post-traumatic stress disorder (PTSD), a new study suggests.

Available as a pre-proof in the Journal of Anxiety Disorders, the study followed the habits of 77 licensed medical cannabis patients and found that shorter time gaps between cannabis use and sleep onset were associated with a lower likelihood of nightmares. Individuals who used medical cannabis products higher in CBD content also reported fewer problems with early awakenings.

These findings provide an important basis for further research – particularly clinical trials – the researchers say.

Using cannabis before bed reduces chance of nightmares

Nightmares and other sleep disturbances are included in the DSM-5 diagnostic criteria for PTSD. Recent studies have indicated that PTSD patients with higher levels of sleep disturbances also tend to have more severe PTSD symptomology, suggesting that there may be some benefits to gain by addressing these sleep issues. As a result, many have reasoned that an effective treatment for sleep disturbances may have beneficial impacts on people with PTSD.

Research into cannabis and sleep is still at an early stage, though there are early findings that suggest that cancer patients given medical cannabis do experience some sleep benefits. Given the fact that people with PTSD often qualify for medical cannabis treatments in jurisdictions with a medical cannabis program, investigating the specific relationship between cannabis and sleep in people with PTSD is a particular subject of interest.

In this new observational study, a group of already licensed medical cannabis patients in Israel were asked to record information twice per day in an electronic diary about their previous night’s sleep and cannabis use habits. Specifically, the researchers were interested in the time elapsed between using medical cannabis and falling asleep, and how this might affect the number of awakenings reported throughout the night, waking up too early, and nightmares.

While the time elapsed between cannabis use and sleep was not found to be a significant factor affecting early waking or waking during the night, it was deemed to have a statistically significant effect on nightmares. From within-person analyses, the researchers found that an individual had lower odds of reporting nightmares when the gap between cannabis use and falling asleep was smaller.

High CBD products may improve sleep

Medical cannabis products in Israel are required to be clearly labeled with their THC/CBD concentrations. This allowed for patients to reliably report the THC and CBD concentrations of the specific products that they were using.

Generally, PTSD patients tend to use high-THC low-CBD medical cannabis products, which the researchers report was reflected in this study. However, the study also found that individuals who used products with higher CBD concentrations had lower odds of reporting unusually early awakenings than their peers.

Yet other studies have suggested that THC may be responsible for some of the improvements in self-reported sleep quality and nightmare frequency in PTSD patients. Pre-clinical trials have also shown that CBD can improve abnormal sleep behaviors in animal models of PTSD.

In light of their findings, the researchers say that further research into medical cannabis products and their effect on PTSD-related sleep outcomes is warranted. While it may be a challenge to run randomized clinical trials on account of issues with study blinding and finding PTSD patients who are completely naive to cannabis use, they say that preclinical and observational studies replicating and expanding upon these results would be welcomed. In particular, efforts to recruit cannabis-naive subjects and administer standardized doses may provide valuable results.

Cannabis and PTSD

While there are few detailed studies on how medical cannabis affects PTSD-related sleeping problems, broader research on medical cannabis and PTSD has returned some interesting results.

According to a recent app-based survey of 400 medical cannabis patients, medical cannabis use was enough to reduce the self-reported severity of PTSD symptoms by more than half.

Based on data from a 31-month period where the app was used more than 11,700 times to record cannabis use and current symptom load, app users reported a 62% reduction in intrusive thought severity, a 51% reduction in flashbacks, a 67% fall in irritability, and a 57% decline in the severity of anxiety.

Anecdotal support for cannabis and cannabinoids in treating PTSD is also strong. Speaking to Analytical Cannabis in 2017, retired US army colonel and private physician, Dr Philip Blair, said: “I’ve seen first-hand in my pre-clinical trials CBD's positive effects: reduced anger, reduced anxiety and jumpiness, reduced drug dependency, increase in quality of sleep, increased feelings of well-being and more.”

“From a medical perspective, there’s no doubt in my mind, CBD is a non-addictive, non-psychoactive, incredibly viable treatment for PTSD patients.”

However, despite these strong personal convictions, there remains a clear need for further rigorous research. A 2019 review by scientists at University College London also concluded that there is not yet enough adequate evidence to fully endorse the clinical use of cannabis for PTSD symptoms.

While the review did note the positive effects of cannabis on certain PTSD symptoms, including insomnia and nightmares, the studies identified in the review were generally assessed to have a medium-to-high risk of bias and were of comparatively low quality. Further research, especially the use of randomized controlled clinical trials, are highly warranted, they concluded.


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