Sleep and Marijuana Products in 2020
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INSOMNIA AND PHARMACOTHERAPY (H ATTARIAN AND M KAY-STACEY, SECTION EDITORS)
Sleep and Marijuana Products in 2020 Lee Sullivan 1
&
John Winkelman 1
Accepted: 15 October 2020 # Springer Nature Switzerland AG 2020
Abstract Purpose of Review The growing availability, legality, and use of marijuana products in the USA has contributed to increased patient and clinician interest in the treatment of sleep disorders, especially insomnia and restless legs. What should clinicians know about these drugs and what should they tell patients that inquire about using them? Recent Findings Increasing numbers of studies are being published revealing clear subjective improvement of sleep-onset latency, subjective improvement of sleep disruptions, and subjective improvement of restless legs symptoms. However, objective findings are most often mixed, with some studies demonstrating improvement of sleep characteristics, and some demonstrating worsening. There is a trend for improvement in sleep with short-term use of marijuana products and a longer-term attenuation of effect, or possibly worsening. Summary Evidence for their effectiveness in these disorders is robust from subjective patient reports but limited or mixed in objective measures. Discussions with patients should be individualized and risks and benefits weighed. Future large, randomized, placebo-controlled studies are needed to help clarify the discrepancy between subjective and objective measures. Keywords Marijuana . Cannabis . Sleep . Insomnia . Restless legs
“Doctor, I’ve been having problems falling asleep for the last few months. Usually, it is worse when I’m stressed or had a busy day. A friend recommended marijuana gummies and they seem to be working. Do you have any advice about using them?” The growing availability and use of marijuana products have increased these types of questions to physicians regardless of specialty. While marijuana products have been used medicinally since the 1850s in the USA, decreased cultural stigma and increased legality have led to a dramatic increase in recent years, and it is estimated that 8–10% of adults use marijuana products in the USA, and even larger numbers of teenagers experiment with them [1]. As of 2020, all but 4 states in the USA have some program for medical marijuana. Recreational use is legal in 9 states and Canada. Many, especially southern states, limit products to cannabidiol This article is part of the Topical Collection on Insomnia and Pharmacotherapy * Lee Sullivan [email protected] 1
Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
(CBD) only, or with a limited quantity of tetrahydrocannabinol (THC). Federally, marijuana products continue to be classified as schedule I, meaning they have no recognized medical use [2]. Sleep disorders are highly prevalent, with OSA affecting up to 30% of males and 10% of females, insomnia complaints affecting up to 33% of the general population, and restless legs affecting as much as 19% of the population in some European countries [3]. Upon
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