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New study reports an unusual side effect of cannabis

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Side effects were even more pronounced among heavy users (20 out of preceding 30 days)

Cannabis use in North America continues to rise, with over 45 million adults in the United States reporting use in 2019, more than twice the figure reported in the early 2000s.

According to the researchers, this shift has been fueled in part by growing legalization in many states over the last decade, as well as research indicating that cannabinoids may have the medicinal potential for pain treatment, as well as anxiety and sleep issues.

Cannabis has grown in popularity as a sleep aid, particularly since sleep deprivation and insomnia have become more common. Only around two-thirds of Americans receive the recommended 7-9 hours of sleep per night, and nearly half experience daytime tiredness on a daily basis.

However, the evidence on the effect of cannabis on the sleep-wake cycle has been inconclusive thus far.

The study attempted to see whether cannabis use was associated with nightly sleep duration in a nationally representative sample of US individuals (aged 20-59) who participated in the biennial National Health and Nutrition Examination Survey (NHANES) from 2005 to 2018.

They also wanted to know if respondents had difficulties falling asleep, staying asleep, or sleeping too much in the previous two weeks; if they had ever seen a doctor about a sleep problem; and if they had experienced daytime sleepiness on at least five of the previous 30 days.

Volunteers were grouped as recent or non-users if they had or hadn’t used cannabis in the last 30 days. Bedtime time was classified as either too short (less than six hours) or too lengthy (six to nine hours) (more than 9 hours).

Age, race, educational attainment, weekly working hours, a history of high blood pressure, diabetes, and coronary artery disease; weight (BMI); smoking; heavy alcohol use (4 or more drinks daily); and prescriptions for opioids, benzodiazepines, ‘Z drugs’ (approved for insomnia), barbiturates, other sedatives, and stimulants were all gathered as potential influencing factors.

Between 2005 and 2018, 25,348 participants replied to the questionnaires, however, the final analysis is based on 21,729 people who answered all of the questions, representing an estimated 146.5 million adults in the United States.

Over the course of the study, the average nightly sleep duration was little under 7 hours. Only 12% of people slept less than 6 hours every night, while 4% slept more than 9 hours.

In the last 30 days, 3132 (14.5 percent) of respondents claimed they had used cannabis. Recent users were more likely to say they didn’t get enough sleep or slept too much.

After controlling for potentially important factors, they were 34% more likely to report short sleep and 56% more likely to report long sleep than those who hadn’t used cannabis in the previous 30 days.

They were also 31% more likely in the previous two weeks to have had trouble falling asleep, staying asleep, or sleeping too much, and 29 percent more likely to have discussed a sleeping problem with a doctor. However, recent cannabis usage was not linked to excessive daytime sleepiness.

Further examination of cannabis usage frequency found that moderate users, defined as those who used less than 20 times in the previous 30 days, were 47 percent more likely than non-users to sleep 9 or more hours each night.

Heavy users, defined as those who used 20 or more times in the previous 30 days, were 64 percent more likely than non-users to have short sleep and 76 percent more likely to have extended sleep.

The results didn’t vary much between survey years.

This is observational research, thus it can’t prove the main cause or, for that matter, reverse causality.

The researchers also note to a number of study limitations, including as the reliance on self-reported data and the lack of information on cannabis dose. They speculate that the historical and present stigma associated with cannabis use may have influenced respondents’ replies to questions about cannabis use.

But they write: “Increasing prevalence of both cannabis use and sleep deprivation in the population is a potential cause for concern.

“Despite the current literature demonstrating mixed effects of cannabis and various cannabinoid formulations on sleep architecture and quality, these agents are being increasingly used as both prescribed and unprescribed experimental therapies for sleep disturbances.”

They further add: “Our findings highlight the need to further characterize the sleep health of regular cannabis users in the population…Sleep-wake physiology and regulation is complex and research about related endocannabinoid pathways is in its early stages.”

Source: 10.1136/rapm-2021-103161I 

Image Credit: Getty

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