Chest. 2022 May 7:S0012-3692(22)00895-9. doi: 10.1016/j.chest.2022.04.151. Online ahead of print.
Sleep disturbances are often cited as a primary reason for medicinal cannabis use and there is increasing clinical interest in the therapeutic potential of cannabinoids in treating sleep disorders. Burgeoning evidence suggests a role of the endocannabinoid system in regulating the circadian sleep-wake cycle, highlighting a potential avenue for developing novel therapeutics. Despite widespread use of cannabis products as sleep aids globally, robustly designed studies verifying efficacy in sleep-disordered populations are limited. While some study outcomes have suggested cannabinoid utility in insomnia disorder and sleep apnea, most studies to date are limited by small sample sizes, lack of rigorously controlled study designs, and high risk of bias. This critical review summarises the current evidence for the use of cannabinoids as a treatment for sleep disorders, and provides an overview of endocannabinoid modulation of sleep-wake cycles, and the sleep-modulating effects of plant-derived cannabinoids such as Δ⁹-tetrahydrocannabinol (THC), cannabidiol (CBD), and cannabinol (CBN). The review also discusses practical considerations for clinicians regarding cannabinoid formulations, routes of administration, respiratory concerns, dosing, potential side effects, drug interactions, and effects relevant to driving, tolerance, and withdrawal. While current interest in, and uptake of, medicinal cannabis use for sleep disorders may have surpassed the evidence-base, there is a strong rationale for continued investigation into the therapeutic potential of cannabinoids.