Can Medical Marijuana Help with Sleep?

Can Medical Marijuana help you sleep?

A patient called the other day and asked me to prescribe medical marijuana to help her sleep. She had heard that it would help her sleep better. She's in her 50's, has 2 kids, works full time and says that she only used marijuana in college a few times. After this jaw dropping request, I stopped and asked a few more questions, because more information was needed to help solve this her issue.

Marijuana helps with Pain

I'm not a sleep or pain specialist and so I needed to know what was going on before making a recommendation. I'm learning more about cannabinoid receptors and the effect of medical marijuana on neuropathic pain,  and especially to treat the pain that results from Multiple Sclerosis. Neuropathic pain is often described as the burning and searing pain deep inside the tissues that arises from nerve irritation and inflammation.

Some varieties of marijuana contain specific canabinoids that have been shown in very well controlled research to help with these burning, searing, raw kinds of pain that many people suffer not only with conditions such as Multiple Sclerosis, but also from cancers, amputations, diabetic foot ulcers and others. 

For people who have nerve pain (neuropathic pain), medical marijuana might make sense to help them get to sleep.  However, research has also shown that while medical marijuana can help people get to sleep, it might not be the best option for improving REM sleep and helping people stay asleep for more than 4 hours and feel well rested the next day. 

We know that many people find that they're able to relax, turn off their over active brains and sleep after using marijuana. This might be the answer for this patient if she's having pain, but I still needed more information before making a recommendation.

Night time waking

Turns out, she has no problem falling asleep, but does wake up at about 4-5 am and can't get back to sleep for about 1 hour. When she's frustrated with tossing and turning, she gets up and watches TV, mostly the shopping networks, then she orders something that she doesn't need. When I asked her if her mind races when she wakes up, she said yes because she worries about money all the time. There were other things that came up, she had no pain, no chronic illnesses.

Her hot flashes and night sweats had improved by using an estrogen patch that I prescribed a few months back. Instead of 6 night sweats that were causing her sleep disturbances, now it was 1 every few days. But now, the waking couldn't be blamed on night sweats. Puzzling....Time for more CSI detective work.

Then I asked about sleep routines, what she does before bed, where she sleeps, who sleeps with her, noise, distractions, waking to go to the bathroom, husband snoring, and that's when she said that her husband doesn't sleep with her anymore because her snoring is so loud. Aha! Now, we're getting somewhere. She needed a thorough sleep evaluation. I'm lucky, because I can refer my patients to the Sleep Program at El Camino Hospital.

Avoid self diagnosis and self-prescribing 

I recommended that this patient not skip ahead and use hopeful trial and error to correct what turned out to be a long-standing sleep issue, but instead to have a thorough and complete sleep assessment. Sleep is such a multi-faceted event that each of us engage in for hours every day, that it's important to look at all the different aspects that influence falling and staying asleep. This patient's history was significant, yes, she would need a sleep study and she would also need to also be evaluated for the chronic allergies that might be causing swelling in her nasal and sinus passages? Could money worries from middle of the night shopping excursions be making this worse? There were many factors influencing her sleep.

 Sleeplessness is a Serious Issue

• An estimated 95 percent of Americans with chronic sleep issues go undiagnosed
• According to the National Highway Traffic Safety Administration, drowsy driving is a factor in more than 100,000 crashes, resulting in 1,550 deaths and 40,000 injuries annually
• Over a period of four years, obstructive sleep apnea increases a person’s risk of having a heart attack or dying by 30 percent
• 30-50 percent of people with heart disease and 60 percent of stroke patients have obstructive sleep apnea

What's recommended

When it comes to a sleep evaluation, do have thorough evaluation. Find a center that doesn't just do a sleep study and then tosses you a CPAP machine that sits in your closet collecting dust. You may not need a CPAP machine, but if you do, then make sure that you know how to use it, that it's comfortable and that you're feeling better and more rested when you wake up.

Do have a thorough evaluation by a sleep specialist.  If you're not sure where to start, I like this video from Dr. Tony Masri, that explains the Sleep Program at El Camino Hospital. 

My patient's progress

I sent her for a thorough evaluation and she's awaiting a sleep study. Will she get medical marijuana?  Good Question. I don't know, but what I do know is that when it comes to sleep, do have thorough evaluation so that you can get to the root of the issue or issues and solve them.

Disclosure: I'm working with El Camino Hospital in Mt. View, California, the heart of Silicon Valley to help increase awareness of the programs and innovations that they provide.