Cannabis and Sleep Apnea

By Admin

According to an American Academy of Sleep Medicine (AASM), “cannabis or synthetic marijuana extracts should not be used for the treatment of obstructive sleep apnea...due to unreliable delivery methods and insufficient evidence of treatment effectiveness, tolerability and safety.” The AASM is one of the leading sleep health organizations in the world, and its position on cannabis is a cautionary one which balances the potential risks of cannabis with perceived benefits not yet thoroughly examined. At the same time, some studies have shown improvements to sleep and reduction of sleep apnea symptoms among patients using cannabis and cannabinoid medicines. And cannabis continues to be a substance of choice for many patients experiencing sleep problems and sleep-related breathing disorders. While research in this area is still in its early stages, support for the medical use of cannabinoids is on the rise, both for sleep disorders and for other related conditions. In order to recognize the full benefits of these widely used substances, patients and their healthcare providers should have a thorough understanding of the primary cannabinoid compounds, their effects and possible side effects, and other potential risks in taking them.

The Statement

The AASM's position statement on cannabis drugs was published this year in the Journal of Clinical Sleep Medicine. In support of their recommendations against using cannabis drugs for sleep apnea, the authors emphasize that further research needs to be conducted in order to achieve a full understanding of the substance and its effects.

AASM President Dr. Ilene Rosen is quoted on the AASM website as saying, “Until there is sufficient scientific evidence of safety and efficacy, neither marijuana nor synthetic medical cannabis should be used for the treatment of sleep apnea.”

Rosen goes on to emphasize that effective treatments do exist for sleep apnea, including CPAP therapy, but there is no reference to cannabis as a complementary treatment alongside CPAP or for associated comorbidities. While it is true that effective and safe treatments for sleep apnea are currently available from licensed medical providers at accredited sleep facilities, it is also true that cannabis drugs may have benefits to sleep, sleep apnea, and related conditions that for some patients outweigh the perceived risks. While professional opinions may vary in this area, individuals with sleep apnea or other related sleep problems should always follow the recommendations of their primary healthcare provider.

CBD vs THC - Understanding the Cannabinoids

Cannabis refers to the cannabis plant, and is sometimes used as a blanket term for all cannabis derivatives (cannabinoids), whether synthetic or natural. The two primary compounds of cannabis, which are often extracted to produce cannabinoid drugs, are tetrahydrocannabinol (THC) and cannabidiol (CBD). Both compounds interact with the body’s natural endocannabinoid system via cannabinoid receptors in the body’s nerve cells, but they have very different effects. CBD, probably the most misunderstood of the two chemicals, does not cause euphoria or produce a high. While CBD does produce psychoactive effects, they are much more subtle, and its effects on the nervous system are more mild and gradual. This is why CBD is often used for anxiety or nervous system abnormalities such as seizures. THC, on the other hand, produces the high that marijuana is historically known for.

Medical Benefits

THC and CBD have many of the same medical benefits, but they also have very specific differences. Both are used to treat pain, nausea, and appetite problems, as well as anxiety and sleep disorders, though each compound has its own targeted symptoms. For example, THC is used for insomnia or severe sleeplessness, while CBD is used for sustained periods to help balance energy and sleep-wake cycles. CBD is also used to treat epilepsy and seizures. The compound’s antioxidant and anti-inflammatory effects are one of the reasons it is studied as a potential treatment for many conditions associated with inflammation, including diabetes, cardiovascular disease, and sleep apnea. In some clinics, it is regularly used to treat Inflammatory Bowel Disease, and Irritable Bowel Syndrome (IBS), among other conditions associated with digestion and the body’s immune system. As a more gradual, subtle drug, CBD is also used to target depression, post-traumatic stress disorder (PTSD), and other mood disorders, while THC is not recommended for these conditions. Traditionally, THC has been used to treat glaucoma due to its pressure-relieving effects on the eyes. Patients undergoing cancer treatment such as chemotherapy are sometimes prescribed THC specifically for help with nausea and appetite, as well as pain. Research continues on these many possible benefits, as well as the potential risks and other health considerations, of both THC and CBD.

Other Benefits

Another perceived benefit of cannabinoids has to do with patient preference and individualized treatments. Some patients prefer cannabis medicines to other options, particularly when it comes to pain or sedatives. More common pain medications such as opiate drugs can be problematic, and cannabis can be a milder alternative. The same can be said for conventional sleep medicines, which can have side effects that differ dramatically from cannabinoids.

Effects and Side Effects

The U.S. Food and Drug Administration lists the following physical and mental effects for each compound:

CBD

Changes in alertness, including possible fatigue
Gastrointestinal changes, including diarrhea or decreased appetite
Mood changes

Longer-term and higher doses:

In high doses, CBD can cause liver problems or injury.
Some studies have observed damage to fertility in male animal subjects exposed to CBD.
Some individuals experience weight loss with long-term use.

THC

Euphoria
Drowsiness
Increased heart rate
Increased appetite
Mood changes
Dry mouth
Reddening of the eyes
Slower reaction times

In some cases, the following can result:

Anxiety
Nausea and/or vomiting
Hallucinatory effects
Paranoia

Other Mental Effects

Long-term marijuana use has been linked to psychological problems, particularly in patients diagnosed with schizophrenia.
THC can also be harmful to young people, as the effects on the developing brain are not yet fully understood.
Some studies have identified risks for cognitive impairment, memory loss, and other mental problems associated with long-term and heavy use.

When Smoked

When smoked, cannabis can cause breathing problems similar to those caused by cigarettes. Marijuana smoke can irritate the lungs, and smoking large amounts or inhaling deeply can cause immediate coughing and damage to the lungs.

Uncertainties

Many effects of cannabis have not been studied enough to draw definitive conclusions, but In some cases, problems with child development during and after pregnancy have been observed.
It is also observed that THC and CBD have some contradictory effects, which suggests a form of balance between the two primary compounds.

Safety Issues

Use of cannabis products along with alcohol or other drugs, including those used to treat sleep disorders, can increase the risk of sedation, which can be dangerous to the patient and others.
Neither compound, it should be noted, is fatal from use alone, but with THC there are standard risks associated with sedative drugs. Anyone taking cannabis or THC should refrain from driving, using heavy machinery, or working in a dangerous environment.

Cannabis and Sleep

Like many drugs, the active compounds in cannabis—THC and CBD—can have different effects on different people, as the cannabis plant can produce many variations. This is why cannabis processors often isolate or dilute the compounds for more precise measurements of the chemicals. But generally, cannabis has a sedative effect that can help to induce sleep. This is mostly due to the THC, the psychoactive compound known for its euphoric effects. Strains of the plant that are high in THC are sometimes used for insomnia, while CBD can actually have the opposite effect, making people more alert or awake.

While cannabis drugs are known to have sedative effects, there are studies that have linked them to REM-sleep inhibition, meaning that important, deep stages of sleep may not be achieved as much or as long as they should be when taking cannabis drugs. As the AASM points out in their statement, these types of risks may in some cases outweigh the benefits in the long term. While most drugs have risks or potential side effects, those concerns can be exacerbated by limited knowledge.

According to the National Center for Complementary and Integrative Health (NCCIH), studies do show evidence of better sleep quality, fewer sleep disturbances, and decreased sleep latency in people taking cannabis drugs, but it is not always certain whether “the cannabis products affected sleep directly or whether people slept better because the symptoms of their illnesses had improved.” This is because many studies that observe the effects of cannabis on sleep are also focused on other illnesses. Thus, further research is needed to accurately determine the effects of cannabis on sleep alone, in the absence of other conditions. Furthermore, studies on the general effects of psychoactive drugs have identified alterations in sleep from the chronic use of any addictive substances, including cannabis. Chronic use, which is the regular intake of high or increasing doses of the drug, can have effects beyond those of acute or temporary use. In some cases, these effects can even be the opposite of the sedative effects mentioned above.

Despite the AASM Statement, several studies have supported the hypothesis that cannabis can alleviate the symptoms of sleep apnea, including a study published in the journal Sleep in 2002 that found that cannabis drugs could improve breathing patterns in rats. Follow-up studies have found similar effects in humans, decreasing apnea events by up to 30 percent or more. As a result, some medical institutions such as the Minnesota Department of Health now support the use of cannabis products for problems such as sleep apnea and other sleep disorders. And grants from the National Institute of Health continue to support research in this area.

While the AASM statement is a word of caution to those who wish to use cannabis products to treat sleep apnea, it is a subject of continuing research and increasing popularity, as a number of patients look to cannabis as a complementary aid, rather than an alternative to traditional sleep apnea treatments.

Legalities

The FDA has not approved the cannabis plant itself for medical use, but they have approved a number of cannabinoid drugs, including forms of both THC and CBD. At the same time, the FDA has ruled that cannabinoid substances cannot be sold as dietary supplements. Interstate commerce involving these substances is also prohibited, and federal law still considers marijuana a schedule-1 narcotic, in the same category as heroin, LSD, and ecstacy. While states are allowed to create their own laws and regulations concerning drugs, interstate selling or shipping of any product that includes a cannabis substance, including foods and medicines, is not allowed.

Current Cannabis Drugs Approved by the FDA:

Epidiolex - a CBD derivative from cannabis, was approved for the treatment of seizures caused by epilepsy.
Marinol and Syndros - also referred to as Dronabinol and Cesamet, each contains a synthetic form of THC and both are used to treat nausea and appetite loss caused by cancer treatments such as chemotherapy.

These drugs are approved by the FDA for specific conditions and are not yet federally approved for other uses mentioned above. While Dronabinol has shown benefits for conditions such as sleep apnea, it is not yet federally approved as a treatment for sleep apnea, and its effects on sleep-related breathing disorders continues to be a subject of ongoing medical research.

State Laws

At this time, the majority of American states (all but two: Nebraska and Idaho) have legalized some form of medical and/or recreational use of cannabis, though some conditions are very strict and limited to very specific uses. Every state has laws against children using cannabis products unless prescribed for a condition such as epilepsy. There are also different laws on quantities, transport, and home growing. In some states, only medical use and not recreational use is allowed, while in many states, new legislation on cannabis is under consideration.