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Chapter 31 - Snoozing on Pot: Cannabis and Sleep

from Part VIII - Special Topics

Published online by Cambridge University Press:  12 May 2023

By
Patrick D. Skosnik  and
Toral S. Surti
Edited by
Deepak Cyril D'Souza ,
David Castle  and
Sir Robin Murray
Deepak Cyril D'Souza
Affiliation:
Staff Psychiatrist, VA Connecticut Healthcare System; Professor of Psychiatry, Yale University School of Medicine
David Castle
Affiliation:
University of Tasmania, Australia
Sir Robin Murray
Affiliation:
Honorary Consultant Psychiatrist, Psychosis Service at the South London and Maudsley NHS Trust; Professor of Psychiatric Research at the Institute of Psychiatry
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Summary

Sleep is a vital biological process, serving an important role in proper neurodevelopment, energy conservation, brain waste clearance, modulation of immune responses, neurocognition, mood, memory consolidation and performance/vigilance. Many of these processes are altered in psychiatric illnesses. There is mounting evidence that the endocannabinoid system (ECS) plays a key role in the sleep/wake cycle. Acute administration and chronic use of THC and cannabis have been shown to alter sleep in small studies of healthy, young people. Sleep disturbances are also part of cannabis withdrawal syndrome and include increased sleep complaints, decreased SWS and increased REM. Sleep disturbances are a promising target for treatment of cannabis use disorder. Given the link between cannabinoids and psychosis, the role of cannabis-induced sleep alterations in psychosis-prone individuals and schizophrenia patients warrants further study.

Keywords

cannabiscannabinoidsendocannabinoid systemtolerancewthdrawalsleepinsomniapolysomnographyslow wave sleeprapid eye movements
Type
Chapter
Information
Marijuana and Madness , pp. 333 - 345
Publisher: Cambridge University Press
Print publication year: 2023

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References

Albaugh, M. D., Ottino-Gonzalez, J., Sidwell, A., et al. (2021). Association of cannabis use during adolescence with neurodevelopment. JAMA Psychiatry, 78, 1031–1040.Google Scholar
Amiri, S., Hasani, J., and Satkin, M. (2021). Effect of exercise training on improving sleep disturbances: A systematic review and meta-analysis of randomized control trials. Sleep Med, 84, 205–218.Google Scholar
Anafi, R. C., Kayser, M. S., and Raizen, D. M. (2019). Exploring phylogeny to find the function of sleep. Nat Rev Neurosci, 20, 109–116.Google Scholar
Babson, K. A., Ramo, D. E., Baldini, L., et al. (2015). Mobile app-delivered cognitive behavioral therapy for insomnia: Feasibility and initial efficacy among veterans with cannabis use disorders. JMIR Res Protoc, 4, e87.Google Scholar
Barratt, E. S., Beaver, W., and White, R. (1974). The effects of marijuana on human sleep patterns. Biol Psychiatry, 8, 47–54.Google Scholar
Bassetti, C. L., Ferini‐Strambi, L., Brown, S., et al. (2015). Neurology and psychiatry: Waking up to opportunities of sleep: State of the art and clinical/research priorities for the next decade. Eur J Neurol, 22, 1337–1354.Google Scholar
Bolla, K. I., Lesage, S. R., Gamaldo, C. E., et al. (2008). Sleep disturbance in heavy marijuana users. Sleep, 31, 901–908.Google Scholar
Bolla, K. I., Lesage, S. R., Gamaldo, C. E., et al. (2010). Polysomnogram changes in marijuana users who report sleep disturbances during prior abstinence. Sleep Med, 11, 882–889.Google Scholar
Bonn-Miller, M. O., Boden, M. T., Bucossi, M. M., et al. (2014). Self-reported cannabis use characteristics, patterns and helpfulness among medical cannabis users. Am J Drug Alcohol Abuse, 40, 23–30.Google Scholar
Bootzin, R. R., and Stevens, S. J. (2005). Adolescents, substance abuse, and the treatment of insomnia and daytime sleepiness. Clin Psychol Rev, 25, 629–644.Google Scholar
Borgan, F., Kokkinou, M., and Howes, O. (2021). The cannabinoid CB1 receptor in schizophrenia. Biol Psychiatry Cogn Neurosci Neuroimaging, 6, 646–659.Google Scholar
Boys, A., Marsden, J., Griffiths, P., et al. (1999). Substance use among young people: The relationship between perceived functions and intentions. Addiction, 94, 1043–1050.Google Scholar
Boys, A., Marsden, J., and Strang, J. (2001). Understanding reasons for drug use amongst young people: A functional perspective. Health Educ Res, 16, 457–469.Google Scholar
Budney, A. J., Vandrey, R. G., Hughes, J. R., et al. (2007). Oral delta-9-tetrahydrocannabinol suppresses cannabis withdrawal symptoms. Drug Alcohol Depend, 86, 22–29.Google Scholar
Calik, M. W., and Carley, D. W. (2017). Effects of cannabinoid agonists and antagonists on sleep and breathing in Sprague-Dawley rats. Sleep, 40, zsx112.Google Scholar
Carley, D. W., Paviovic, S., Janelidze, M., et al. (2002). Functional role for cannabinoids in respiratory stability during sleep. Sleep, 25, 391–398.Google Scholar
Cazzullo, C. L., Fornari, M. G., Maffei, C., et al. (1977). Sleep, psychophysiological functioning and learning processes in schizophrenia. Act Nerv Super (Praha), 19, 409–417.Google Scholar
Chan, M. S., Chung, K. F., Yung, K. P., et al. (2017). Sleep in schizophrenia: A systematic review and meta-analysis of polysomnographic findings in case-control studies. Sleep Med Rev, 32, 69–84.Google Scholar
Chouinard, S., Poulin, J., Stip, E., et al. (2004). Sleep in untreated patients with schizophrenia: A meta-analysis. Schizophr Bull, 30, 957–967.Google Scholar
Christensen, H., Batterham, P. J., Gosling, J. A., et al. (2016). Effectiveness of an online insomnia program (SHUTi) for prevention of depressive episodes (the GoodNight Study): A randomised controlled trial. Lancet Psychiatry, 3, 333–341.Google Scholar
Cohen-Zion, M., Drummond, S. P., Padula, C. B., et al. (2009). Sleep architecture in adolescent marijuana and alcohol users during acute and extended abstinence. Addict Behav, 34, 976–979.Google Scholar
Cohrs, S. (2008). Sleep disturbances in patients with schizophrenia: Impact and effect of antipsychotics. CNS Drugs, 22, 939–962.Google Scholar
Cooper, Z. D., Foltin, R. W., Hart, C. L., et al. (2013). A human laboratory study investigating the effects of quetiapine on marijuana withdrawal and relapse in daily marijuana smokers. Addict Biol, 18, 993–1002.Google Scholar
Cousens, K., and DiMascio, A. (1973). (-) Delta 9 THC as an hypnotic. An experimental study of three dose levels. Psychopharmacologia, 33, 355–364.Google Scholar
D’Souza, D. C., Cortes-Briones, J., Creatura, G., et al. (2019). Efficacy and safety of a fatty acid amide hydrolase inhibitor (PF-04457845) in the treatment of cannabis withdrawal and dependence in men: A double-blind, placebo-controlled, parallel group, phase 2a single-site randomised controlled trial. Lancet Psychiatry, 6, 35–45.Google Scholar
D’Souza, D. C., Cortes-Briones, J. A., Ranganathan, M., et al. (2016). Rapid changes in CB1 receptor availability in cannabis dependent males after abstinence from cannabis. Biol Psychiatry Cogn Neurosci Neuroimaging, 1, 60–67.Google Scholar
Feinberg, I., Jones, R., Walker, J., et al. (1975). Effects of high dosage delta-9-tetrahydrocannabinol on sleep patterns in man. Clin Pharmacol Ther, 17, 458–466.Google Scholar
Feinberg, I., Jones, R., Walker, J., et al. (1976). Effects of marijuana extract and tetrahydrocannabinol on electroencephalographic sleep patterns. Clin Pharmacol Ther, 19, 782–794.Google Scholar
Freemon, F. R. (1972). Effects of marihuana on sleeping states. JAMA, 220, 1364–1365.Google Scholar
Freemon, F. R. (1982). The effect of chronically administered delta-9-tetrahydrocannabinol upon the polygraphically monitored sleep of normal volunteers. Drug Alcohol Depend, 10, 345–353.Google Scholar
Garani, R., Watts, J. J., and Mizrahi, R. (2021). Endocannabinoid system in psychotic and mood disorders, a review of human studies. Prog Neuropsychopharmacol Biol Psychiatry, 106, 110096.Google Scholar
Goonawardena, A. V., Plano, A., Robinson, L., et al. (2015). Modulation of food consumption and sleep–wake cycle in mice by the neutral CB1 antagonist ABD459. Behav Pharmacol, 26, 289–303.Google Scholar
Han, B. H., Sherman, S., Mauro, P. M., et al. (2017). Demographic trends among older cannabis users in the United States, 2006–13. Addiction, 112, 516–525.Google Scholar
Haney, M., Hart, C. L., Vosburg, S. K., et al. (2004). Marijuana withdrawal in humans: Effects of oral THC or divalproex. Neuropsychopharmacology, 29, 158–170.Google Scholar
Haney, M., Hart, C. L., Vosburg, S. K., et al. (2008). Effects of THC and lofexidine in a human laboratory model of marijuana withdrawal and relapse. Psychopharmacology (Berl), 197, 157–168.Google Scholar
Hart, C. L., Haney, M., Ward, A. S., et al. (2002). Effects of oral THC maintenance on smoked marijuana self-administration. Drug Alcohol Depend, 67, 301–309.Google Scholar
Herrmann, E. S., Cooper, Z. D., Bedi, G., et al. (2016). Effects of zolpidem alone and in combination with nabilone on cannabis withdrawal and a laboratory model of relapse in cannabis users. Psychopharmacology (Berl), 233, 2469–2478.Google Scholar
Hirvonen, J., Goodwin, R. S., Li, C. T., et al. (2012). Reversible and regionally selective downregulation of brain cannabinoid CB1 receptors in chronic daily cannabis smokers. Mol Psychiatry, 17, 642–649.Google Scholar
Hofstetter, J. R., Lysaker, P. H., and Mayeda, A. R. (2005). Quality of sleep in patients with schizophrenia is associated with quality of life and coping. BMC Psychiatry, 5, 13.Google Scholar
Hosko, M. J., Kochar, M. S., and Wang, R. I. (1973). Effects of orally administered delta-9-tetrahydrocannabinol in man. Clin Pharmacol Ther, 14, 344–352.Google Scholar
Huggins, J. P., Smart, T. S., Langman, S., et al. (2012). An efficient randomised, placebo-controlled clinical trial with the irreversible fatty acid amide hydrolase-1 inhibitor PF-04457845, which modulates endocannabinoids but fails to induce effective analgesia in patients with pain due to osteoarthritis of the knee. Pain, 153, 1837–1846.Google Scholar
Johnson, E. C., Demontis, D., Thorgeirsson, T. E., et al. (2020). A large-scale genome-wide association study meta-analysis of cannabis use disorder. Lancet Psychiatry, 7, 1032–1045.Google Scholar
Jones, S. G., and Benca, R. M. (2015). Circadian disruption in psychiatric disorders. Sleep Med Clin, 10, 481–493.Google Scholar
Karacan, I., Fernandez-Salas, A., Coggins, W. J., et al. (1976). Sleep electroencephalographic-electrooculographic characteristics of chronic marijuana users: Part I. Ann N Y Acad Sci, 282, 348–374.Google Scholar
Kesner, A. J., and Lovinger, D. M. (2020). Cannabinoids, endocannabinoids and sleep. Front Mol Neurosci, 13, 125.Google Scholar
Koffel, E., Bramoweth, A. D., and Ulmer, C. S. (2018). Increasing access to and utilization of cognitive behavioral therapy for insomnia (CBT-I): A narrative review. J Gen Intern Med, 33, 955–962.Google Scholar
Krystal, A. D. (2020). Sleep therapeutics and neuropsychiatric illness. Neuropsychopharmacology, 45, 166–175.Google Scholar
Krystal, A. D., Goforth, H. W., and Roth, T. (2008). Effects of antipsychotic medications on sleep in schizophrenia. Int Clin Psychopharmacol, 23, 150–160.Google Scholar
Li, G. L., Winter, H., Arends, R., et al. (2012). Assessment of the pharmacology and tolerability of PF-04457845, an irreversible inhibitor of fatty acid amide hydrolase-1, in healthy subjects. Br J Clin Pharmacol, 73, 706–716.Google Scholar
Li, S., Li, Z., Wu, Q., et al. (2021). Effect of exercise intervention on primary insomnia: A meta-analysis. J Sports Med Phys Fitness, 61, 857–866.Google Scholar
Li, S. X., Lam, S. P., Zhang, J., et al. (2016). Sleep disturbances and suicide risk in an 8-year longitudinal study of schizophrenia-spectrum disorders. Sleep, 39, 1275–1282.Google Scholar
Livne, O., Shmulewitz, D., Lev-Ran, S., et al. (2019). DSM-5 cannabis withdrawal syndrome: Demographic and clinical correlates in U.S. adults. Drug Alcohol Depend, 195, 170–177.Google Scholar
Lu, H. C., and Mackie, K. (2016). An introduction to the endogenous cannabinoid system. Biol Psychiatry, 79, 516–525.Google Scholar
Lunsford-Avery, J. R., Goncalves, B., Brietzke, E., et al. (2017). Adolescents at clinical-high risk for psychosis: Circadian rhythm disturbances predict worsened prognosis at 1-year follow-up. Schizophr Res, 189, 37–42.Google Scholar
Manoach, D. S., Cain, M. S., Vangel, M. G., et al. (2004). A failure of sleep-dependent procedural learning in chronic, medicated schizophrenia. Biol Psychiatry, 56, 951–956.Google Scholar
Manoach, D. S., Pan, J. Q., Purcell, S. M., et al. (2016). Reduced sleep spindles in schizophrenia: A treatable endophenotype that links risk genes to impaired cognition? Biol Psychiatry, 80, 599–608.Google Scholar
McCartney, D., Isik, A. D., Rooney, K., et al. (2021). The effect of daily aerobic cycling exercise on sleep quality during inpatient cannabis withdrawal: A randomised controlled trial. J Sleep Res, 30, e13211.Google Scholar
McPherson, K. L., Tomasi, D. G., Wang, G. J., et al. (2021). Cannabis affects cerebellar volume and sleep differently in men and women. Front Psychiatry, 12, 643193.Google Scholar
Mechoulam, R., Fride, E., Hanus, L., et al. (1997). Anandamide may mediate sleep induction. Nature, 389, 25–26.Google Scholar
Murillo-Rodriguez, E., Cabeza, R., Mendez-Diaz, M., et al. (2001). Anandamide-induced sleep is blocked by SR141716A, a CB1 receptor antagonist and by U73122, a phospholipase C inhibitor. Neuroreport, 12, 2131–2136.Google Scholar
Murillo-Rodriguez, E., Desarnaud, F., and Prospero-Garcia, O. (2006). Diurnal variation of arachidonoylethanolamine, palmitoylethanolamide and oleoylethanolamide in the brain of the rat. Life Sci, 79, 30–37.Google Scholar
Murillo-Rodriguez, E., Sanchez-Alavez, M., Navarro, L., et al. (1998). Anandamide modulates sleep and memory in rats. Brain Res, 812, 270–274.Google Scholar
Nicholson, A. N., Turner, C., Stone, B. M., et al. (2004). Effect of delta-9-tetrahydrocannabinol and cannabidiol on nocturnal sleep and early-morning behavior in young adults. J Clin Psychopharmacol, 24, 305–313.Google Scholar
O’Connell, K. S., Frei, O., Bahrami, S., et al. (2021). Characterizing the genetic overlap between psychiatric disorders and sleep-related phenotypes. Biol Psychiatry, 90, 621–631.Google Scholar
Pacek, L. R., Herrmann, E. S., Smith, M. T., et al. (2017). Sleep continuity, architecture and quality among treatment-seeking cannabis users: An in-home, unattended polysomnographic study. Exp Clin Psychopharmacol, 25, 295–302.Google Scholar
Pava, M. J., Makriyannis, A., and Lovinger, D. M. (2016). Endocannabinoid signaling regulates sleep stability. PLoS ONE, 11, e0152473.Google Scholar
Perez-Morales, M., de la Herran-Arita, A. K., Mendez-Diaz, M., et al. (2013). 2-AG into the lateral hypothalamus increases REM sleep and cFos expression in melanin concentrating hormone neurons in rats. Pharmacol Biochem Behav, 108, 1–7.Google Scholar
Piper, B. J., Dekeuster, R. M., Beals, M. L., et al. (2017). Substitution of medical cannabis for pharmaceutical agents for pain, anxiety, and sleep. J Psychopharmacol, 31, 569–575.Google Scholar
Pivik, R. T., Zarcone, V., Dement, W. C., et al. (1972). Delta-9-tetrahydrocannabinol and synhexl: Effects on human sleep patterns. Clin Pharmacol Ther, 13, 426–435.Google Scholar
Pranikoff, K., Karacan, I., Larson, E. A., et al. (1973). Effects of marijuana smoking on the sleep EEG. Preliminary studies. JFMA, 60, 28–31.Google Scholar
Qaseem, A., Kansagara, D., Forciea, M. A., et al. (2016). Management of chronic insomnia disorder in adults: A clinical practice guideline from the American College of Physicians. Ann Intern Med, 165, 125–133.Google Scholar
Ranganathan, M., Cortes-Briones, J., Radhakrishnan, R., et al. (2016). Reduced brain cannabinoid receptor availability in schizophrenia. Biol Psychiatry, 79, 997–1005.Google Scholar
Reeve, S., Sheaves, B., and Freeman, D. (2015). The role of sleep dysfunction in the occurrence of delusions and hallucinations: A systematic review. Clin Psychol Rev, 42, 96–115.Google Scholar
Ritsner, M., Kurs, R., Ponizovsky, A., et al. (2004). Perceived quality of life in schizophrenia: Relationships to sleep quality. Qual Life Res, 13, 783–791.Google Scholar
Robertson, I., Cheung, A., and Fan, X. (2019). Insomnia in patients with schizophrenia: Current understanding and treatment options. Prog Neuropsychopharmacol Biol Psychiatry, 92, 235–242.Google Scholar
Santucci, V., Storme, J. J., Soubrie, P., et al. (1996). Arousal-enhancing properties of the CB1 cannabinoid receptor antagonist SR 141716A in rats as assessed by electroencephalographic spectral and sleep–waking cycle analysis. Life Sci, 58, PL103–PL110.Google Scholar
Sateia, M. J., Buysee, D. J., Krystal, A. D., et al. (2017). Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults: An American Academy of Sleep Medicine Clinical Practice guideline. J Clin Sleep Med, 13, 307–349.Google Scholar
Schutte-Rodin, S., Broch, L., Buysse, D., et al. (2008). Clinical guideline for the evaluation and management of chronic insomnia in adults. J Clin Sleep Med, 4, 487–504.Google Scholar
Schwartz, M. D., and Kilduff, T. S. (2015). The neurobiology of sleep and wakefulness. Psychiatr Clin North Am, 38, 615–644.Google Scholar
Suchecki, D., Tiba, P. A., and Machado, R. B. (2012). REM sleep rebound as an adaptive response to stressful situations. Front Neurol, 3, 41.Google Scholar
Surti, T. S., Skosnik, P. D., Ranganathan, M., et al. (2018). Sleep-dependent perceptual learning in schizophrenia. 57th Annual Meeting of the American College of Neuropsychopharmacology, December 2018, Hollywood, FL.Google Scholar
Thomas-Brown, P. L., Martin, J. S., Sewell, C. A., et al. (2018). Risperidone provides better improvement of sleep disturbances than haloperidol therapy in schizophrenia patients with cannabis-positive urinalysis. Front Pharmacol, 9, 769.Google Scholar
Vandrey, R., Smith, M. T., McCann, U. D., et al. (2011). Sleep disturbance and the effects of extended-release zolpidem during cannabis withdrawal. Drug Alcohol Depend, 117, 38–44.Google Scholar
Vandrey, R., Stitzer, M. L., Mintzer, M. Z., et al. (2013). The dose effects of short-term dronabinol (oral THC) maintenance in daily cannabis users. Drug Alcohol Depend, 128, 64–70.Google Scholar
Vaughn, L. K., Denning, G., Stuhr, K. L., et al. (2010). Endocannabinoid signalling: Has it got rhythm? Br J Pharmacol, 160, 530–543.Google Scholar
Winiger, E. A., Ellingson, J. M., Morrison, C. L., et al. (2021). Sleep deficits and cannabis use behaviors: An analysis of shared genetics using linkage disequilibrium score regression and polygenic risk prediction. Sleep, 44, zsaa188.Google Scholar
Winiger, E. A., Huggett, S. B., Hatoum, A. S., et al. (2019). Onset of regular cannabis use and adult sleep duration: Genetic variation and the implications of a predictive relationship. Drug Alcohol Depend, 204, 107517.Google Scholar
Xiang, Y. T., Weng, Y. Z., Leung, C. M., et al. (2009). Prevalence and correlates of insomnia and its impact on quality of life in Chinese schizophrenia patients. Sleep, 32, 105–109.Google Scholar
Zachariae, R., Lyby, M. S., Ritterband, L. M., et al. (2016). Efficacy of internet-delivered cognitive-behavioral therapy for insomnia: A systematic review and meta-analysis of randomized controlled trials. Sleep Med Rev, 30, 1–10.Google Scholar
Zanini, M., Castro, J., Coelho, F. M., et al. (2013). Do sleep abnormalities and misaligned sleep/circadian rhythm patterns represent early clinical characteristics for developing psychosis in high risk populations? Neurosci Biobehav Rev, 37, 2631–2637.Google Scholar
Zielinski, M. R., McKenna, J. T., and McCarley, R. W. (2016). Functions and mechanisms of sleep. AIMS Neurosci, 3, 67–104.Google Scholar

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