Smack in the middle of the pandemic, I learned I had breast cancer. At 45, with no family history of cancer, it was a shock. I had delayed getting my yearly scans (because, COVID-19), and my GP basically saved my life by harassing me into making a mammogram appointment. Six months of panic, surgery, and radiation came next, followed by a medication that thrust me violently through early “medical” menopause like a car hitting a brick wall. And oh, the sleep-disrupting hot flashes…
All my life I had been a champion sleeper — even for an afternoon cat nap. But the hot flashes that were now my constant companion kept me miserably awake at night. The rotations of my top sheet and blanket and direct fan blast weren’t cutting it and I was in a sleep crisis — getting between one to three hours total a night (all while parenting, wife-ing, and working full time). My oncologist threw everything at the problem — from natural solutions like melatonin to heavy drugs like trazodone. Nothing worked.
At the tail end of a 10-day stretch of crisis-level insomnia, I was referred to a doctor whose specialty is helping cancer patients solve a myriad of issues that conventional pharmaceuticals could not. He suggested taking an edible, 5mg to start, an hour before bedtime. After one week we would increase it to 10mg. The morning after my first dose, after I slept peacefully and restfully for a full eight hours, I sat up and burst into tears. Relief from insomnia is a powerful thing.
But how does no one seem to know about this? And how exactly does it all work? In honor of National CBD Day, we talked to Dr. Jordan Tishler for the latest on cannabis and sleep.*
Meet the Experts
Dr. Jordan Tishler is faculty at Harvard Medical School, President of the Association of Cannabinoid Specialists, and CEO/CMO at inhaleMD.
*Ed note: Although this information in this article is vetted by an expert, it should not be used to treat a health problem, and you should seek advice from your licensed physician before making any changes to your health care.
Sunday Edit: First of all, what causes insomnia?
Dr. Tishler: The causes of insomnia vary, from anxiety to post-traumatic stress disorder to poor sleep environment to neurologic diseases like Parkinson’s. For most people, insomnia is benign but quite frustrating. In extreme cases, it can severely disable one’s waking life.
In treating insomnia, I find it more helpful to think about the type of insomnia: trouble getting to sleep, trouble staying asleep, or both. The approach to treatment varies with these types.
Sunday Edit: How can cannabis help when you can’t sleep?
Dr. Tishler: The primary medicine in cannabis that is helpful for insomnia is THC. While THC does cause intoxication, it also causes sleepiness. The exact neurologic mechanism isn’t known, but we don’t know much about what generally causes sleep.
Sunday Edit: What’s the difference between THC and CBD?
Dr. Tishler: Both are chemicals of the cannabinoid variety. They have slightly different structures, which lead to very different behavior. Overall, we have 70+ years of good research on THC and only about 10 years of pretty crappy research on CBD (except for children with rare genetic seizure disorders, where the data are pretty good).
In terms of insomnia, THC has good data and a lot of experience. CBD has no data, but lots of people say it works. The problem with that is that it falls prey to the Placebo Effect.
Sunday Edit: Why is cannabis sometimes preferred over Tylenol PM, melatonin, and other more traditional sleep aids?
Dr. Tishler: Some people focus on the fact that cannabis is a plant and therefore “natural” compared to pharmaceuticals. I’m not much moved by this logic. They’re all chemicals and do what they do — it doesn’t matter to me if they come from a plant [in the garden] or a [pharmaceutical] plant in New Jersey.
Some people have tried all of the conventional medications without success. Some find the side effects to be intolerable. For example, the “p.m. part” of Tylenol PM is an antihistamine that can cause dry mouth, grogginess, and difficulty with urination. Trazadone has a similar side effect profile. Melatonin is generally benign but can cause vivid or disturbing dreams for some folks.
Cannabis has its own side effects: intoxication, dry mouth, and occasionally elevated heart rate are most common. There’s no free lunch. Some people just find cannabis to be more effective and more tolerable than those other medicines.
As with all medications, side effects can be addressed by careful attention to dose and timing.
Sunday Edit: How should cannabis be taken? Orally, smoking, or vaping?
Dr. Tishler: The options that actually work are inhalation (not smoking, not vape pens, but an actual computer-controlled vaporizer) or oral (edible). However, contrary to popular belief, these methods cause different effects and must be chosen to best address the type of insomnia (as mentioned above), not by personal preference.
Sunday Edit: How will you feel the morning after?
Dr. Tishler: Ideally, awake and refreshed. If not, something is amiss, and your doctor should be able to help you fix the situation.
Sunday Edit: Does cannabis pair well with other medications?
Dr. Tishler: Yes, cannabis (THC dominant) can be used with other conventional medications. On the other hand, CBD can interact with a range of conventional medicines and poses some danger. In addition, CBD isn’t effective for sleep in general anyway, despite current marketing hype.
Sunday Edit: What should we be aware of legally?
Dr. Tishler: Currently, you can’t take cannabis out of your state legally. This especially includes any travel involving an airplane.
Even if you’re a medical patient, driving while intoxicated is illegal and unsafe. At least in the case of insomnia, this should not be an issue.
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