Category Archives: Insomnia

Medicinal use of non-prescribed cannabis: a cross-sectional survey on patterns of use, motives for use, and treatment access in the Netherlands

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“Background: Despite the Netherlands having one of the world’s oldest medical cannabis programs, the majority of people who use cannabis for medicinal purposes continue to rely on non-prescribed sources. This study investigates patterns of use, motives for use, perceived effectiveness, and barriers to accessing prescribed cannabis among individuals self-medicating with non-prescribed cannabis.

Methods: A cross-sectional online survey was conducted between January and April 2023, using convenience sampling primarily via social media. Participants (N = 1059) were adults (18 years or older) residing in the Netherlands who self-reported current use of non-prescribed cannabis-based products to manage physical or mental health symptoms.

Results: Cannabis was used to manage a wide range of conditions, most commonly chronic pain, sleep disorders, depression, and ADHD/ADD, with three out of four participants reporting use for multiple conditions. Most participants obtained cannabis from coffeeshops, although one in four also reported home cultivation as a source. Participants typically smoked cannabis with tobacco, reported (near-)daily use for therapeutic purposes, and indicated a monthly expenditure of €100. The majority was not aware of the THC and CBD content of their products. Perceived effectiveness was rated as high, and more than half of those with a history of prescription medication use reported substituting cannabis for these medications. Only a minority of participants had ever used, or were currently using, prescribed cannabis. Commonly cited barriers included perceived lower quality, higher cost, and lower ease of access compared with non-prescribed cannabis.

Conclusions: The widespread use of non-prescribed cannabis for medicinal purposes in the Netherlands reflects both unmet health needs and barriers within the regulated medical cannabis system. Risky use practices – such as smoking cannabis with tobacco and using products without knowing their cannabinoid content – raise public health concerns. The findings highlight the need for harm reduction strategies and policies that better align medical cannabis regulation with patients’ real-world behaviours and care needs.”

https://pubmed.ncbi.nlm.nih.gov/41331499

https://link.springer.com/article/10.1186/s42238-025-00355-y

Cannabis Use in Central Disorders of Hypersomnolence in the Netherlands

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“Introduction: The endocannabinoid system plays a role in sleep-wake regulation. In clinical practice, people with central disorders of hypersomnolence (CDH) frequently report use of cannabis.

Methods: We compared lifetime and current use of cannabis of people with CDH to the Dutch general population. Additionally, we assessed cannabis use in relation to hypersomnolence symptoms.

Results: In total, 76 (out of 88) patients completed the online questionnaire. Lifetime cannabis use (42% vs. 23%, p < 0.001) and current use (18% vs. 4%, p < 0.001) were higher in people with CDH compared to the Dutch general population. For 57% of patients currently using cannabis, improvements of at least one CDH symptom were the motivation for use. Additionally, 79% of current cannabis users reported cannabis-related effects on a symptom, which were mostly positive (43%), some negative (7%), or mixed effects (29%). Patients that stopped using mostly started using cannabis before symptom onset and for recreational purposes. The most reported reasons to stop using were disadvantages of using or changes in the social environment.

Conclusion: This study provides a rationale for future research on the potential benefits of cannabis in CDH.”

https://pubmed.ncbi.nlm.nih.gov/41321442

https://karger.com/mca/article/8/1/181/935204/Cannabis-Use-in-Central-Disorders-of

Full Spectrum Cannabis Oil for the treatment of chronic pain and sleep dysfunction in myofascial temporomandibular disorder: a case report

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“Medicinal cannabis has been the subject of extensive research, with recent studies demonstrating its potential in managing chronic pain and enhancing quality of life.

This case report examines the use of medicinal cannabis in a patient treated at the School of Dentistry of Araçatuba (FOA-UNESP). The patient, a 28-year-old female with no comorbidities, presented with chronic muscular TMD and reported poor sleep quality. Full-spectrum cannabis oil (1:1 ratio of THC to CBD), was prescribed for a period of 60 days, with a maximum dosage of 10 drops per day. Pain intensity was measured using the Visual Analog Scale (VAS), while sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Evaluations were conducted at three intervals: baseline, day 30, and day 60. To ensure patient safety, pre- and post-treatment blood tests were performed, and dosage adjustments were made every three days under the supervision of the study’s medical team.

The results revealed significant improvements in pain management, with the patient’s orofacial pain score decreasing from 7 to 3 on the NRS. Additionally, sleep quality improved, as reflected by a lower PSQI score (global sleep quality at level 6 at the end), indicating more restorative sleep. Throughout the treatment period, the patient experienced mild side effects, including drowsiness and gastrointestinal discomfort, which were effectively managed through dosage modifications.

In conclusion, full-spectrum cannabis oil shows promise as a therapeutic strategy for managing orofacial pain and improving sleep quality, providing significant relief in conditions where other interventions are ineffective or poorly tolerated. Further research is warranted to better understand the therapeutic mechanisms and potential side effects of medicinal cannabis in the management of chronic pain and related conditions.”

https://pubmed.ncbi.nlm.nih.gov/41092177/

“In conclusion, the use of Full Spectrum Cannabis Oil in this case was associated with a clinically meaningful reduction in chronic orofacial pain and improvement in sleep quality, with no adverse effects or laboratory abnormalities observed during the treatment period. These outcomes suggest that individualized cannabinoid-based therapy may be a safe and effective approach for selected patients with temporomandibular disorders and comorbid sleep disturbances.”

https://www.scielo.br/j/bjb/a/bK69ZBYPSB4dJ9yqcFxSzcf/?lang=en

Effectiveness of cannabinoids on subjective sleep quality in people with and without insomnia or poor sleep: A systematic review and meta-analysis of randomised studies

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“Study objectives: This systematic review and meta-analysis assessed the efficacy of cannabinoids compared to placebo for improving sleep quality.

Methods: Searches were conducted in MEDLINE, Embase, and Cochrane databases for randomised controlled trials comparing cannabinoids vs. placebo for improving sleep quality in adults with or without insomnia or poor sleep. The primary outcome was self-reported sleep quality (PROMIS, PSQI, LSEQ, Sleep Diary). Secondary outcomes included actigraphy parameters, anxiety (GAD-7, STAI-T), well-being (WHO-5 index), and insomnia severity (ISI). Additional analyses focused on sleep quality in (1) participants with insomnia or poor sleep, and (2) cannabidiol (CBD) vs. non-CBD interventions. Statistical analysis was performed using RevMan 5.4.1, with p < 0.05 considered significant.

Results: Six trials (1077 patients) were included. Cannabinoids significantly improved sleep quality compared to placebo [SMD 0.53; 95 % CI 0.03-1.02; p = 0.04; I2 = 88 %], particularly in those with insomnia or poor sleep [SMD 0.60; 95 % CI 0.09-1.11; p = 0.02; I2 = 89 %]. Non-CBD cannabinoids demonstrated greater efficacy [SMD 0.82; 95 % CI 0.24-1.40; p = 0.005], whereas CBD-only therapies showed no significant effect [SMD 0.13; 95 % CI -0.38-0.65; p = 0.61].

Conclusion: Cannabinoids, particularly non-CBD formulations, improve sleep quality, justifying further investigation as therapeutic options for insomnia or poor sleep.”

https://pubmed.ncbi.nlm.nih.gov/40929927/

https://www.sciencedirect.com/science/article/abs/pii/S1087079225001091?via%3Dihub

UK Medical Cannabis Registry: A clinical outcomes analysis for insomnia

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“Insomnia affects approximately 10% of adults globally. Current treatments have their limitations, and there is growing evidence on the therapeutic potential of cannabis-based medicinal products for insomnia.

This study aimed to assess changes in sleep-specific and general patient-reported outcome measures (PROMs) in individuals prescribed cannabis-based medicinal products for insomnia and to assess the incidence of adverse events.

A case series was analysed with patients diagnosed with primary insomnia from the UK Medical Cannabis Registry (UKMCR). The primary outcome examined changes in the Single-Item Sleep Quality Scale (SQS), Generalised Anxiety Disorder-7 (GAD-7), and EuroQol-5 Dimension-5 Level (EQ-5D-5L). Changes in PROMs were assessed from baseline to 1-, 3-, 6-, 12- and 18-months. Adverse events were classified according to the CTCAE version 4.0. The inclusion criteria were met by 124 participants.

SQS scores showed improvement from baseline (2.66 ± 2.41) to 1- (5.67 ± 2.65; p < 0.001), 3- (5.41 ± 2.69; p < 0.001), 6- (4.80 ± 2.89; p < 0.001), 12- (4.24 ± 3.01; p < 0.001) and 18-months (3.81 ± 2.90; p < 0.001). GAD-7 scores improved from baseline to 1-, 3-, 6-, 12- and 18-months (p < 0.050). There were also improvements in EQ-5D-5L dimensions of usual activities, pain/discomfort, anxiety/depression, and index values (p < 0.001). Eleven (8.87%) participants reported a total of 112 (90.32%) adverse events, but none were disabling or life-threatening.

The study demonstrated improvements in subjective sleep quality and other captured PROMs in insomnia patients treated with cannabis-based medicinal products. Although the treatment was generally well-tolerated, randomised controlled trials are needed to confirm the effectiveness and safety of cannabis-based medicinal products.”

https://journals.plos.org/mentalhealth/article?id=10.1371/journal.pmen.0000390

“Study finds cannabis improves sleep where other drugs fail”

https://www.sciencedaily.com/releases/2025/09/250901104658.htm

Expanding the Therapeutic Profile of Topical Cannabidiol in Temporomandibular Disorders: Effects on Sleep Quality and Migraine Disability in Patients with Bruxism-Associated Muscle Pain

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“Background: Cannabidiol (CBD) has demonstrated potential as a therapeutic agent for muscle tension, pain, and sleep bruxism, yet its broader impact on comorbid conditions such as sleep disturbance and migraine disability remains underexplored. This study aimed to assess the effects of topical CBD on sleep quality and migraine-related disability in patients with bruxism-associated muscular pain. 

Methods: In a randomized, double-blind clinical trial, 60 participants with bruxism were allocated equally into three groups: control (placebo gel), 5% CBD gel, and 10% CBD gel. Participants applied the gel intraorally to the masseter muscles nightly for 30 days. Sleep quality and migraine-related disability were assessed using the Pittsburgh Sleep Quality Index (PSQI) and the Migraine Disability Assessment Scale (MIDAS), respectively. Surface electromyography (sEMG) and the Bruxoff® device were used for objective evaluation of muscle tension and bruxism intensity. 

Results: Both CBD treatment groups demonstrated statistically significant improvements in PSQI and MIDAS scores compared to the control group (p < 0.001). No significant differences were observed between the 5% and 10% CBD groups, suggesting comparable efficacy. The sEMG findings corroborated a reduction in muscle tension. Improvements in sleep and migraine outcomes were positively correlated with reductions in muscle activity and pain. 

Conclusions: Topical CBD gel significantly improved sleep quality and reduced migraine-related disability in patients with bruxism-associated muscular pain, supporting its role as a multifaceted therapeutic option in the management of TMD and related comorbidities. Further research is needed to confirm long-term benefits and determine optimal dosing strategies.”

https://pubmed.ncbi.nlm.nih.gov/40732351/

“This study demonstrates that topical application of cannabidiol (CBD) gel, at both 5% and 10% concentrations, significantly improves sleep quality and reduces migraine-related disability in patients with bruxism-associated muscular pain. These effects were observed alongside reductions in muscle tension and pain, suggesting a broader therapeutic impact of CBD beyond localized symptom relief. Notably, no substantial differences were found between the two concentrations, indicating that lower doses may achieve comparable clinical outcomes.

The findings support the use of topical CBD as a well-tolerated, non-invasive adjunct in the multimodal management of temporomandibular disorders (TMD), especially in patients experiencing comorbid sleep and headache disturbances. Future research should explore long-term efficacy, optimal dosing, and underlying mechanisms through objective neurophysiological and sleep assessments”

https://www.mdpi.com/1424-8247/18/7/1064

Acute Effects of Oral Cannabinoids on Sleep and High-Density EEG in Insomnia: A Pilot Randomised Controlled Trial

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“Cannabinoids, particularly Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD), have gained popularity as alternative sleep aids; however, their effects on sleep architecture and next-day function remain poorly understood.

Here, in a pilot trial, we examined the effects of a single oral dose containing 10 mg THC and 200 mg CBD (THC/CBD) on objective sleep outcomes and next-day alertness using 256-channel high-density EEG in 20 patients with DSM-5 diagnosed insomnia disorder (16 female; mean (SD) age, 46.1 (8.6) years).

We showed that THC/CBD decreased total sleep time (-24.5 min, p = 0.05, d = -0.5) with no change in wake after sleep onset (+10.7 min, p > 0.05) compared to placebo. THC/CBD also significantly decreased time spent in REM sleep (-33.9 min, p < 0.001, d = -1.5) and increased latency to REM sleep (+65.6 min, p = 0.008, d = 0.7). High-density EEG analysis revealed regional decreases in gamma activity during N2 sleep, and in delta activity during N3 sleep, and a regional increase in beta and alpha activity during REM sleep. While there was no observed change in next-day objective alertness, a small but significant increase in self-reported sleepiness was noted with THC/CBD (+0.42 points, p = 0.02, d = 0.22). No changes in subjective sleep quality, cognitive performance, or simulated driving performance were observed.

These findings suggest that a single dose of cannabinoids, particularly THC, may acutely influence sleep, primarily by suppressing REM sleep, without noticeable next-day impairment (≥ 9 h post-treatment).”

https://pubmed.ncbi.nlm.nih.gov/40631525/

“This study is the first to use high-density EEG to explore the acute effects of oral THC/CBD on objective sleep outcomes in individuals with insomnia. A single oral dose significantly reduced total sleep time and REM sleep, without impairing next-day alertness.”

https://onlinelibrary.wiley.com/doi/10.1111/jsr.70124

Long-term cannabinoid therapy can ameliorate chronic sleep deprivation-induced behavioral and neuroinflammatory changes in mice

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“Endocannabinoid system is an important contributor to body’s immune responses which are significantly impaired by chronic sleep deprivation (cSD). Although cannabinoids can modulate the endocannabinoid system, most are understudied, especially regarding cSD.

To investigate the therapeutic potential of CBD, CBG, CBC and their combinations, current study analyzed cSD-induced memory impairment, depression, microglial responses, cytokine profile and therapeutic effects of cannabinoid treatments using behavioral test and ELISA. Furthermore, molecular docking of these cannabinoids was performed to deduce the binding affinity with cannabinoid receptors and possible entrouge effects.

The results showed that memory impairment and depression were more evident in cSD groups. Moreover, microglial activation and pro-inflammatory polarization was also more evident and was supported by increased pro-inflammatory cytokine concentrations in cSD groups.

These changes were significantly reversed the cannabinoid groups but the combination of CBD + CBC was more effective than other treatments in reversing these cSD-induced behavioral and neuroinflammatory changes. Whereas, the molecular docking results also corroborated with the neuroimmunological changes observed in the current study, pointing towards the possible therapeutic role.

SIGNIFICANCE STATEMENT: Chronic SD employs microglial activation/polarization, to exert behavioral impairments and neuroinflammation.

This study signifies the therapeutic potential of proper sleep and cannabinoid intake.”

https://pubmed.ncbi.nlm.nih.gov/40628367/

“This study demonstrates the therapeutic efficacy of cannabinoid treatments in ameliorating cSD-induced behavioral and neuroinflammatory alterations. Notably, a multiple-compound treatment of CBD and CBC exhibited superior effectiveness compared to single-compound treatments. These findings suggest potential avenues for developing effective interventions against cSD-induced detrimental changes.”

https://www.sciencedirect.com/science/article/abs/pii/S0304394025002022?via%3Dihub

Daily Impact of Medical Cannabis on Anxiety and Sleep Quality in Older Adults

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“Objective: Older adults represent the fastest growing demographic of cannabis users, and they endorse cannabis use for a variety of reasons including modulation of chronic pain, mental health symptoms, and sleep concerns. However, current evidence leaves questions of efficacy unanswered among these groups. Goals of the present study were to examine the hypothesis that medical cannabis (MC) use will, at the daily level, predict lower pain, depression, anxiety, and improved sleep.

Method: A final sample of 106 MC users were recruited nationwide (ages 55-74, 66.67% female, 82.86% white). A fully within-subject multilevel structural equation model was conducted with use patterns and symptomology broken into four temporal epochs. MC use, operationalized as subjective intoxication (Epoch 1), averaged across the day was used to predict subsequent pain, anxiety, and depression levels (Epoch 2), which were then used to predict sleep that night (Epoch 3), then subsequent pain, anxiety, and depression the following day (Epoch 4) prior to initiation of MC use.Results: Subjective intoxication predicted lower post-use pain, anxiety, and depression. Subjective intoxication is related to lower anxiety and better sleep the following night.

Conclusions: These findings provide evidence of momentary improvements in pain, anxiety, depression, and indirect benefits for sleep quality. In combination with other findings, the results advance our understanding of the efficacy and limitations of MC among older adults. Findings are limited by MC measurement and sample homogeneity (primarily White, non-Hispanic female). Future research should seek to further measurement of use and corresponding effects and examine expectancy effects in aging clinical populations.”

https://pubmed.ncbi.nlm.nih.gov/40372396/

https://www.tandfonline.com/doi/full/10.1080/00332747.2025.2484827

Improvements in health-related quality of life are maintained long-term in patients prescribed medicinal cannabis in Australia: The QUEST Initiative 12-month follow-up observational study

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“Aims: Since 2016, more than one million new patients with chronic health conditions have been prescribed medicinal cannabis in Australia. We aimed to assess overall health-related quality of life (HRQL), pain, fatigue, sleep, anxiety, depression, and motor function in a large real-world sample of patients prescribed medicinal cannabis. We previously found all patient-reported outcomes improved in the first 3-months and hypothesised that improvements would be maintained to 12-months.

Methods: The QUEST Initiative, a multicentre prospective study, recruited adult patients with any chronic health condition newly prescribed medicinal cannabis oil between November 2020 and December 2021. Participants identified by 114 clinicians across Australia completed validated questionnaires at baseline, then 2-weeks titration, and 1-,2-,3-,5-,7-,9- and 12-months follow-up.

Results: Of 2744 consenting participants who completed baseline assessments, 2353 also completed at least one follow-up questionnaire and were included in analyses, with completion rates declining to 778/2353 (38%) at 12-months. Ages ranged between 18-97 years (mean 50.4y; SD = 15.4), 62.8% were female. Chronic conditions commonly treated included musculoskeletal pain (n = 896/2353; 38.1%), neuropathic pain (n = 547/2353; 23.2%), insomnia (n = 546/2353; 23.2%), anxiety (n = 520/2353; 22.1%), and mixed depressive and anxiety disorder (n = 263/2353; 11.2%). Clinically meaningful improvements were observed in HRQL: EQ-5D-5L index (d = 0.52) and QLQ-C30 summary scores (d = 0.91), PROMIS fatigue (d = 0.51) and sleep disturbance (d = 0.76). Participants diagnosed with chronic pain experienced clinically meaningful improvement in scores on QLQ-C30 pain (d = 0.5), PROMIS pain intensity (d = 0.76), and PROMIS pain interference (d = 0.76). There was significant improvement in DASS anxiety (d = 0.69) and DASS depression (d = 0.65) for those with anxiety or depressive conditions, but no motor function improvements observed for participants with movement disorders. All observed improvements were statistically significant.

Conclusions: Statistically significant and clinically meaningful improvements in overall HRQL, fatigue, and sleep disturbance were maintained over 12-months in patients prescribed medical cannabis for chronic health conditions. Anxiety, depression, insomnia, and pain also improved over time for those with corresponding health conditions.”

https://pubmed.ncbi.nlm.nih.gov/40173146/

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0320756