Out of all the symptoms I see in my practice, sleep problems are among the most important; they affect
every aspect of a patient’s life. If someone doesn’t sleep well, all their other problems will worsen. So
sleep is often the first symptom that I concentrate on, not only because it’s usually the easiest one to
improve, but because other conditions are difficult to treat if someone is not sleeping well.
Dispensaries often recommend pure THC products for sleep problems. However, combining THC with
CBD decreases the chances of side effects, so I usually start patients with a low dose of a combination of
sublingual THC and CBD. Speaking of side effects, most potentially disturbing cannabis-related side
effects go away while you sleep. But if there are any morning side effects, they tend to be fewer and less
intense compared with conventional sleeping medications.
My patients who have the hardest time falling asleep often have the best responses; they tend to
respond quickly — usually within a few days. They have said things like, “Oh, my God, where were you
before? I slept better right after the first dose.” Even if it takes longer for the pot to kick in, most are
very pleased with the results.
If you have difficulty falling asleep, try a sublingual tincture of 3 to 10 mg of 1:1 THC:CBD. If you haven’t
had THC before, start out a very small amount: 1 mg at the most. It’s important that whatever product
you choose should contain calming terpenes, such as myrcene or linalool. Take it an hour before
bedtime for three days. If you need more, increase the dose by 1 mg of THC each night until you get the
response you need. As soon as you find an effective dose, do not increase it any further. It will not be
more effective, and you may experience more side effects, which can include dizziness and morning
drowsiness. So be sure to follow my marijuana mantras: “Start low, go slow” and “Stop when you get to
where you need to go.”
If you don’t have trouble falling asleep but wake up in the middle of the night and can’t fall back asleep,
I recommend 1:1 THC:CBD by the oral route, either as capsules or edibles. When orally, it takes longer to
get absorbed, so the effects take longer to kick in. Although you’ll have reaction, the effects will last
There’s some concern that people who use cannabis for a long time may develop tolerance and need to
increase their dose to get the same sleep benefits, which is the case with a few of my patients. However,
some researchers believe that tolerance doesn’t occur when using low doses that the body gets used to
better sleep and continues doing well after using cannabis for a period of time on a low dosage, and that
patients are very unlikely to develop tolerance with cautious, intermittent use.
I’m often asked by patients if taking CBD at bedtime would help them sleep. I commonly find that those
patients who swear that CBD works for their insomnia are the ones whose insomnia is driven by anxiety.
For them, CBD can be a great tool. They should start with 15 to 30 mg a few hours before bedtime and
titrate up by 15 to 20 mg every night until they find a minimally effective dose.
Not only is medical cannabis a godsend to the sleep deprived, there’s increasing evidence that it can
help people suffering from what is arguably the most disturbing and debilitating sleep disorders:
recurrent night terrors or nightmares. These conditions are, unfortunately, very common in adults
suffering from post-traumatic stress disorder, which affects about 8 million adults in the United States.
Conventional treatments for night terrors and PTSD typically involve Rx drugs — such as sedatives,
antidepressants, antipsychotics, and anticonvulsives — and/or psychotherapy, CBT, or other behavioral
approaches. While these therapies, especially CBT, have proven helpful, most medications have not.
Plus, they all have potentially serious side effects.
Veterans suffering from PTSD have been self-medicating with marijuana for decades to help cope with
the often-debilitating symptoms. And they’re onto something. Medical marijuana has been shown to
reduce the frequency of nightmares, and the combination of THC and CBD appears to be especially
helpful for treating both PTSD-related night terrors and insomnia.
While weed can do wonders for sleep disorders and PTSD, other integrative approaches can also be
remarkably effective. These include:
- Herbs and essential oils
- CBT and other forms of therapy