Insomnia

We’ve all had those nights — tossing, turning, checking the clock every hour, and wondering why sleep is so hard to come by.

For millions of people, this isn’t just an occasional frustration; it’s a constant struggle. Welcome to the world of insomnia. Whether it’s trouble falling asleep, waking up too early, or not staying asleep long enough, insomnia affects nearly 30% of the U.S. population at some point. And for about 10%, it’s a long-term battle.

But this isn’t just about feeling tired. Lack of good sleep can seriously mess with your life — weakening your immune system, making you more vulnerable to illness, and even intensifying issues like anxiety, depression, and migraines. The ripple effect of insomnia can be overwhelming, but there’s hope.

While traditional treatments include therapy and medications, people are increasingly turning to alternative solutions. One promising option? Cannabis. As research evolves, many are exploring how cannabis might help calm the mind, ease chronic pain, and promote better sleep. Ready to dive deeper and find out how you can finally catch some solid Z’s? Let’s get started.

Insomnia Causes

Insomnia can be broadly classified into two types: primary and secondary.

Primary insomnia is unlinked to any other health condition and can be caused by psychological factors such as stress, anxiety, and depression. These mental health issues can lead to racing thoughts and increased alertness, making it hard to fall or stay asleep.

Secondary insomnia occurs due to other medical conditions or factors. Common causes include:

• Medical Conditions: Chronic illnesses like asthma, arthritis, heart disease, and gastrointestinal disorders can cause discomfort that disrupts sleep. Neurological conditions such as Parkinson’s and Alzheimer’s disease also affect sleep patterns.

• Medications: Certain drugs, including ADHD medications, short-acting benzodiazepines, and stimulants found in weight-loss products, can cause insomnia. Withdrawal from alcohol, opioids, or sedatives, as well as high caffeine intake, can also lead to sleep problems.

• Lifestyle Factors: Irregular sleep schedules from shift work or frequent travel can disrupt the body’s internal clock. Poor sleep habits, using devices with bright screens before bed or consuming caffeine and alcohol late in the day, can also hinder sleep.

• Environmental Factors: A noisy, uncomfortable, or disruptive sleeping environment, including an uncomfortable mattress, too much light, or an inappropriate room temperature, can prevent restful sleep.

• Hormonal Changes: Women may experience insomnia due to hormonal fluctuations during menstruation, pregnancy, and perimenopause, affecting sleep-wake cycles.
• Learned Condition: Insomnia can sometimes be a learned behavior, where anxiety about not sleeping leads to a cycle of worry and sleeplessness, making it harder to fall asleep.

Understanding these causes can help address and manage insomnia effectively.

Insomnia Symptoms & Health Effects

Insomnia can present with a variety of symptoms, such as:

• Difficulty Falling Asleep: Lying awake for long periods before drifting off is often one of the first signs of insomnia.
• Frequent Night Awakenings: Waking up multiple times during the night can disrupt the sleep cycle and prevent deep, restorative sleep.
• Early Morning Awakenings: Waking up too early and being unable to fall back asleep leads to insufficient sleep and daytime fatigue.
• Daytime Fatigue: Persistent tiredness, low energy, and lethargy are common during the day, affecting daily activities and quality of life.
• Irritability and Mood Changes: Lack of sleep can cause increased irritability, stress, anxiety, and even depression.
• Cognitive Impairment: Insomnia can make it hard to concentrate, remember things, and make decisions, impacting work, school, and daily tasks.
• Physical Symptoms: Chronic insomnia can cause headaches, tension, and gastrointestinal issues, adding to the discomfort and distress.

Those who suffer from persistent sleep disturbances and insomnia have elevated cortisol levels and adrenocorticotropic hormones, suggesting an elevated level of stress and anxiety at night and a hyperactive HPA axis. This flight-or-fight response may have been helpful for our ancestors when you needed to be more alert to danger, but it is less useful in modern life.

Those with insomnia are also likely to have drastic shifts in the levels of inflammatory cytokines (i.e., proteins that help send signals to other immune and blood cells) in their bodies. This imbalance can cause autoimmune disorders and lead to the development of other conditions directly related to immune function.

What Patients Say About Their Symptoms

Carla had trouble sleeping for decades and tried everything from melatonin to weighted blankets to address the symptoms. She would go to sleep early but then wake up all night long. She was not able to get any REM sleep. “Now, when I wake up I feel completely different,” Carla told Leafwell in a patient story interview where she discusses her success with cannabis as medicine.

Insomnia Diagnosis

To diagnose insomnia, doctors start with a detailed medical and sleep history. They ask about sleep patterns, such as how long it takes to achieve sleep, how often you wake in the middle of the night, and how refreshed you feel in the morning. They also inquire about daytime symptoms like tiredness, mood changes, or trouble concentrating.

Doctors often use sleep questionnaires and diaries to gather a clearer picture of your sleep behavior. Tools like the Insomnia Severity Index (ISI) and the Pittsburgh Sleep Quality Index (PSQI) help measure how severe your insomnia is and how it affects your daily life.

A physical exam is done to check for any medical issues that might be causing your insomnia, like sleep apnea or restless legs syndrome. Doctors might order blood tests to look for problems like thyroid issues or anemia that can impact sleep.

Sometimes, a sleep study or polysomnography is needed. This involves staying overnight in a sleep lab where your brain activity, eye movements, heart rate, and breathing are monitored to spot any sleep disorders.

Doctors also consider your mental health, as conditions like depression, stress, and anxiety often contribute to insomnia. A psychological evaluation may be part of the process to see if these factors affect your sleep.

What Patients Say About Their Diagnosis

Virginia-based author Carla Vergot, known for her “Lily Barlow” series, turned to medical cannabis after struggling with decades of sleep issues.

After trying countless remedies, she found cannabis offered the relief she needed. With some trial and error, Vergot discovered the right products and dosages, uncovering her most effective solution for better sleep.

Insomnia Prognosis

The outlook for insomnia diagnosis can vary greatly, influenced by factors such as its root cause, how long it’s been going on, and how effective the treatment plan is. Acute insomnia, which often arises due to stress or a traumatic event, usually resolves itself once the stressor is managed or removed. In these cases, the outlook is generally positive, with most people returning to their standard sleep patterns within a few days to weeks.

Chronic insomnia, on the other hand – defined as having trouble sleeping at least three times a week for three months or more – tends to have a more complex outlook. It often requires a multipronged approach to treatment, including behavioral therapies, lifestyle changes, and sometimes medication. The prognosis for chronic insomnia is more tentative, as it can be linked to other health issues like depression, anxiety, or chronic pain, which can complicate treatment and extend the recovery period.

For those who stick to a comprehensive treatment plan, the outlook improves significantly. Many people find substantial relief from their symptoms and see an overall improvement in their quality of life. However, it’s important to remember that some may still experience intermittent bouts of insomnia, especially during times of stress or illness.

While insomnia can be a persistent and challenging condition, many individuals can achieve significant improvement with the proper treatment and lifestyle changes. Early intervention and proactive strategies for managing insomnia are key to achieving a better outcome.

Insomnia Treatments

Tackling insomnia starts with first-line treatment options, which typically include behavioral changes and lifestyle adjustments. Cognitive Behavioral Therapy for Insomnia (CBT-I), for example, aims to change sleep habits and attitudes by addressing the thoughts and behaviors that keep you awake.

For some, however, first-line treatments may be insufficient. That’s where second-line treatments come in, often consisting of pharmacological approaches or alternative therapies. Sleep medications, while not a long-term solution, can be effective for short-term relief. However, they do come with risks of dependency and side effects, making careful monitoring essential.

Whether you’re at the beginning of your insomnia journey or have tried multiple treatment avenues, understanding these options can equip you with the knowledge to make more informed decisions about your health.

First-Line Treatments

First-line treatments for insomnia usually focus on non-medical approaches, with Cognitive Behavioral Therapy for Insomnia (CBT-I) being the most effective and helping 70-80 percent of insomnia cases. CBT-I is a structured program that helps you change thoughts and behaviors that negatively impact your sleep. It combines cognitive therapy, behavioral interventions, and educational components to promote better sleep habits.

Sleep hygiene education is another vital part of treatment. This involves teaching you about good sleep practices, such as maintaining a regular sleep schedule, creating a comfortable sleep environment, and skipping caffeine and nicotine several hours before bedtime. Good sleep hygiene also includes limiting naps and doing relaxing activities before bed.

In combination with CBT approaches and better sleep hygiene, the following techniques are the most commonly used behavioral interventions for insomnia:

• Stimulus control therapy is a technique to help you associate your bed/bedroom with sleep. Guidelines include going to bed only when you’re sleepy, laying in the bed only for sleep, and getting out of bed if you can’t sleep within 20 minutes.
• Sleep restriction therapy limits the total time you spend in bed to the actual time you sleep, creating mild sleep deprivation to help consolidate sleep. Gradually, as your sleep improves, the time in bed is increased.
• Relaxation techniques, like deep breathing exercises, progressive muscle relaxation, and mindfulness meditation, are also commonly recommended. These techniques help reduce physical tension and anxiety, making falling and staying asleep easier.
• Paradoxical intention is a cognitive technique where you focus on staying awake instead of forcing yourself to sleep. This technique reduces the anxiety associated with trying to sleep, which can paradoxically make it easier to fall asleep.

If first-line treatments don’t fully resolve your insomnia, it’s okay to move to second-line treatments, which might include medications. Remember, everyone’s journey to better sleep is unique, and finding the best combination of treatments can take time.

What Patients Say About Their Treatment

Diagnosed with chronic insomnia in the army, Asad Shalami has now used medical cannabis for the past five years to help treat his sleep disorder. In 2011 he was working 12 hour night shifts and was sometimes unable to sleep for days. He was prescribed anxiety and sleeping pills to help with the insomnia.

He reached a breaking point when he had to take 3-4 Ambien a night to fall asleep only to wake up with no energy to exercise or work. He found tremendous success with CBD as an alternative therapy and was able to cut out pills entirely, and he’s not alone. Plenty of medical cannabis forums discuss CBD and medical cannabis products as viable treatment options for those struggling to sleep.

Other Treatments

Second-line treatments for insomnia are considered when first-line treatments like CBT-I and good sleep hygiene haven’t worked. These treatments often involve prescription medications, a standard second-line option to manage insomnia more effectively.

Benzodiazepines like temazepam help induce sleep by enhancing the effect of the neurotransmitter GABA, which promotes feelings of relaxation. However, they are usually recommended for short-term use due to the risk of developing dependence or experiencing side effects.

Non-benzodiazepine sleep aids, such as zolpidem and eszopiclone, also act on GABA receptors but have a lower dependence risk and fewer side effects, making them a preferable option for some patients. Sedating antidepressants like trazodone and mirtazapine can also be helpful for people with both secondary insomnia and depression, addressing both issues simultaneously.

Antihistamines like diphenhydramine and doxylamine are also sometimes used for their sedative properties. While available over-the-counter, they are generally less effective and can cause next-day drowsiness, so they aren’t ideal for long-term use.

Melatonin receptor agonists, like ramelteon, mimic the natural hormone melatonin to help regulate the sleep-wake cycle. They are often considered for people who have trouble falling asleep, especially those with circadian rhythm disorders.

Finally, orexin receptor antagonists, like suvorexant, are a newer class of medications that block orexin, a neurotransmitter involved in wakefulness. These medications help those who have trouble staying asleep throughout the night.

Second-line prescription medications can offer effective relief, but they have potential pros and cons and unique factors tailored to each individual, which your doctor will help you navigate.

Adjunctive Therapy & Alternative Treatments

Often, first- and second-line treatments are used simultaneously to tackle insomnia, combining CBT-I and good sleep hygiene with medication-based remedies. There are also alternative treatments for insomnia, encompassing a variety of non-conventional approaches that can be used alone or in combination with some of the methods we covered above. These treatments focus on holistic and natural methods to improve sleep quality and overall well-being:

• Herbal Remedies: Valerian root, chamomile, lavender, and passionflower are popular herbs that promote relaxation and improve sleep. These are generally safe, but consult a healthcare provider before starting any herbal treatment.
• Acupuncture: This traditional Chinese medicine technique involves inserting tiny needles into specific areas of the body to balance energy flow (Qi). Some studies suggest acupuncture can help improve sleep quality and reduce insomnia symptoms.
• Mind-Body Practices: Yoga, tai chi, and meditation are effective for insomnia. These practices promote relaxation, reduce stress, and improve overall mental and physical health, contributing to better sleep. Regular practice can help establish a more restful sleep pattern.
• Nutritional Supplements: Melatonin, a hormone that regulates the sleep-wake cycle, and magnesium, which aids in muscle relaxation and stress reduction, are often used to improve sleep onset and quality.
• Aromatherapy: Essential oils like lavender, bergamot, and sandalwood can promote relaxation and improve sleep. Diffusing these oils in your bedroom or adding a few drops to a warm bath before bedtime can create a soothing environment that will help promote relaxation.

Cannabis for Insomnia

There are several good reasons why medical cannabis for insomnia might be a preferential treatment option. These include:

• Cannabis is used as an alternative to sedatives, which can be highly addictive.
• Endocannabinoids play a significant role in regulating the sleep-wake cycle – phytocannabinoids like THC, CBD, and CBN may help restore a disturbed sleep-wake cycle in insomniacs.
• Cannabis contains several terpenes that help aid sleep, including linalool, myrcene, and ocimene.
• Cannabis may reduce the amount of time it takes for a person to get to sleep.
• CBN has sedative properties that can equal that of benzodiazepines but with far less addiction potential.

In terms of specific cannabinoids, both THC and CBN have been shown to have sedative effects, as could some CBD when used in combination with THC and CBN. However, CBD alone may keep some awake when used in low doses. If you use CBD with little to no THC, you may require high doses of CBD to achieve a sedative effect.

Below are some of the best strains for insomnia, among others that patients turn to to manage their symptoms:

• Blackberry Kush
• ACDC
• Lavender
• Northern Lights
• Granddaddy Purple

Research has found cannabis use may help with sleep disorders like insomnia. In particular indica strains may be particularly helpful for insomnia treatment. Individuals with insomnia may also find relief by targeting particular terpenes in cannabis or hemp products, including:

• Myrcene
• Linalool
• Humulene
• Ocimene
• Nerolidol
• Pinene
• Beta-caryophyllene

Research on using cannabis for insomnia is still in its early stages, but there’s growing interest in its potential as a treatment.

A 2019 study found that cannabis use significantly improved perceived insomnia symptoms, with participants reporting they fell asleep faster, woke up less at night, and had better overall sleep quality. However, higher doses of THC sometimes increase sleep disturbances, showing the importance of finding the correct dosage.

Another review in 2022 noted that while some patients experienced better sleep with cannabis, others had side effects like daytime drowsiness and cognitive impairment. This mixed evidence highlights the need for more rigorous clinical trials.

Individuals with insomnia must weigh the benefits of cannabis treatment against its risks. Long-term use can lead to tolerance, dependence, and withdrawal symptoms, potentially worsening sleep issues. Cannabis might also disrupt REM sleep, which is crucial for memory and emotional regulation.

Legal and regulatory issues are also important. In many places, cannabis is still a controlled substance, and its medical marijuana use is heavily regulated. If you’re considering cannabis for insomnia, it’s crucial to consult with a healthcare provider to discuss its benefits, risks, and legal implications.

While early research is promising, cannabis isn’t yet considered a first-line treatment for insomnia. More high-quality studies are needed to understand its safety and effectiveness fully. Always seek professional medical advice to determine if cannabis is a potential option for your specific condition.

What Patients Say About Cannabis for Insomnia

One patient’s advice for those considering medical cannabis for insomnia? Don’t wait. Talk with a trusted friend who is familiar with cannabis use and go to the dispensary together. Consult with a medical cannabis doctor on the proper dosage and products that may be beneficial.

Additional Information for Patients

Insomnia and Genetics

Insomnia can run in families, with research indicating a 31-58 percent increase in you experiencing insomnia if a family member carries a diagnosis. If you have a family history of insomnia, you’re more likely to experience it, too, indicating that genetics play a role in developing insomnia.

Studies have found several genes related to sleep regulation and insomnia, meaning they play a part in one’s ability to sleep well. These genes affect the circadian rhythm, neurotransmitter function, and stress response, all of which influence sleep quality and duration.

However, having a genetic predisposition toward insomnia doesn’t mean you or your children definitely develop it. Insomnia is a complex condition influenced by a mix of genetic, environmental, psychological, and behavioral factors. Understanding this can help you approach insomnia with a comprehensive view, recognizing that various aspects of your life can contribute to its onset and management.

Insomnia Support Groups

Support groups for people with insomnia provide a space to share experiences, coping strategies, and emotional support. These groups are available both online and in-person, offering flexibility for those who have trouble attending physical meetings due to sleep issues.

Online Support Groups: Popular and accessible options include websites like Alliance of Sleep Apnea Partners, Project Sleep, and dedicated insomnia forums. Social media platforms also host various groups and pages dedicated to insomnia support.

In-Person Support Groups: These may be available through local hospitals, sleep clinics, or community health centers. They offer a more personal touch and the opportunity for face-to-face interaction, which can be great for emotional support and accountability.

Professional Organizations: Groups like the American Academy of Sleep Medicine (AASM) and the National Sleep Foundation provide resources and can direct individuals to local support groups. They also offer educational materials and updates on the latest research and treatments for insomnia.

How to Get Medical Cannabis for Insomnia

Insomnia is a qualifying condition for medical cannabis in many states – be sure to check out the laws and regulations in your state to see what is required to become a medical marijuana patient for insomnia.

While many states have legalized medical cannabis, insurance companies generally do not cover cannabis treatments due to federal regulations. Patients interested in using cannabis for insomnia should consult with their healthcare provider and review their state’s medical cannabis laws, as well as consider the out-of-pocket costs associated with this treatment option.

Insomnia FAQs

How do I stop my insomnia?

To help stop insomnia, try these steps:

1. Set a Routine: Go to bed and wake up at the same time every day, even on weekends.
2. Create a Restful Environment: Keep your bedroom dark, quiet, and cool. Avoid using electronic devices before bed.
3. Relax Before Bed: Use relaxation techniques like deep breathing, meditation, or progressive muscle relaxation to help you unwind.

If these steps don’t work, consider other treatments like medications or alternative options such as cannabis or herbal supplements.

What is the main cause of insomnia?

The main causes of insomnia can be different for each person. It often comes from stress, anxiety, or depression, which mess up the body’s natural sleep pattern. Other common causes include bad sleep habits, irregular sleep schedules, and medical issues like chronic pain or sleep apnea.

Will my insomnia go away?

The way insomnia gets better can be different for everyone and depends on what’s causing it and how well the treatment works. Some people can see a significant improvement or completely get over insomnia by changing their lifestyle or treating other health problems. Others might have long-term insomnia that needs ongoing care with a mix of medical treatments, behavioral therapies, and sometimes alternative methods like using cannabis.

Note that the information in this article does not constitute medical advice.

Get your medical marijuana card

Connect with a licensed physician online in minutes.

Select State

Get started