1. In this systematic review and meta-analysis, medical cannabis and cannabinoids versus placebo were found to provide a small increase in sleep quality amongst patients experiencing chronic pain
2. Furthermore, the study highlighted an increase in nausea and dizziness as adverse effects of cannabis and cannabinoids use.
Evidence Rating Level: 1 (Excellent)
Sleep disorders affect a sizeable portion of the general population, with cannabis increasingly being studied as a component of therapy for improved sleep. Previous studies have showed a large percentage of cannabis users purchase cannabis for sleep disorders. This study addressed the lack of meta-analyses on the effect of medical cannabis and cannabinoids on impaired sleep.
This systematic review and meta-analyses of randomized controlled trials (RCTs) evaluated the effect of medical cannabis or cannabinoids on sleep. Inclusion criteria includes: 1) patients aged 18 or older with impaired sleep; 2) RCTs that compared medical cannabis to a non-cannabis control; 3) studies that collected outcome data greater than 13 days after treatment. Open-label trials and studies with patients using cannabis for recreational purposes were excluded. Study outcomes assessed measures such as effect on sleep quality, sleep disturbance, other sleep-related outcomes, and adverse events.
Results demonstrated 39 RCTs met inclusion criteria. Pooled data suggest that cannabinoids and medical cannabis lead to a small increase in sleep quality, at or above the minimally important difference (MID). Subgroup analyses showed small benefit in chronic noncancer pain and very small benefit in patients with chronic cancer pain. Cannabinoids and medical cannabis were also shown to increase the risk of adverse events such as nausea and dizziness, compared to placebo. Interestingly, study findings also suggest a decreased frequency and intensity of nightmares in patients with post-traumatic stress disorder with cannabinoid use. However, this study was limited as it assessed mostly oral cannabis and chronic pain patients, limiting generalizability to inhaled cannabis forms and to nonchronic pain patients. Additionally, the study only provides brief follow-up and cannot comment on long-term use of cannabis. Nonetheless, this study was significant in suggesting the magnitude of benefit in the use of cannabis and cannabinoids amongst chronic pain patients with impaired sleep is small.
1. In this large prospective cohort study, shift workers with night shifts had a significant incidence of prescriptions for sleep disorder medications, regardless of age, sex, and occupation, compared to daytime workers.
2. Older age, female sex, divorcees, and smokers tended to have increased prescription incidence whereas occupation type (white- vs. blue- collar) had no differences in hypnotic and sedative prescription incidence.
Evidence Rating Level: 2 (Good)
Shift and night workers have commonly faced acute sleep disruptions and the development of sleep disorders. Previous studies (mostly based on self-reported sleep disorders) have shown little to no evidence of an association between night work or shift work being associate with sleep problems. This study addressed the limitation of self-reporting bias by identifying an association between shift work and the prescribing of medications to treat sleep problems.
This prospective cohort study was conducted on Finnish public sector workers as well as Finnish hospital personnel in Finland. Cohorts were classified as day workers (n = 33,014), shift workers with nigh shifts (n = 7,557) and shift workers without night shifts (n = 10,062). Individuals with mental health problems at baseline were excluded due to confounding risk. The study outcomes assessed incident of hypnotic and sedative prescriptions from a national drug reimbursement register.
The study results showed highest incidence of sleep medication prescriptions among all shift workers, older individuals, females, divorcees, and smokers. Hazard ratios controlling for all covariates further showed a significant incidence in medication use amongst shift workers with night shifts (across all ages) compared to day shift workers. Importantly, the study did not show any differences between white-collar and blue-collar workers. However, this study was limited in its application as a large portion of the cohort were healthcare workers, leading to poor generalizability. Additionally, the study may not capture all individuals with sleep disorders, as physicians may prescribe other treatment modalities beyond medication. Finally, hypnotics and sedatives may also be prescribed for off-label purposes; therefore, this study may also overestimate sleep disorders. Nonetheless, this study was significant as it further strengthened the association between shift work and circadian disruption, as well as increased incidence of sleep disorders.
1. This retrospective analysis of college students demonstrated a relationship between adverse childhood experiences and sleep disorders such as insomnia and sleep difficulties.
2. There were no differences in the relationship between adverse childhood experiences and sleep health between difference races/ethnicities and between sexes.
Evidence Rating Level: 2 (Good)
Adverse childhood experiences (ACEs) have been studied in-depth regarding their poor health outcomes in individuals later in life. They have been noted to show patterns of association with having sleep health issues in adulthood. Disorders of sleep and sleep difficulty can consequently evolve into other poor health outcomes in mental and physical health. This is especially burdensome for post-secondary students; as such, this retrospective study assessed whether the patterns of ACEs and poor sleep exist in post-secondary student populations.
The study conducted analyses on secondary data from a national college health assessment survey and took samples of college students in Texas (n = 407) and California (n = 3606), United States of America. Students enrolled in post-secondary education between the ages of 19 and 27 were included. Primary outcomes assessed sleep health measures including sleep disorder diagnoses and self-reported sleep difficulty. Furthermore, ACEs were classified as maltreatment (verbal, physical, and sexual abuse) and household dysfunction (familial incarceration, alcohol and drug misuse, and witnessed physical violence).
Results showed significant patterns in ACEs and sleep issues amongst post-secondary students. The study showed increased risks of sleep difficulties and disorders in students that experience both maltreatment and household dysfunction during childhood, followed by maltreatment alone. Importantly, the study did not show any interaction with ACEs and race/ethnicity or sex in a multivariate analysis. However, this study was limited due to a risk of response bias that may underestimate the actual ACE incidence, and a self-reporting bias that may not accurately evaluate the severity of sleep disorders amongst post-secondary students. Nonetheless, this study was significant as it further strengthened the association between ACEs and sleep issues, which may help encourage earlier identification and interventions of ACEs in childhood.
©2022 2 Minute Medicine, Inc. All rights reserved. No works may be reproduced without expressed written consent from 2 Minute Medicine, Inc. Inquire about licensing here. No article should be construed as medical advice and is not intended as such by the authors or by 2 Minute Medicine, Inc.