In Italy, according to the Italian Association of Sleep Medicine, insomnia affects approximately 13.4 million people.
In recent years, interesting data has been emerging on the use of cannabinoids in the management of sleep disorders. A recent survey by the Bloomwell Group, conducted on over 1,000 patients who use medical cannabis for sleep, highlights that 70% consider it more effective than prescribed sleeping pills, while over 90% consider it more effective than over-the-counter remedies. Additionally, 86% of respondents report improved quality of life, and approximately 42% were able to reduce or discontinue other sleep medications.
Similar indications also emerge from the clinical data collected by Clinn, a project dedicated to access to cannabinoid-based treatments: among all the patients treated for sleep-wake rhythm disorders, 64% declared feeling much improved, 10% extremely improved, while 24% reported a slight improvement.
But behind the numbers there is an increasingly widespread reality: people who sleep badly for months or years and who are looking for alternatives to classic sleeping pills. Insomnia today is not just a clinical problem, but one of the disorders most linked to contemporary lifestyle: chronic stress, shift work, digital hyperconnection, anxiety and persistent pain are among the most frequent causes of sleepless nights.
For this reason, there is growing interest in different approaches, often perceived as more “natural” or in any case more customizable. Among these, in recent years, medical cannabis is emerging as one of the most discussed – but also most controversial – options in the treatment of sleep disorders.
Interview with Doctor Michele Antonelli
Interview with Dr. Michele Antonelli, doctor affiliated with Clinn, a project dedicated to facilitating access to cannabinoid-based medical treatments. With him we explored the role of therapeutic cannabis in the management of sleep disorders, trying to understand in which cases it can be useful, what scientific evidence exists and what the main indications and precautions for patients are.
Benzodiazepines make us sleep but alter the structure of sleep. Does medical cannabis really make us sleep better, or does it just make us feel like we slept better?
Benzodiazepines are effective drugs in the short term, but we know that they can modify the physiological architecture of sleep: this means that the patient often sleeps more easily, but does not always sleep better in terms of quality.
Medical cannabis acts through a different mechanism, modulating the endocannabinoid system, and the main effects depend largely on two substances in the plant: THC (tetrahydrocannabinol), which promotes relaxation and falling asleep, and CBD (cannabidiol), which is non-psychoactive and helps calm anxiety and tension. In many patients we observe not only a reduction in the latency to fall asleep, but also an improvement in sleep continuity and a decrease in nocturnal awakenings.
Naturally it is not a universal solution: the answer depends greatly on the patient’s profile, the type of preparation used and the correct balance between THC and CBD. I believe it is important to point out that, while medical cannabis dosed and balanced by a doctor can promote regular sleep, the recreational use of uncontrolled extracts can instead cause sleep disorders.
According to recent research by the German company Bloomwell Group, 70% of patients with insomnia prefer cannabis to classic sleeping pills. Is this surprising, or do you now consider it the norm in your daily practice?
This is not something that surprises me. More and more people are looking for natural and phytotherapeutic strategies to improve sleep, often thanks to a greater awareness of their health and the possible side effects of traditional sleeping pills. Patients usually come to medical cannabis after trying other therapies and appreciate the possibility of a personalized approach that can help them sleep better.
However, it should be remembered that in Italy, by law, medical cannabis is only indicated as a second-line integrative therapy, i.e. when the symptoms do not respond adequately to standard treatments. Furthermore, “natural” does not always mean harmless or appropriate: medical cannabis also has risks and contraindications and must always be used under medical supervision.
Benzodiazepine dependence: a known and documented problem. But is there also a medical cannabis addiction that isn’t talked about enough yet?
The risk of benzodiazepine dependence is well documented and is often a problem in long-term treatment. With medical cannabis, the risk of developing a similar disorder is not zero, but it is important to distinguish between controlled therapeutic use and recreational use.
In recreational use, especially with extracts with a high THC content and without supervision, the risk of tolerance, withdrawal symptoms and dependence increases significantly, especially in predisposed subjects or with frequent use. For this reason, in clinical practice the prescription of therapeutic cannabis is always accompanied by a medical examination, clinical monitoring and follow-up.
Is there a typical patient to whom you would say: this therapy is not for you?
There is no single “typical patient”, but there are some clinical conditions in which I prefer not to propose this treatment or evaluate it with extreme caution. For example, in patients with a history of psychotic disorders or some non-stabilised psychiatric conditions, during pregnancy and breastfeeding, in developmental age or in the presence of serious cardiovascular, hepatic, renal or respiratory pathologies.
It is also important to evaluate any interactions with other pharmacological therapies and verify that there are no situations of substance abuse. As with any medical treatment, the goal is to choose the most appropriate and safe solution for the individual person.
Not all patients with insomnia are the same. For which types can medical cannabis be an option?
Sleep disorders can manifest themselves in different ways: difficulty falling asleep, frequent nocturnal awakenings, early awakening or alterations in the sleep-wake rhythm. Insomnia remains the most frequent disorder and affects between 10% and 30% of the adult population.
When it becomes chronic and does not respond to first-line therapies – behavioral, cognitive or pharmacological interventions – medical cannabis can represent an integrative option, especially in patients whose sleep disorder is associated with pain, anxiety or neurodegenerative diseases. Some studies also suggest a possible role in reducing benzodiazepine consumption. (Purcell, C., Davis, A., Moolman, N., & Taylor, S. M. (2019). Reduction of benzodiazepine use in patients prescribed medical cannabis. Cannabis and Cannabinoid Research4(3), 214-218.).
In Italy, access to medical cannabis still depends a lot on where you live. Why?
In Italy, therapeutic cannabis is provided for by law, but its use remains uneven across the territory. This depends on organizational differences between regions, complex bureaucratic procedures and variable levels of training of health professionals on the topic.
The availability of pharmacies with experience in the preparation of cannabis extracts is also not uniform, and this can make it more difficult for some patients to obtain the prescribed therapy. Added to these factors is a cultural element: the stigma linked to the recreational use of the plant still makes the process of integrating cannabis as a therapeutic tool into the healthcare system slow.
