Prescription Sleep Medications or Medical Cannabis?
Many, untold thousands of Mass Retirees members are among the 50% of older adults who experience trouble falling asleep, staying asleep, or waking too early, there are many prescription medications that may be appropriate. Recently, medical cannabis has also emerged as a popular sleep aid.
If you’re wondering if medical cannabis might be an option for you, it’s important to understand a bit more about what can often seem like a very complicated landscape of potential treatments for sleep-related issues.
PRESCRIPTION SLEEP MEDICATIONS: BENEFITS AND RISKS
The most commonly prescribed sleep medications overall include benzodiazepines (e.g., lorazepam, diazepam), non-benzodiazepine hypnotics, often referred to as Z-drugs (e.g., zolpidem, better known as Ambien). These medications work by enhancing the effect of a neurotransmitter called gamma-aminobutyric acid (GABA), which has calming effects on the brain, helping individuals fall asleep more easily.
Tricyclic antidepressants and nerve pain medicines such as Doxepin are at times prescribed for sleep issues as well. However, because these drugs can significantly increase the risk of falls and accidents, diminish cognitive function and some (such as benzodiazepines) even have the potential for addiction and challenging withdrawal, many doctors avoid prescribing them for older adults.
Instead, some doctors may recommend drugs like Trazodone, which while initially developed for the treatment of major depressive disorder can help address sleep issues with somewhat less severe impacts on cognitive function and balance.
In short, all prescription sleep medications come with risks for older adults, which is why many doctors may initially recommend non-prescription options such as melatonin before moving to prescription medications only if needed.
MEDICAL CANNABIS AS AN ALTERNATIVE FOR OLDER ADULTS
While the research on medical cannabis and sleep is both newer and not as deep as it is for most prescription sleep aids, it has shown significant potential as an alternative treatment for insomnia and other sleep disorders. This is most likely due to its ability to increase adenosine levels (which can make you feel more sleepy) and by suppressing some types of arousal.
A comprehensive research review published by McMaster University in Canada in 2019 found that cannabis can help improve sleep quality, especially for those whose ability to get to sleep and stay asleep is being compromised by pain or stress.
A 2022 Journal of Sleep Research study found that for adults with insomnia, cannabis containing a blend of THC and CBD was both well tolerated and effective in improving sleep quality and duration, quality of life, and mood. Research has also shown that compared to benzodiazepines or Z-drugs, cannabis when used under the guidance of a clinician may carry less risk of physical dependence and withdrawal.
However, long-term use of higherTHC cannabis products (5-10mg or more) is typically not recommended for sleep issues as their ongoing use can negatively impact both sleep duration and quality. Clinician’s believe it is best to start with a CBDonly or low-dose THC (1-2mg) product in order to assess tolerance and potential side effects. And non-combustible forms of cannabis such as capsules, gummies, tinctures or inhalers are of course healthier than smoking or vaping.
Finally, and importantly, THC cannabis products can lead to dizziness and an increased risk of falls and accidents as with many prescription sleep medications (though it does come in a much wider variety of forms and potency levels). Cannabis can also interact with blood thinners and may not be appropriate for those with some cardiac conditions.
Actions to Consider
First, always consult with your doctor to better understand the causes of any sleep issues you might be having and to discuss which sleep-related treatments might be most right for you. Should medical cannabis be an option that you want to consider, Mass Retirees suggests you visit EO, a provider of free, clinician-led medical cannabis care and affordable, purpose-designed products at https://partner. eo.care/mass-retirees.