Sleep problems during withdrawal from cannabis use are a common experience. The details regarding how abstinence from cannabis impacts sleep are not well described. This article reviews the literature including a measure of cannabis withdrawal and sleep in humans.
Methods
A literature search using a set of cannabinoid and sleep-related terms was conducted across 8 electronic databases. Human studies that involved the administration of cannabinoids and at least 1 quantitative sleep-related measure were included. Review articles, opinion pieces, letters or editorials, case studies (final N < 8), published abstracts, posters, and non-English articles were excluded. Thirty-six publications were included in the review.
Results
Sleep was frequently interrupted during cannabis withdrawal, although the specific mechanisms of disruption remain unclear.
Conclusions
Methodological issues in the majority of studies to date preclude any definitive conclusion on the specific aspects of sleep that are affected.
United Nations Office on Drugs and Crime. World Drug Report 2013. New York: United Nations Publication; 2013.
2.
HallW, DegenhardtL. The adverse health effects of chronic cannabis use. Drug Test Anal. 2014;6:39–45.
3.
BudneyAJ, HughesJR. The cannabis withdrawal syndrome. Curr Opin Psychiatry. 2006;19:233–238.
4.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington: American Psychiatric Association; 1994.
5.
WuLT, WoodyGE, YangC, PanJJ, ReeveBB, BlazerDG. A dimensional approach to understanding severity estimates and risk correlates of marijuana abuse and dependence in adults. Int J Methods Psychiatr Res. 2012;21:117–133.
6.
AgrawalA, PergadiaML, LynskeyMT. Is there evidence for symptoms of cannabis withdrawal in the national epidemiologic survey of alcohol and related conditions?Am J Addict. 2008;17:199–208.
7.
ComptonWM, SahaTD, ConwayKP, GrantBF. The role of cannabis use within a dimensional approach to cannabis use disorders. Drug Alcohol Depend. 2009;100:221–227.
8.
GillespieNA, NealeMC, PrescottCA, AggenSH, KendlerKS. Factor and item-response analysis DSM-IV criteria for abuse of and dependence on cannabis, cocaine, hallucinogens, sedatives, stimulants and opioids. Addiction. 2007;102:920–930.
9.
HartmanCA, GelhornH, CrowleyTJ, . Item response theory analysis of DSM-IV cannabis abuse and dependence criteria in adolescents. J Am Acad Child Adolesc Psychiatry. 2008;47:165–173.
10.
HasinDS, O'BrienCP, AuriacombeM, . DSM-5 criteria for substance use disorders: recommendations and rationale. Am J Psychiatry. 2013;170:834–851.
11.
PiontekD, KrausL, LegleyeS, BuhringerG. The validity of DSM-IV cannabis abuse and dependence criteria in adolescents and the value of additional cannabis use indicators. Addiction. 2011;106:1137–1145.
12.
BudneyAJ.Are specific dependence criteria necessary for different substances: how can research on cannabis inform this issue?Addiction. 2006;101(Suppl 1):125–133.
13.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington: American Psychiatric Association; 2013.
14.
AllsopDJ, NorbergMM, CopelandJ, FuS, BudneyAJ. The Cannabis Withdrawal Scale development: patterns and predictors of cannabis withdrawal and distress. Drug Alcohol Depend. 2011;119:123–129.
15.
HasinDS, KeyesKM, AldersonD, WangS, AharonovichE, GrantBF. Cannabis withdrawal in the United States: results from NESARC. J Clin Psychiatry. 2008;69:1354–1363.
16.
LevinKH, CopersinoML, HeishmanSJ, . Cannabis withdrawal symptoms in non-treatment-seeking adult cannabis smokers. Drug Alcohol Depend. 2010;111:120–127.
17.
WiesbeckGA, SchuckitMA, KalmijnJA, TippJE, BucholzK, SmithTL. An evaluation of the history of a marijuana withdrawal syndrome in a large population. Addiction. 1996;91:1469–1478.
18.
ArendtM, RosenbergR, FoldagerL, SherL, Munk-JorgensenP. Withdrawal symptoms do not predict relapse among subjects treated for cannabis dependence. Am J Addict. 2007;16:461–467.
19.
BudneyAJ, VandreyRG, HughesJR, ThostensonJD, BursacZ. Comparison of cannabis and tobacco withdrawal: severity and contribution to relapse. J Subst Abuse Treat. 2008;35:362–368.
20.
CopersinoML, BoydSJ, TashkinDP, . Cannabis withdrawal among non-treatment-seeking adult cannabis users. Am J Addict. 2006;15:8–14.
21.
CorneliusJR, ChungT, MartinC, WoodDS, ClarkDB. Cannabis withdrawal is common among treatment-seeking adolescents with cannabis dependence and major depression, and is associated with rapid relapse to dependence. Addict Behav. 2008;33:1500–1505.
22.
DawesGM, SitharthanT, ConigraveKM, PhungN, WeltmanM. Patients admitted for inpatient cannabis detoxification: withdrawal symptoms and impacts of common comorbidities. J Subst Use. 2011;16:392–405.
23.
EhlersCL, GizerIR, VietenC, . Cannabis dependence in the San Francisco family study: age of onset of use, DSM-IV symptoms, withdrawal, and heritability. Addict Behav. 2010;35:102–110.
24.
WinstockAR, LeaT, CopelandJ. Lithium carbonate in the management of cannabis withdrawal in humans: an open-label study. J Psychopharmacol. 2009;23:84–93.
25.
VandreyR, BudneyA, MooreB, HughesJ. A cross-study comparison of cannabis and tobacco withdrawal. Am J Addict. 2005;14:54–63.
26.
GatesPJ, AlbertellaL, CopelandJ. The effects of cannabinoid administration on sleep: a systematic review of human studies. Sleep Med Rev. 2014;18:477–487.
27.
ReinarmanC, NunbergH, LanthierF, HeddlestonT. Who are medical marijuana patients? Population characteristics from nine California assessment clinics. J Psychoact Drugs. 2011;43:128–135.
28.
TringaleR, JensenC. Cannabis and insomnia. Depression. 2011;4:0–68.
29.
SchofieldD, TennantC, NashL, . Reasons for cannabis use in psychosis. Aust N Z J Psychiatry. 2006;40:570–574.
30.
GlozierN, MartiniukA, PattonG, . Short sleep duration in prevalent and persistent psychological distress in young adults: the DRIVE study. Sleep. 2010;33:1139–1145.
31.
FreemanD, BrughaT, MeltzerH, JenkinsR, StahlD, BebbingtonP. Persecutory ideation and insomnia: findings from the second British national survey of psychiatric morbidity. J Psychiatr Res. 2010;44:1021–1026.
32.
WongMM, BrowerKJ, ZuckerRA. Childhood sleep problems, early onset of substance use and behavioral problems in adolescence. Sleep Med. 2009;10:787–796.
33.
MednickSC, ChristakisNA, FowlerJH. The spread of sleep loss influences drug use in adolescent social networks. PLoS ONE. 2010;5:e9775.
34.
MoherD, LiberatiA, TetzlaffJ, AltmanDG. The PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Med. 2009; 6(6): e1000097. doi:10.1371/journal.pmed1000097
35.
VandreyR, BudneyAJ, KamonJL, StangerC. Cannabis withdrawal in adolescent treatment seekers. Drug Alcohol Depend. 2005;78:205–210.
36.
BudneyAJ, MooreBA, VandreyRG, HughesJR. The time course and significance of cannabis withdrawal. J Abnorm Psychol. 2003;112:393–402.
37.
BudneyAJ, NovyPL, HughesJR. Marijuana withdrawal among adults seeking treatment for marijuana dependence. Addiction. 1999;94:1311–1322.
38.
HaneyM, CooperZD, BediG, VosburgSK, ComerSD, FoltinRW. Nabilone decreases marijuana withdrawal and a laboratory measure of marijuana relapse. Neuropsychopharmacology. 2013;38:1557–1565.
39.
VandreyR, StitzerML, MintzerMZ, HuestisMA, MurrayJA, LeeD. The dose effects of short-term dronabinol (oral THC) maintenance in daily cannabis users. Drug Alcohol Depend. 2013;128:64–70.
40.
VandreyR, SmithM, McCannU, BudneyA, CurranE. Sleep disturbance and the effects of extended-release zolpidem during cannabis withdrawal. Drug Alcohol Depend. 2011;117:38–44.
41.
VandreyR, BudneyA, HughesJ, LiguoriA. A within-subject comparison of withdrawal symptoms during abstinence from cannabis, tobacco, and both substances. Drug Alcohol Depend. 2008;92:48–54.
42.
PranikoffK, KaracanI, LarsonEA, WilliamsRL, ThornbyJI, HurschCJ. Effects of marijuana smoking on the sleep EEG. Preliminary studies. J Fla Med Assoc.1973;60:28–31.
43.
PenetarDM, LoobyAR, RyanET, MaywaltMA, LukasSE. Bupropion reduces some of the symptoms of marihuana withdrawal in chronic marihuana users: a pilot study. J Subst Abuse Res Treat. 2012;6:63–71.
44.
MilinR, ManionI, DareG, WalkerS. Prospective assessment of cannabis withdrawal in adolescents with cannabis dependence: a pilot study. J Am Acad Child Adolesc. 2008;47:174–179.
45.
McClureEA, StitzerML, VandreyR. Characterizing smoking topography of cannabis in heavy users. Psychopharmacology. 2012;220:309–318.
46.
MathersDC, GhodseAH. Cannabis and psychotic illness. Br J Psychiatry. 1992;161:648–653.
47.
JonesRT, BenowitzN, BachmanJ. Clinical studies of cannabis tolerance and dependence. Ann N Y Acad Sci. 1976;282:221–239.
48.
HaneyM, BediG, CooperZD, . Predictors of marijuana relapse in the human laboratory: robust impact of tobacco cigarette smoking status. Biol Psychiatry. 2013;73:242–248.
49.
HaneyM, HartCL, VosburgSK, . Effects of baclofen and mirtazapine on a laboratory model of marijuana withdrawal and relapse. Psychopharmacology. 2010;211:233–244.
50.
HaneyM, HartCL, VosburgSK, ComerSD, ReedSC, FoltinRW. Effects of THC and lofexidine in a human laboratory model of marijuana withdrawal and relapse. Psychopharmacology. 2008;197:157–168.
51.
HaneyM, WardAS, ComerSD, FoltinRW, FischmanMW. Abstinence symptoms following oral THC administration to humans. Psychopharmacology. 1999;141:385–394.
52.
HaneyM, WardAS, ComerSD, FoltinRW, FischmanMW. Abstinence symptoms following smoked marijuana in humans. Psychopharmacology. 1999;141:395–404.
53.
HaneyM, WardAS, ComerSD, HartCL, FoltinRW, FischmanMW. Bupropion SR worsens mood during marijuana withdrawal in humans. Psychopharmacology. 2001;155:171–179.
54.
CooperZD, FoltinRW, HartCL, VosburgSK, ComerSD, HaneyM. A human laboratory study investigating the effects of quetiapine on marijuana withdrawal and relapse in daily marijuana smokers. Addict Biol. 2013;18:993–1002.
55.
Cohen-ZionM, DrummondSP, PadulaCB, . Sleep architecture in adolescent marijuana and alcohol users during acute and extended abstinence. Addict Behav. 2009;34:976–979.
56.
BudneyAJ, HughesJR, MooreBA, NovyPL. Marijuana abstinence effects in marijuana smokers maintained in their home environment. Arch Gen Psychiatry. 2001;58:917–924.
57.
BollaKI, LesageSR, GamaldoCE, . Sleep disturbance in heavy marijuana users. Sleep. 2008;31:901–908.
58.
BollaKI, LesageSR, GamaldoCE, . Polysomnogram changes in marijuana users who report sleep disturbances during prior abstinence. Sleep Med. 2010;11:882–889.
59.
The Cochrane Collaboration. The Cochrane Collaboration's tool for assessing risk of bias. In: HigginsJPT, GreenS, ed. Cochrane Handbook for Systematic Reviews of Interventions. Vol. 5.1.0. Oxford, UK: The Cochrane Collaboration; updated March 2011. Available atwww.cochrane-handbook.org. Accessed January 29, 2014.
ViswanathanM, AnsariMT, BerkmanND, . Assessing the risk of bias of individual studies in systematic reviews of health care interventions. In: Agency for Healthcare Research and Quality, ed. Methods Guide for Effectiveness and Comparative Effectiveness Reviews. AHRQ Publication No. 12-EHC047-EF. Rockville, MD: Agency for Healthcare Research and Quality; 2012.
