I am not a cannabis expert by any means. This post is meant to share what I do know about cannabis and research that we have just published in Sleep Health: Journal of the National Sleep Foundation. The publication is available on the journal’s website for the month of September only. I have no financial connection to this journal and get no benefit from your clicking on this, but the journal notifies authors of a short period of time they can all publications.

 

Cannabis is a broad term that includes many different plant types (strains). The plants include numerous different components (cannabinoids) that can have different effects on the body, not to mention different effects on different people. Cannabis and the cannabinoids have received substantial attention for possible medical uses, including for sleep disorders. Most commonly, these have been used to help with different types of insomnia: difficulty falling asleep, staying asleep, and falling back asleep after waking up.

Could cannabis make snoring and sleep apnea better or worse?

It turns out that cannabis has been proposed as a possible treatment for snoring and obstructive sleep apnea. THC (tetrahydrocannabinol) is the component of marijuana associated with euphoria and reduced pain and nausea, but it is also possible that THC can increase activity of upper airway muscles to keep the airway open during sleep. In 2018, a research group studied whether dronabinol (synthetic form of THC) could improve obstructive sleep apnea. The results of the PACE trial showed that dronabinol resulted in a notable improvement in daytime sleepiness but not sleep apnea, at least not based on sleep studies done before and during treatment. It turns out that there was some interest in use of this medication to treat sleep apnea. I was actually briefly a consultant for one company that proposed exploring cannabinoids to treat obstructive sleep apnea, but this company never gained traction.

There are multiple other effects of cannabis and cannabinoids. One is that sedating effects can do what is called raise the arousal threshold; this can allow individuals who wake up a little too easily to sleep through periods where the space for breathing in their throat is slightly narrowed but maybe not to the extent where it causes real decreases in breathing. This would improve obstructive sleep apnea, as people could sleep through disruptions of sleep and get to periods of more-stable breathing. In fact, this idea is actually part of the basis of some of my sleep apnea surgery research funded by the National Institutes of Health. An opposite effect would be that sedation can cause affect the brain and cause muscle relaxation, worsening snoring and obstructive sleep apnea. My research uses a medication that does not cause muscle relaxation, but many sedating substances do have these effects. Finally, inhaled use of cannabis or cannabinoids can result in swelling of the lining of the nose and throat, narrowing the space for breathing.

What about cannabis use in general use outside of clinical trials?

With the growth in medical and recreational use of cannabis and cannabinoids that has accompanied legalization in many states, some have wondered whether there has, in fact, been some benefit to snoring or sleep apnea. When I was at USC, medical students (Tyler Gallagher and Matt Lin) who are now otolaryngology-head and neck surgery residents at USC and UCLA, respectively, approach me with their research. They wanted to examine whether cannabis use was associated with signs of snoring and obstructive sleep apnea. I became involved with the work, along with some other collaborators, but they deserve the credit for doing the real work.

Every year, the Centers for Disease Control and Prevention (CDC) performs a telephone-based survey of individuals in the US through the Behavioral Risk Factor Surveillance System that collects information about health-related risk behaviors, chronic health conditions, and use of preventive services. Drs. Gallagher and Lin obtained data from the 2017 and 2018 surveys and evaluated an association between cannabis use and signs of obstructive sleep apnea (two separate questions: loud snoring and stopping breathing during sleep). Among almost 15,000 adults, the research showed that cannabis use was associated with both snoring and stopping breathing during sleep. Regular use (16-30 days a month) was associatd with almost a doubling of the odds of having either loud snoring or stopping breathing during sleep, as compared to no use. Each day (from 1-30 days per month) was incrementally associated with an increase in the odds of having these signs. Real strengths of the work is that this was a large study population and that all results included statistical adjustment for many other risk factors for snoring and sleep apnea that were included in the Survey: age, sex, race/ethnicity, education, income, body mass index, tobacco use, and alcohol use. Of course, the study determined association without establishing causation (that cannabis use causes loud snoring or stopping breathing during sleep). Another limitation is that the Survey did not ask about method of cannabis use, as inhalation is probably worse than other methods of use.

The bottom line: be cautious about cannabis use when it comes to snoring and sleep apnea

Cannabis and cannabinoids may have important benefits for patients with some sleep disorders. Unfortunately, it seems that cannabis and cannabinoids may worsen snoring and sleep apnea but, at a minimum, are not – yet – viable treatment options.