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Each month Nurse Practitioner Eloise Theisen will explain how to use cannabis for a specific ailment or issue. Have a protocol you want outlined? Email [email protected] 

Insomnia can be relatively easy to treat with cannabis. In some cases though, insomnia can be resistant to most treatments, including cannabis. Finding the right cannabis product depends on the cause and the severity of the insomnia.

Let’s say someone has a hard time falling asleep.

Utilizing a product that is quick acting such as inhaling of cannabis, can help someone fall asleep within 15-20 minutes. Inhaling can occur through vaporization or smoking.

 

 

Vaporization has been a more popular way of inhaling. The plant material is heated at a lower temperature when vaporizing which is less likely to cause irritation to the lungs and/or throat. Vaporizers steadily heat cannabis to a temperature that vaporizes the cannabinoids and terpenes, but at a temperature too low to vaporize toxins that are released during combustion. Vape pens are abundant and not all are created equal. Some vape pens now deliver metered doses, such as the hmbldt pens. Others have temperature control batteries. Overall, vape pens allow patients to use their medicine discretely and efficiently.

Smoking buds and flowers can also be an effect way to fall asleep. The buds and flowers can either be used in a vaporizer, rolled up in a joint or simply placed in a pipe. Some patients are reticent to smoke cannabis for fear of side effects commonly attributed to tobacco use. In fact, cannabis smoke contains some of the same carcinogens as tobacco smoke, and even greater concentrations of harmful aromatic hydrocarbons, such as benzopyrene. Critics have used this information to promote fears that chronic cannabis inhalation may be a risk factor for tobacco-use related cancers. But cannabis smoke also contains non-carcinogenic cannabinoids that demonstrate anti-cancer properties in vivo and in vitro. And whereas nicotine promotes the development of cancer cells and their blood supply, cannabinoids mitigate the carcinogenic effects of smoke by inhibiting the production of potentially carcinogenic free radicals that accelerate the progression of cancer.

Inhaling cannabis will provide immediate effects at the lowest dose, thereby giving patients the most control over their dosing. Often 1-3 inhalations is enough to induce sleep. Please be sure to look for products that have been tested for molds, pesticides, bacteria, fungus, potency and are free of additives such as propylene glycol and/or coconut oil.

Choosing the right flowers or vape cartridge can be overwhelming. Strain names don’t always tell you how the medicine will affect you. In general, indicas tend to be more relaxing and sedating. With most strains being hybrids (a mix of sativa and indica), look for strains that are more indica dominant. And if terpene profiles are available, look for strains high in myrcene, linalool and/or nerolidol. I often recommend starting with a THC product for sleep as CBD can be stimulating in about 33% of people.

Staying asleep is the more common compliant associated with insomnia.

Often patients find themselves waking up frequently throughout the night. In those situations, choosing a product that has long lasting effects, such as an edible or tincture is best for staying asleep. Cannabis can enter the body through the gut by ingestion. The absorption is variable (depending on metabolism and gut content), with onset from 30 minutes to 2 hours, and lasting 5 to 8 hours. Most cannabis products that patients ingest are called edibles – these are any foods and drinks that are infused with cannabis. Typically, edibles contain at least one ingredient that is high in fat like butter or olive oil. These fats enable the extraction of the plant’s cannabinoids. Ingesting of cannabis can produce effects significantly different than from other delivery methods.

Low doses of cannabinoids, often between 2.5-5mg is enough to promote a good night sleep without feeling groggy in the morning. Tinctures are easiest to regulate the dose. In a new, inexperienced user, a tincture allows a patient to start with a few drops at a time. It is important to note that cannabis-infused medications may not absorb well into the oral mucosa and much of the preparation is likely swallowed, meaning that the duration and effects follow the pattern of ingestion.

Low dose edibles are a great place to start as well. It is best to find relief at the lowest dose possible. The lower the dose, the less likely someone will experience side effects as well as build a tolerance to the effectiveness of the dose. Higher doses can produce unwanted side effects such as dry mouth, increased heart rate, anxiety and even insomnia. I recommend waiting 2 days before increasing the dose as ingested cannabis can have an accumulative effect thereby leading to more side effects. Some patients may find that their dose is somewhere between 5 and 50 mg for sleep.

As always, it is best to talk with your health care professional if you are taking other medication before beginning cannabis. If you’ve tried all of the above and you’re still having trouble sleeping, consider consulting with a cannabis practitioner.

References –

  1. http://www.webmd.com/lung-cancer/news/20060523/pot-smoking-not-linked-to-lung-cancer#1
  2. http://norml.org/component/zoo/category/cannabis-smoke-and-cancer-assessing-the-risk
  3. http://online.liebertpub.com/doi/pdfplus/10.1089/can.2016.0009

 


For over 17 years, Eloise Theisen has been a dedicated and patient-focused nurse specializing in aging, cancer, chronic pain, dementia, Alzheimers, Parkinsons, anxiety, depression, fibromyalgia, and various auto-immune and neurological diseases. The founder of Radicle Health (formerly Green Health Consultants), she started her career at John Muir Medical Center caring for patients suffering from cancer, terminal illnesses, respiratory failure/complaints, drug overdoses, acute alcohol ingestion, gastrointestinal bleeds, traumatic brain injury, and multiple traumas and from there worked her way up to management. Following that, her work with Aunt Zelda’s and the American Cannabis Nurses Association gained her an extensive knowledge of the Endocannabinoid system and how cannabis and cannabinoids can be used successfully to treat patients. 

An East Bay, California native, Eloise is a passionate advocate for medical cannabis and cannabis oil alternatives after seeing the positive benefits it has had for patients. In partnership with Dr. R. David Ferrara MD, she started Radicle Health, a clinic dedicated to ensuring patients receive the qualified counseling they need to safely and effectively use cannabinoids to manage a health condition, cure an illness or reduce their intake of pharmaceuticals. She also provides education and training to other medical practitioners on the therapeutic potential of cannabis as a treatment option.

Eloise was a board director for the American Cannabis Nurses Association (ACNA) (2014-2016) where she helped develop the first on-line core curriculum program for nurses on cannabinoid therapeutics. She currently serves on the scope and standards committee for the ACNA. She is working to help further legalize and destigmatize therapeutic cannabis therapy. She’s a regular speaker at industry events and teaches classes at universities in the San Francisco Bay Area.

She has a Post Masters certification as an Adult-Geriatric nurse practitioner from University of Mass, Boston; an MSN in Nursing Administration from California State University; and a Bachelor of Science in Nursing from San Francisco State University.

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