BY MARIE LODI | Original illustration for Ember by Derek Abella
"Coronasomnia." "COVID-somnia." Whatever you want to call it, the reality is, more than half of Americans are struggling with sleep at record highs during this pandemic. According to the CDC, an estimated 70 million people in the United States suffer from chronic sleep disorders, including insomnia. And after the year we’ve had, the number has gone up—a study from the American Academy of Sleep Medicine (AASM) showed that web searches for insomnia had increased by 58% during the first five months of 2020 compared to the previous three years.
When the AASM repeated the survey in March of 2021, 56% of the over two-thousand people surveyed reported struggling with pandemic-related insomnia, including "problems falling or staying asleep, sleeping less, experiencing worse quality sleep, and having more disturbing dreams."
I was certainly one of those people. Sleep had never really been a problem for me before the pandemic. However, I soon became one of the many experiencing “coronasomnia,” as it has been called. Between the stress and fear of the pandemic and my dog passing away, I’d find myself lying awake as the hours crept by, a million thoughts running through my head. (When I did sleep, I would have stress dreams about forgetting my mask out in public, an apparently common nightmare.)
“Insomnia is defined as either difficulty falling asleep, maintaining sleep, or early morning awakening,” explained Dr. Alon Y. Avidan, director of the UCLA Sleep Disorders Center and a professor in the department of neurology at the David Geffen School of Medicine at UCLA. “And you have to have next-day consequences, meaning that there is often fatigue, cognitive issues, memory problems, stress, or depression the following day.”
In order to understand insomnia, Dr. Avidan told Ember, you have to think about the Spielman model's "3 Ps" of insomnia. The first “P” is a predisposing factor, which he said generally relates to stress. “The patient may be a very anxious person, or are type A, or have a degree of hyper arousal just around bedtime, but they don't necessarily have insomnia,” said Dr. Avidan.
The next “P” refers to precipitating factors. “COVID-19 is a prime example,” he continued. “Someone could be at risk for insomnia and then there is something bad, like the pandemic, a loss of a job, getting divorced, having surgery, or suffering some sort of a loss. It causes that precipitating event, which triggers the insomnia, and now you've crossed the threshold.”
The final “P” is the perpetuating factor, a habit that is developed following the first two. One example Dr. Avidan mentioned is when a person starts using something like Benadryl to fall asleep, but after a while, the dosage loses efficacy so the patient ends up using more of it. “Other examples include caffeine, nicotine, watching TV too close to bedtime, and having an e-device or iPhone in bed. That blue light is never really helpful for sleep because it tends to wake the brain up,” he explained. “Those devices tend to stimulate the circadian clock and inhibit production of melatonin. That's why we recommend that patients stay away from electronics within two hours of bedtime.”
Another perpetuating factor is actually being in bed. “The more you spend time awake in bed, the more you begin to associate the bed with poor sleep, and the brain learns very quickly that that's a place for thinking, that it’s a place for organizing the day and planning,” said Dr. Avidan. “So, we generally recommend never to spend more than 15 minutes awake in bed.”
Studies have shown that insufficient sleep can eventually lead to a number of diseases and conditions, including type 2 diabetes, obesity, cardiovascular disease, depression, anxiety, a weakened immune system, mood disorders, and dementia. With my health on the line (and the general desire to feel well-rested while having respite from the waking nightmare that is the pandemic), I decided to do something about my insomnia. Enter: cannabis.
Dr. Jordan Tishler, MD, president of the Association of Cannabis Specialists and faculty at Harvard Medical School, said that insomnia is well-treated with cannabis, if used properly. “The type of cannabis product and the dose are the key elements to success and vary with the type of insomnia,” he explained to Ember. For people who have the type of insomnia where it’s hard to get to sleep in the first place, Dr. Tishler said low-dose inhaled cannabis is best (he recommends vaporized whole flower), while people who have trouble staying asleep should avoid this method because it wears off too soon. “In that case, orally ingested cannabis, like an edible, is more effective.”
Dr. Tishler also noted to pay close attention to timing your THC dose for sleep—it's important to prevent a “weed hangover” effect the next day, due to a mild slight cognitive impairment due to your body's metabolization of THC. For insomnia encompassing both issues pertaining to falling and staying asleep, he said that oral THC in the form of edibles is best, but the timing of the dose has to be sufficiently enough before bed to allow it to start working. “Low-dose is key, higher doses can interfere with sleep.”
I’ve always fallen asleep easily when consuming cannabis. A couple hits from a joint and I’ll be in snoozeland. But during the pandemic I took a break from flower and decided to get more into THC edibles and sublinguals (tinctures and strips that go under the tongue). Whether it was an CBN gummy from Kiva or a CBN sublingual tab from Sandland, I was always able to fall asleep. However, I didn’t use cannabis every time to avoid developing tolerance. But because my dosage was so low, it was most likely not a risk. “At higher doses people will develop an escalating tolerance to cannabis that can be problematic,” explained Dr. Tishler. “However, at low doses the tolerance does not appear to escalate. So if the dose is appropriately low, then it should not stop working and no increase in dose should be necessary.”
It’s important to point out that while there has been plenty of anecdotal evidence that cannabis has been used as a sleep aid and some recent studies show a possible link between the two, there still needs to be a lot more research done. Preliminary research suggests that there may be therapeutic potential for the treatment of insomnia with cannabidiol (CBD) while Delta-9 tetrahydrocannabinol (THC) may "decrease sleep latency but impair sleep quality in the long term." Which is why sleep experts like Dr. Avidan may not recommend using cannabis. “Maybe we'll have more data in the next few years, but right now I would not advise patients to use cannabis for sleep, particularly for insomnia, because of lack of data,” he said. Instead, Dr. Avidan suggests things to help promote the production of melatonin in the body, like using a cooling pillow to regulate body temperature, and making sure the room that you’re sleeping in is dark.
As researchers learn more about how cannabis might be able to help with sleep, one factor may have to do with terpenes. Myrcene, which is one of the most prevalent terpenes in cannabis and is also found in hops, lemongrass, and mangoes, contributes to somnolence. “Myrcene has been reasonably well-studied for this and is available in Germany as a sleep aid by itself,” explained Dr. Tishler. In the meantime, I’ve been working on my sleep hygiene using Dr. Avidan’s tips while also enjoying my edibles and sublinguals—and my struggles with getting a good night's sleep have vastly improved.
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Marie Lodi is an LA-based writer, editor, and podcaster. Her bylines have appeared in The Cut, PAPER, Buzzfeed News, Bustle, Fashionista, Allure, and more.