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Millions of people all over the world suffer from disrupted and poor quality sleep because they suffer from obstructive sleep apnea (OSA). There are few effective treatments; the most effective is positive airway pressure, which is uncomfortable and sometimes intolerable. There is some evidence that dronabinol, the synthetic version of delta-9 tetrahydrocannabinol, or THC, can improve sleep on some measures.
According to the preclinical trials, dronabinol can improve respiratory stability and improves OSA. Unfortunately, some of the side effects are troubling. Somnolence, or sleepiness, is common, alongside psychoactivity and some discomfort. The long term safety profile is not known either. There has to date been no study of medical cannabis and OSA.
The American Academy of Sleep Medicine (AASM), who commissioned this report, conclude that there is insufficient evidence to recommend medical cannabis can or should be used for treating OSA. Further research is welcomed.
In this review, the AASM compiled the available data, which are limited in scope and representational capability. They cite animal studies that demonstrated that dronabinol “improved respiratory stability”, which led to small studies with humans. A variety of doses of dronabinol were administered to patients, who experienced a 32 percent improvement in a key sleep apnea index. There were some side effects, the most prominent of which was somnolence, which was reported in up to half of patients.
Another later study found that sleep apnea was reduced by 33 percent with no change to the “maintenance of wakefulness test” scores. Only 8 percent reported somnolence or side effects.
This looks promising but it is far from conclusive. They were small tests carried out on relatively few patients. Long-term efficacy has not been established, nor has a safety profile been developed. There are concerns about central nervous system cannabinoid interactions and mental health. The effects on other measures of sleep quality have not been studied.
The cost of obstructive sleep apnea on individuals, businesses, and society as a whole is enormous. The contributing factors of OSA are increasing, mainly due to increasing obesity levels amongst adult populations. While there is some evidence cannabis could be of benefit, there is not enough.
For a drug to be approved by the FDA, it has to undergo intensive testing and evaluation before it can be released for prescription. While medical cannabis has been studied extensively for use in many different conditions, there has been very little for the treatment of OSA. In the absence of solid data on efficacy and safety, it is impossible to recommend cannabis as a treatment for OSA. This does not mean that the evidence will not support cannabis use in the future, just that it has not been produced yet. Further study will fill in the gaps.
The AASM cannot support the prescription or recommendation of medical cannabis for treating obstructive sleep apnea. Doses are inconsistent, the safety profile has not been established, and there is insufficient evidence for efficacy. However, the evidence that does exist is hopeful. Future studies may prove cannabis is effective, until then, however, it cannot be recommended.cannabis-to-help-sleep-apnea