Goodbye, Insomnia: A HelloMD Educational Event

Last week, HelloMD held an educational event—the first of many—in San Francisco, hosted by our Chief Medical Officer Perry Solomon, M.D., and featuring Chris Emerson, Level’s co-founder and chief scientist. Roughly 20 folks attended to find out how cannabis might help with their insomnia.

Dr. Solomon along with Chris, who holds a Ph.D. in small molecule chemistry and attended Stanford University as a post-doctoral fellow, started out by going over the basics—from endocannabinoids produced in our body and phytocannabinoids found in cannabis to how these compounds interact with our endocannabinoid system, helping maintain balance, or homeostasis.

They then spent a good chunk of time going over the what, when and why around insomnia—as well as suggestions on how to get a good night’s sleep. Following are excerpts of their in-depth discussion along with the Q&A session that followed.

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Do you live in or near San Francisco? [Check out our “How to Microdose With Cannabis” event] scheduled for Thursday, July 12.

What components of cannabis or what products would people use to treat their insomnia?

Chris Emerson: Yeah, I think a lot of times it's been about products with delta-9 tetrahydrocannabinol (THC). After you use THC, you don’t feel tired necessarily, but it's not an energizing thing for the most part. By the time you get done with THC, you do feel a little sluggish. So, as people use delta-9 THC, I think it can help facilitate sleep.

There are a lot of different reasons why some of the other cannabinoids that are coming on the market, especially cannabidiol (CBD) and cannabinol (CBN), that may not have—for most people—the psychoactivity of delta-9 THC, can also be really good for helping people relax, and to try and treat persistent sleep issues.

Some people have a problem going to sleep, and some people have a problem staying asleep. Would there be different ways to treat each of those types of insomnia?

CE: Yeah, definitely. I think so. Some people just need help relaxing to fall asleep. Once they fall asleep, they can stay asleep; that's one application. Some people are going to fall asleep, and then they'll rebound and wake up at two or three in the morning—mind's racing, the body's tired, and they can't fall back asleep; it’s a different use case. And then all of the combinations that occur in between. And so, the method of using a certain dosage route of administration of cannabis can be very impactful on how it's going to affect your ability to treat your condition of persistent sleeplessness.

Are there other issues that cannabis can help with so that people can go to sleep? In other words, chronic pain or anxiety or whatever it may be. And would you use different types of products for a given condition or symptom?

CE: Yes, for sure. So, you're talking about clinical manifestations of pain. There's inflammation in inflammatory and neuropathic conditions, and cannabis treats them slightly different. Maybe you have acute pain, so you want to vape. Either flower or concentrate because you need acute relief to help minimize the pain so you can fall asleep.

Or maybe you can fall asleep, but you wake up in the middle of night. So, maybe you want an edible or some type of oral dosage as you fall asleep as their effects last longer than the effects from vaping.

Perry Solomon: Yes, exactly. And it might be different for everybody. Maybe you vape to go to sleep; the vape helps you fall asleep. And then you also take a dosage of an edible, so it helps you maintain sleep throughout the night. And part of the journey that Chris was talking about is for people to keep track of their sleep cycles. Because what you eat has something to do with how cannabis, the medicine, reacts in your body. What time you took it before you went to sleep and how you're feeling the next day are also very impactful in terms of what you use.

Someone may wake up and say, I still feel a little bit high. I took an edible. Maybe I should have used that before—an hour or a half hour before I went to sleep. So, keeping a journal about what it is you took and how you slept that night kind of dials in for each person what works for them. Because everyone reacts differently to cannabis, and everyone goes a different way in their journey of going to sleep.

One of the biggest frustrations to be able to recommend something is that there's no one size fits all with cannabis. It's more about trying something, seeing what and how it works, and moving onto something else or going on to keep using the same product. Because everyone completely depends on their own personal physiology and what else they do during the day. Cannabis isn't the answer. It's a part of a holistic approach that includes changing your lifestyle and eating habits as well as exercise.

Do physicians recognize cannabis as an effective treatment for insomnia?

PS: No, doctors don't have any idea that cannabis works like that at all because no one taught us about cannabis in medical school. Physicians are very afraid of giving recommendations or talking about it mostly due to their ignorance. If you're going to ask your doctor about cannabis for insomnia, they'll look at you with a blank stare or say, “Well, let me give you some Ambien or some Xanax,” because they know how to prescribe that. They can tell you to take a half a pill every hour. Doctors know exactly how it's going to work.

Cannabis is a very individualistic thing, and it's frustrating for a physician not to know exactly how much to prescribe and write that out on their prescription pad. Doctors can write something for pain; they can write something for antibiotics, but they can't write a prescription specifically telling you exactly how much cannabis to take.

They're learning though. When you go in to talk to your physician about using cannabis, I highly recommend you show them what you’ve learned, because you will educate them about using cannabis—for insomnia specifically, and for other medical conditions.

So, how does someone know how much cannabis to take for their insomnia?

CE: It depends on a person’s experience with cannabis—how much have you tried cannabis—and then understanding dosing and different routes of administration. Essentially, there are five routes of administration. You can have a topical route of administration. You can smoke or inhale. You can swallow things; that's an oral route of administration. You can let it dissolve in your mouth through sublingual or mucosal route of delivery; that's sublingual. There's also rectal and vaginal—or suppository.

Most products on the market are topicals, inhalants, sublingual and oral. And each one has a different effect in your body, because your body processes cannabis differently depending on the route of administration or also because of the uptake for it. And so if people are unfamiliar with cannabis, it's important to understand the different routes of administration. Different products are formulated for different routes, and you're going to have different experiences depending on the route of administration.

For people who are new to cannabis, start low and go slow. Microdosing is very popular as a term; these are products that are 5 mg or less. If you're concerned about psychoactivity, start with something that’s high in CBD, or CBD only. There’s some other non-psychoactive cannabinoids out there, but CBD is usually a really good one to start with as the baseline. Then you can start to incorporate some delta-9 THC and find a balance between those two that may work for you. Then once you feel confident with those, you can really start exploring.

If someone were to say that they’re just lying there in bed, and their mind is racing; they’re anxious. What would you suggest to someone like that?

CE: For me, CBD works really well. There’s also a cannabinoid CBN. It's pretty rare. It's kind of hard to find because the plant actually doesn't produce it. It's a non-enzymatic degradation byproduct. So, it converts over time from delta-9 THC to CBN. Purportedly, it has very good sedating or sleep-enhancing properties. But we haven't really been able to look at it, and there's not a lot or very many products on the market that have it.

So, CBD is a great one to really look at. It helps people relax. A lot. It may calm your mind, reduce anxiety. There's also delta-8 THC that's starting to hit the market. This is a very relaxing cannabinoid, and we find that when combined with CBD, it has very relaxing qualities. I actually use a mixture of these two cannabinoids every night to sleep because it helps me calm, helps my mind stop racing.

So, you get into a pattern or ritual of going to sleep every night. You take some cannabis, whatever it is that works for you. You put your phone down since you’re trying to calm your body down and relax from the day, and then potentially use an oral dosage 30–60 minutes before you lay down.

And when you’re lying down, maybe you use a tincture or some type of sublingual that's fast-acting, usually 5–15 minutes, that then helps this onset ramp before the oral dosage kicks in to help you maintain throughout the night. There's a ton of products out there that you can take that are between 5–20 mg, depending on what's going to work for the individual.

Also, can you identify parts of your day when you could incorporate breathing or meditation or supplement with some cannabis, too? During the day, we can get really stressed, whether we're dealing with some crisis or interacting with family or employees. We don't think about it. We just get through the day.

So, when we start shutting our bodies down, and we're in the middle of our sleep, we wake up in a panic, because now our bodies are trying to process all of these emotions from the day. So, can we identify throughout the day what's happening that leads to us having these persistent sleep issues, and then in that, can we use cannabis to help us address these issues?

I think when we don't try to change patterns and adjust throughout the day, that's when we say, “Oh, I want a silver bullet. I just want to sleep, so I'm going to take some Ambien.” We’re going to take something that can knock us out and not address a systemic issue in our lives.

Photo credit: Cris Saur

If you’re new to cannabis and want to learn more, take a look at our Cannabis 101 post. HelloMD can help you get your medical marijuana recommendation; it's easy, private and 100% online.