New frontiers in treating chronic insomnia in Canadian Veterans with PTSD: retrospective analysis reveals an innovative role for medical cannabis in optimizing sleep/wake health

Abstract: There is a bi-directional relationship between sleep and psychological and physical disorders. Chronic insomnia is primarily the result of autonomic nervous system (ANS) instability with increase sympathetic nervous system (SNS) tone, which perpetuates and exacerbates pain symptoms and adversely affects the immune system (Moldofsky et al 2001; Kruger 2008) and endocrine system (Schafers et al 2008). In veterans suffering from PTSD, there is triggering of the flight & fight system (ie. SNS) and this triggers hypervigilance/hyperarousal, resulting in chronic insomnia. Clinically, chronic insomnia is difficult to treat with standard pharmacological agents. Currently, pharmacologic agents are used as first-line to treat insomnia; these include non-benzodiazepine receptor agonists, benzodiazepine receptor agonists, the selective melatonin receptor agonist ramelteon, and sedating antidepressants. When these do not prove to be effective, then other pharmacological agents are used off label to induce sleep and these include: anti-psychotics, gravol, and even opioid, with adverse side-effects on sleep/wake functioning. Veterans suffering from chronic intractable insomnia will self-medicate with alcohol and street cannabis so as to find the relief of sleep. Targeting sleep with medical cannabis (MC) treatment has the potential to have a positive effect on co-morbid psychological and physical disorders, while reducing the unwanted side-effects of other pharmaceutical agents. It also has the potential for harm reduction, by decreasing the off label use of pharmaceutical agents and decreasing the risk of self-medication through alcohol or other illicit substances. This study is a retrospective chart review of 100 Canadian Veterans, who were treated with standard pharmacological agents and then given access to treatment with MC ranging from 3 g–10 g OD. The side-effect profiles of the medications they were prescribed were reviewed. Standardized scales assessing function and sleep quality before and after the initiation of MC revealed a marked improvement in sleep, functioning and improved physical and mental health. Review of the dosing regimens developed by veterans, revealed that daytime microdosing dosing with CBD oil during the day and dosing with hydrid CBD/THC oil and/or high THC whole-plant brought both daytime and nighttime PTSD and SNS hyperarousal under control, resulting in marked improvement in sleep and daytime functioning.

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