Cannabis for Sleep Apnea: The Evidence is Limited. Interview with Dr. Paul Boylan

​The Cannabis Boomer Podcast is not just for baby boomers and older adult, but also for all adults who are interested in the science of cannabis. Key words for the podcast, in general ,are: baby boomers, cannabis, boomers, marijuana, THC, CBD, health, wellness, science, and aging.

For this particular episode, key words are: cannabis, obstructive sleep apnea, marijuana, THC, CBD, and sleep.

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And now your host Alex Terrazas PhD, The Cannabis Boomer.

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paper looked far back as the: 1800

nd, but that was back in like: 2016

Our systematic review only found nine unique records. Now those records did have some positive findings that patients reported having some improvements in their symptoms, a reduction in the number of APNIC episodes that they feel overnight. But we also found some signals saying that these drugs were cannabis aren't benign.

80% of participants across all of the different studies that were included did develop some side effects, whether those were central nervous system related, or gastrointestinal, just some upset stomach. So there's, there's a good balance there in some efficacy along with some safety concerns.

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So and we explain this in the paper as well, if I'm happy to share this with you and your peers, that when we're talking about obstructive sleep apnea, that is more of like an upper airway imbalance, right? And that can deal with. Just chemo reception or changes in neurotransmission. There's some issues that are going on with the, the muscles that relates to patency of the upper airways and.

Under normal physiologic conditions, we have endocannabinoids and those endocannabinoids hit some receptors, the CB receptors, and when they work and activate those CB receptors, they've been shown to decrease the amount of time it takes to fall to sleep, and they may improve the quality and the amount of time that someone would experience in those restorative sleep stages. They may even help to have some positive effect on circadian rhythm, and it was because of those pharmacologic reasons or mechanisms that some researchers were thinking, well, maybe this might be a compelling area for rational drug discovery or experimental trials.

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And we've seen that physiologically and clinically in those spaces. Interestingly enough, we did not see tolerance, or there was very little mention of it in the records that were included in the studies for obstructive sleep apnea. So it's unclear if there's a different mechanism. Or if these agents, the prescription cannabinoids or marijuana or THC or any of those compounds, if there's a difference there when the, the sleep syndrome is different from insomnia and obstructive sleep apnea, but we did not see or encounter that mentioned in any of the studies here.

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In fact, states like Minnesota codified into their law to protect patients and prescribers, and they listed obstructive sleep apnea as a medical indication for the the treatment, with cannabinoids or cannabis to try and kind of say we have to do a little bit more investigation in that space. As a pharmacist, certainly my practice is always guided by do no harm, that I, I don't wanna expose a patient to any sort of medication prescription over the counter recreational that can be unwell for their health. And so I think that there are some promising results that we saw just given the, the data that was collected here.

But definitely there is certainly an opportunity for additional research given the small number of records that we were able to find in our review.

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So in addition to having more experimental studies in this space, the number one thing that is needed that we identified in our systematic review of the literature, what the American Academy of Sleep Medicine has advocated for, and even those papers and editorials that have been out there, the number one limitation of this evidence is the short study duration. The median duration of the trials that we found was about three weeks, the shortest being one week, and the longest duration being six weeks. And so what needs to happen going forward is we need to have randomized controlled trials or experimental studies that are longer in duration, that far exceed that six weeks maximum that we saw in these isolated records.

Because we know that sleep apnea is not an acute condition. It is a, a long-term chronic condition that that patients have to live with, that researchers are studying that prescribers are caring for. And so ideally, something should occur over the course of six months. If we could have something that would be 12 months in duration, that would be wonderful, but certainly those experimental studies that are of longer duration are urgently needed to answer these questions.

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And then what are your supplements? What are your herbals? What are other therapies that you are using alongside those traditional prescriptions and non-prescription drugs? And almost every patient that I speak to here in Oklahoma is, is using it whether or not they do or don't have sleep apnea. And so I think that this is becoming ubiquitous, this is becoming common in practice.

Our patients are seeing that there's perhaps, you know, a wide index of indications that are out there for these compounds. And so I think that we do need to research it as part of their overall healthcare.

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People who choose to use cannabis need to be aware of what they consume. This podcast is intended to make users better informed about cannabis and its effects. The information shared on this podcast is meant as current opinion in science and should not be considered medical advice.