INTRODUCTION: -
Surprised! Using cannabis to treat sleep disorders? Sleep disorders are important diseases in medical treatment that also includes events that interfere with normal sleep, snoring or even on and off stoppages & starting of breathing during sleep. Sleeplessness is mainly due to anxiety, depression, accidents & even bowel disorders. Sleeplessness can also occur due to pain at night, resulting in daytime drowsiness. Giving pain killers may sometimes cause gastric problems like acidity, etc.
In some scientific studies, EEG of the brain was used to study sleep disorders due to pain in the body, where they found out where habit forming opioid drugs created sleep disturbances such as disruptive sleep at night and sleep with rapid eye movements (REM), etc. Since early ages, Cannabis has been known for its pain relieving and hypnotic properties, however its effect on sleep has not been fully studied, until recently. In fact, cannabis gives a temporary relief to such patients of sleep disorder, and works on the brain, spinal cord and even the nerves in the periphery of the body. Historically cannabis has been used for relieving pain in migraine, gynecology and in gastrointestinal pain, and the main ingredient in it is Tetrahydrocannabinol (THC). Another medicine in it known as Cannabidiol (CBD) is shown to reduce side effects of THC like sedation, anxiety, increased heart rate, and is also reported to have anti-inflammatory effect and reduce pain.

CLINICAL STUDIES OF CANNABINOIDS & SLEEP: -
The sleep promoting properties of cannabis was mentioned in Ayurveda in early India and later on spread to the western world. It was in the 1960s that the first studies started with the discovery of THC, whereby the sleep-inducing property was discovered, with a hangover in the morning. Later similar experiments were carried out in Brazil in 1981.

NEW DATA ON SLEEP MODULATION WITH CANNABIS BASED MEDICINE EXTRACTS: -
In 1998, a medicine company in the U K got permission to cultivate and process cannabis into medicinal products, and was earlier used to treat pain in Multiple Sclerosis (MS), nerve pain, cancer and arthritis.
Now combination of THC and CBD are easily available in the global market as an oral spray, with action starting within 15 to 40 minutes, which allows patients to adjust the dose and avoid side effects.
In a group of scientific studies with over 200 patients, it was noticed that patients were able to maintain the ideal dosage, with minimum side effects. A similar medicine was launched in Canada in 2005 for marketing as a prescription medicine for nerve pain and multiple sclerosis, and in 2006 the same product was launched in the USA for cancer pain. Since then many countries have legalised cannabis for medical use though such legal usage is awaited in India.
It was interesting to note that when THC alone was given, memory loss was seen next morning, whereas when CBD was added, memory loss disappeared. It was concluded that THC alone was a sedative, while addition of CBD improved alertness in the patients. In another study, 24 patients were put on combo (THC/CBD) and it was discovered that reduction in nerve pain in those suffering from MS was satisfactory. While CBD extract reduced pain only, THC also reduced muscle spasm, stiffness of muscles and appetite.
The combination of both significantly reduced muscle spasms and improved quality of sleep.
In another scientific study of 34 patients with long term pain; it was found that Combo of THC and CBD not only improved the quality of sleep, but also significantly reduced long term pain, and pain associated with multiple sclerosis.
In other numerous studies, it was clear that Combo of THC and CBD was the medicine of choice, as it reduced pain even in diabetic neuropathy, nerve pain, pain in multiple sclerosis and provided a good quality of sleep in such patients. In another group of 137 patients who were on Combo of THC and CBD for almost a year. It was noticed that there was no need to increase the dosage of medicine, and also there were no withdrawal symptoms in case of suddenly stopping medicines. Hence Combo of THC and CBD did not develop tolerance during long term treatment which is an important factor. compare this to people taking opioids or pain killers who after some time need more dose for treatment and this keeps increasing as the number of years of treatment increases.
Side effects with Combo of THC and CBD were insignificant and there was no need to discontinue the treatment.
Results were also evaluated on the effect of pain using SMOKED cannabis which was average, but there was no improvement on sleep pattern.

DISCUSSION: -
In long term pain or nerve diseases, sleep disturbances clearly affect the patients’ health and welfare. Nearly 80 percent of patients suffering from multiple sclerosis complained of tiredness and sleep disturbances, along with severe pain, which makes the patient's life miserable. Such patients also complain of muscle spasms, stiffness, pain in legs and also urinary tract problems which results in disturbed sleep.
In a recent study of 60 patients suffering from sleep disorders and tiredness, daytime drowsiness was treated with Combo of THC and CBD. There was significant improvement in the above-mentioned symptoms. Sleep disturbances were also noticed in patients suffering from nerve pain, which was recommended to be treated with Combo of THC and CBD. 

In a recent scientific article, the effect of THC on brain mapping like EEG, showed that after stopping treatment, sleep disturbances cropped up again. Whereas patients on Combo of THC and CBD, not only reported improvement in quality of sleep-in patients of nerve pain and multiple sclerosis, but reduction of pain, muscle spasms, and even frequency of night time urination in the majority of the patients.
Patients and their relatives have told their treating doctors that Combo of THC and CBD has changed their lives by not only providing good sleep at night, but also increased their daytime activities and hence transformed their quality of life.

Compiled from various international research journals available at google scholar by D. Mukherjee having 38 years of pharmaceutical (Cardiac, Diabetic, Neurology, Pain & Inflammation products) experience with a Swiss Multinational Company NOVARTIS and edited by Dr Sandeep Ahlawat, MBBS