Sleep, Cannabis Use, and ADHD: A Vicious Cycle
What’s sleep got to do with cannabis use? A whole lot.
Many teens and young adults with ADHD turn to cannabis to help them sleep, an unsurprising motivator given the extraordinarily high prevalence of sleep problems and disturbances associated with ADHD, from sleep apnea and insomnia to delayed sleep phase disorder and more.1
In the short term, cannabis can help with sleep. But frequent cannabis use builds up tolerance; more and more of it is required to exert the same effect on sleep. Ultimately, chronic cannabis use only worsens sleep and feeds a vicious cycle.2 Poor sleep increases cravings for cannabis3 and dampens the cognitive resources that allow an individual to resist cravings, make better choices, and curb impulsivity. Insomnia, a common symptom of cannabis withdrawal, can drive further cannabis use.
Another potential outcome of chronic cannabis use? Dependence. Youth with ADHD — a group that may be far more likely to use cannabis daily to try to get some shut-eye because of condition-related sleep issues — are at greater risk for developing cannabis use disorder compared to neurotypical peers.4
[Take This Self-Test: Symptoms of Substance Use Disorder]
So what can be done? Improving sleep may be key to curbing cannabis use and even increasing adherence to substance use treatment.
A Primer on Sleep Interventions
First, assess the following dimensions of sleep quality in adolescent patients with ADHD. Developed by Dr. Daniel Buysse, the RuSATED acronym can be used to recall elements of multidimensional sleep health:
- Regularity — does the patient go to bed and get up around the same time daily?
- Satisfaction — does the patient feel well-rested after sleep?
- Alertness — how alert or sleepy is the patient during the day?
- Timing — does the patient feel sleepy/fall asleep around the same time regularly?
- Efficiency — how much time in bed is spent sleeping?
- Duration — How many hours of sleep does the patient get, including naps?
Next, consider the following sleep interventions for improving one or more dimensions of sleep quality:
- Sleep hygiene education
- Cognitive behavioral therapy for insomnia
- Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C)
- Chronotherapy (light therapy)
- Brief Behavioral Treatment of Insomnia (BBTI)
[Read: Sleep Problems in Teens with ADHD — Causes and Solutions]
A benefit of behavioral sleep interventions is that they can be started immediately, even as the patient is still using cannabis. It may not take long to see incremental results. In addition to using these interventions, properly treating ADHD and other comorbid conditions that impact sleep and functioning is crucial. Patients may be less motivated to use cannabis if underlying causes of sleep problems are effectively treated.
Anxiety and pain may be other motivators of cannabis use, so be sure to inquire about other reasons your patient may be using. Pharmacologic or behavioral interventions to treat these concerns can be part of your patient’s treatment plan alongside reducing cannabis use.
Cannabis and Sleep for ADHD Adolescents: Next Steps
- Free Download: Sleep Disorders Linked to ADHD
- Read: How to Treat a Teen Self-Medicating ADHD and Anxiety with Marijuana
- Read: How to Fall Asleep with a Rowdy, Racing ADHD Brain
The content for this article was derived from the ADDitude ADHD Experts webinar titled, “How Cannabis Use Affects ADHD Symptoms and Sleep in Adolescents” [Video Replay & Podcast #504] with Mariely Hernandez, Ph.D., which was broadcast on May 7, 2024.
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View Article Sources
1 Hernandez, M., & Levin, F. R. (2022). Attention-Deficit Hyperactivity Disorder and Therapeutic Cannabis Use Motives. The Psychiatric clinics of North America, 45(3), 503–514. https://doi.org/10.1016/j.psc.2022.05.010
2 Kaul, M., Zee, P. C., & Sahni, A. S. (2021). Effects of Cannabinoids on Sleep and their Therapeutic Potential for Sleep Disorders. Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics, 18(1), 217–227. https://doi.org/10.1007/s13311-021-01013-w
3 Graupensperger, S., Fairlie, A. M., Ramirez, J. J., Calhoun, B. H., Patrick, M. E., & Lee, C. M. (2022). Daily-level associations between sleep duration and next-day alcohol and cannabis craving and use in young adults. Addictive behaviors, 132, 107367. https://doi.org/10.1016/j.addbeh.2022.107367
4 Zaman, T., Malowney, M., Knight, J., & Boyd, J. W. (2015). Co-Occurrence of Substance-Related and Other Mental Health Disorders Among Adolescent Cannabis Users. Journal of addiction medicine, 9(4), 317–321. https://doi.org/10.1097/ADM.0000000000000138
Updated on July 11, 2024