When regular cannabis use stops, sleep often gets worse for a week or two, and dreams become vivid. For someone who started cannabis because of insomnia, those nights feel the same as the original problem. This part explains that trap and what the trials show for cannabinol and cannabidiol. It also covers the treatment with the best evidence and how to plan an exit before the first dose.
Part 1 covered the evidence for THC. The best trial (Walsh and colleagues, 2021) followed 23 adults for two weeks. They rated their insomnia as clearly better on a THC-based oil, but a full sleep-laboratory recording found almost no difference in their sleep. THC also tends to reduce REM sleep, the dream-rich stage of sleep. When use stops, REM tends to rebound, which means there is more of it than usual for a while.
This is general information, not medical advice. It is not a recommendation to use cannabis for sleep. Chronic insomnia is usually a symptom of something else. Common causes are pain, anxiety, depression, sleep apnoea (breathing that repeatedly stops during sleep), a medication or a sleep schedule. If only the symptom is treated, the real cause can go unfound for years, even when it has a treatment. In Thailand, cannabis flower is a controlled herb. It may be sold only against a PT 33 prescription (ภ.ท.33) from an authorised practitioner.
This is Part 2. Part 1: Cannabis and Chronic Insomnia: The Evidence, the REM Rebound and Planning an Exit
1. The Withdrawal Trap
Withdrawal is common after regular use. Stopping suddenly after regular use causes a recognised withdrawal syndrome. Trouble sleeping and strange or vivid dreams are among its core features.
How common it is. In 2020, Bahji and colleagues published a meta-analysis (a study that pools the results of many studies). It covered 47 studies with 23,518 participants. Cannabis withdrawal syndrome appeared in 47% of people with regular or dependent use.
The rate varied widely by setting:
- about 17% in samples from the general population;
- 54% in outpatients (people treated while living at home);
- 87% in inpatients (people admitted for treatment).
How long it lasts. Clinical descriptions say symptoms usually begin within 1–3 days of stopping. They peak in the first week and settle over 1–2 weeks. This timing comes from clinical descriptions. The meta-analysis did not establish it.
What the sleep laboratory shows. In 2008, Bolla and colleagues recorded the sleep of heavy users in their first nights after stopping. They compared them with people who did not use cannabis. The heavy users slept less, had less deep (slow-wave) sleep and lower sleep efficiency, and took longer to fall asleep. The study compared two groups at one point in time. So it cannot show how much of this difference existed before the users stopped.
Why this becomes a trap. Picture a person who uses cannabis for insomnia. After some months, they try to stop, and their sleep becomes much worse than before. The natural conclusion is “this proves I need it”. They cannot test that from the inside, because withdrawal insomnia and the original insomnia feel the same.
This is the trap. After a period of regular use, you can no longer tell which problem you are treating. It may be the insomnia you started with. It may be the insomnia that stopping now causes.
This problem is not unique to cannabis. Every sleeping pill (hypnotic) has it. It is one reason sleep medicine moved away from long-term use of sleeping pills, and the same reasoning applies to cannabis.
What this means in practice. The conclusion is not “never use it”. It is that the plan for stopping belongs in the decision from the start. Agree on three things with your prescriber before the first dose:
- A set duration. Decide when you will review and stop, so that use does not become open-ended.
- A taper instead of a sudden stop. Agree a step-by-step dose reduction with your prescriber. This is meant to soften the withdrawal.
- An expectation set in advance. Expect the first one or two weeks after stopping to be worse than before you started. Those bad nights do not prove that you need the drug.
What you can do: keep a sleep diary for two weeks before your first dose. Record bedtime, roughly how long you take to fall asleep, night wakings and wake time. This gives you a starting point. After the withdrawal weeks are over, you can then see whether your sleep settled above or below where it started.
2. Cannabinol and Cannabidiol (CBN and CBD) for Sleep
Products sold for sleep often feature CBN (cannabinol). CBN forms as THC breaks down when cannabis ages. There are now randomised trials of CBN, and the results are modest.
Bonn-Miller and colleagues, 2024. This trial had links to industry. It included 321 adults who rated their own sleep as poor. They took 20 mg of CBN each night for a week. Compared with placebo, CBN did not significantly improve the primary outcome, sleep quality. It did reduce night-time awakenings and overall sleep disturbance. Adding CBD gave no extra benefit.
Lavender and colleagues, 2026. This Australian trial included 20 adults with diagnosed insomnia. It was a crossover trial: each person took every treatment, each on a single night. The doses were 30 mg and 300 mg of CBN. Neither dose changed the primary outcome, time awake after first falling asleep, as measured in a sleep laboratory. The 300 mg dose shortened the time to fall asleep by about 7 minutes and improved how well people felt they had slept. The authors concluded that the trial gives no direct evidence that CBN works for insomnia in routine care.
CBD on its own. In a study by Linares and colleagues (2018), a single 300 mg dose of CBD had no immediate effect on the sleep of healthy volunteers. An improvement is often quoted from Shannon and colleagues (2019). That was a case series: a report on 72 patients from one clinic, with no comparison group. Most of these patients were being treated for anxiety, not insomnia.
Neither CBN nor CBD has enough evidence to be called a sleep treatment.
What you can do: if a product is sold for sleep because it contains CBN, compare its dose with the trial doses of 20, 30 and 300 mg. Remember that even those doses gave only small results. Ask your prescriber or a pharmacist to check any cannabinoid product against your other medicines (drug interactions list).
3. What Has the Best Evidence: Cognitive Behavioural Therapy for Insomnia
What doctors recommend first. The American College of Physicians is a professional body of doctors in the United States. In its 2016 guideline (Qaseem and colleagues), it recommends cognitive behavioural therapy for insomnia (CBT-I) as the first treatment for chronic insomnia disorder in adults, ahead of medication.
What CBT-I is. It is not general relaxation advice. It is a structured programme, usually run over a few weeks, and more and more often offered online. It combines four parts:
- Sleep restriction: time in bed is first limited to roughly the time you actually sleep, then extended as sleep becomes more solid. The aim is to make sleep deeper and less broken.
- Stimulus control: the bed is used only for sleep, and you get up if you cannot sleep. The aim is for the brain to link the bed with sleeping, not with lying awake.
- Cognitive work: you work on worried or fixed thoughts about sleep. The aim is to reduce the worry that keeps people awake.
- Sleep hygiene: habits such as caffeine, light and bedroom conditions. This is only a minor part of the programme.
Why it comes first. CBT-I takes more effort than taking something at bedtime. Unlike any sleeping pill, it produces improvements that last after the treatment ends, and there is no withdrawal. It is included here because most people who read about cannabis for sleep have never been offered it.
Translator’s note: in Thailand, ask your doctor for a referral to a sleep clinic or to a doctor who treats sleep disorders, a psychiatrist or a clinical psychologist. Ask specifically for CBT-I, and ask whether it is available in Thai or online. One example: in 2023, the Excellence Center for Sleep Disorders at King Chulalongkorn Memorial Hospital published a study of an internet-based CBT-I programme developed in Thailand. Before the appointment, keep the two-week sleep diary described in section 1, and add caffeine, alcohol, naps and bedroom temperature. In the Thai hot season, a warm bedroom, night-time noise and shift work are common reasons for poor sleep. The diary helps the clinician find causes like these before any medicine is considered.
What you can do: start the sleep diary this week, and ask your doctor about CBT-I before you ask about any sleep medicine.
4. Where a Cannabinoid Might Reasonably Fit
A cannabinoid for sleep should be used only under a prescriber’s supervision and within these limits:
- Short-term. Set a duration and a tapering exit in advance, rather than taking it every night with no end date.
- For insomnia caused by something a cannabinoid is already prescribed for. Examples are pain, nausea or spasticity (muscle stiffness and spasms). In these cases, better sleep is a side benefit of treating the main problem.
- Not as a substitute for finding the cause. Sleep apnoea, depression, thyroid disease, restless legs and medication side effects can all show up as insomnia. Each of these has its own treatment.
- Not where next-day impairment matters. Higher doses cause grogginess the next day. The usual cautions about driving and machinery therefore apply the following morning, not only at night.
- With particular care in older patients. Older people are more sensitive to sedation. They are also more sensitive to the drop in blood pressure when standing up, which causes falls. A night-time dose followed by a trip to the bathroom at 3 a.m. is a specific and predictable risk.
Translator’s note: in many Thai homes the bathroom floor stays wet. For an older person taking any sedating medicine at night, keep a night light on and the path to the bathroom dry and clear. This lowers the risk of a fall on the way to the bathroom at night.
What you can do: take this list to your prescriber and agree in writing on the duration, the reason for treatment and the taper plan.
5. The Thai Rules
Flower. Cannabis flower is a controlled herb under the Notification of the Ministry of Public Health Re: Controlled Herbs (Cannabis), B.E. 2568. It was issued under the Thai Traditional Medicine Protection Act B.E. 2542 (1999) and has been in force since 26 June 2025. Flower may be sold only against a PT 33 (ภ.ท.33) prescription from an authorised practitioner. Each prescription covers no more than 30 days. Advertising and online sale of flower are prohibited.
The 2026 regulations. Two Ministerial Regulations of B.E. 2569 (2026) tightened licensing further:
- Ministerial Regulation on Cannabis or Hemp Extracts B.E. 2569, in force since 26 April 2026. Licences for extracts above 0.2% THC go only to Thai juristic persons that are not “foreign” under the Foreign Business Act B.E. 2542, to state agencies and to the Thai Red Cross Society.
- Ministerial Regulation on Controlled Herbs (No. 2) B.E. 2569, in force since 30 April 2026, the day it was published in the Royal Gazette. It tightens the licence criteria for cannabis flower.
Enforcement and the draft law. On 20 June 2026, the government reported that officials had inspected more than 1,200 cannabis shops nationwide over the previous month. The draft Cannabis Control Act is not law yet. The Cabinet approved the draft on 22 September 2026 and sent it to the House of Representatives.
These rules are still changing. Check the current requirements with your prescriber or with the Department of Thai Traditional and Alternative Medicine.
A prescription that lasts at most 30 days has one advantage for a sleep aid. Long-term nightly use cannot build up unnoticed, because it has to be reviewed at each new prescription.
What you can do: at each new prescription, bring your sleep diary and decide with your prescriber whether to continue, taper or stop.
If you have used a cannabinoid for sleep under a prescription for more than a few months, please post below what happened when you stopped. Tell us how long the bad nights lasted and whether your sleep finally settled above or below where it started. There is almost no data on this, and no trial has followed anyone long enough to answer it. Share only experience under a lawful prescription. Do not post sources, prices or recreational use.
References
- Babson KA, Sottile J, Morabito D. Cannabis, cannabinoids, and sleep: a review of the literature. Curr Psychiatry Rep. 2017. doi:10.1007/s11920-017-0775-9
- Bahji A, Stephenson C, Tyo R, Hawken ER, Seitz DP. Prevalence of cannabis withdrawal symptoms among people with regular or dependent use of cannabinoids: a systematic review and meta-analysis. JAMA Netw Open. 2020;3(4):e202370. doi:10.1001/jamanetworkopen.2020.2370
- Bolla KI, et al. Sleep disturbance in heavy marijuana users. Sleep. 2008;31(6):901–908. PMID 18548836
- Bonn-Miller MO, et al. A double-blind, randomized, placebo-controlled study of the safety and effects of CBN with and without CBD on sleep quality. Exp Clin Psychopharmacol. 2024;32(3):277–284. doi:10.1037/pha0000682
- Lavender IG, et al. Cannabinol for acute treatment of insomnia disorder in a randomized placebo-controlled crossover trial. J Sleep Res. 2026;35(4):e70284. doi:10.1111/jsr.70284
- Linares IM, et al. No acute effects of cannabidiol on the sleep-wake cycle of healthy subjects. Front Pharmacol. 2018;9:315. doi:10.3389/fphar.2018.00315
- Qaseem A, et al. Management of chronic insomnia disorder in adults: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2016;165(2):125–133. doi:10.7326/M15-2175
- Shannon S, et al. Cannabidiol in anxiety and sleep: a large case series. Perm J. 2019;23:18-041. doi:10.7812/TPP/18-041
- Walsh JH, Maddison KJ, Rankin T, et al. Treating insomnia symptoms with medicinal cannabis: a randomized, crossover trial of the efficacy of a cannabinoid medicine compared with placebo. Sleep. 2021;44(11):zsab149. doi:10.1093/sleep/zsab149
General information, not medical advice. Persistent insomnia deserves a diagnosis, not just a remedy.