The man had not slept through the night in four years. He was sixty-two, a retired electrician living outside Minot, and the pattern was invariable: asleep by ten, awake by one-thirty, staring at the ceiling fan until the room started to blue with predawn light. His doctor had tried trazodone, then melatonin at escalating doses, then a referral to a sleep specialist in Bismarck who suggested cognitive behavioral therapy for insomnia. He did six sessions. He still woke at one-thirty. When he finally asked his provider about medical cannabis last fall, the question came out the way these questions often do — half apology, half desperation.
His experience is common in North Dakota and everywhere else. The American Academy of Sleep Medicine estimates that thirty to thirty-five percent of adults experience brief insomnia symptoms, and roughly ten percent meet criteria for chronic insomnia disorder. Among medical cannabis patients nationally, sleep is consistently the most frequently cited reason for use, ahead of pain and anxiety. A 2022 survey of dispensary patients published in Journal of Cannabis Research by Kruger and colleagues at the University of Michigan found that seventy-four percent reported using cannabis for sleep at least occasionally.
But citing patient reports is not the same as citing clinical evidence, and the distance between the two is where this subject gets complicated.
The most rigorous review of existing research — a 2022 systematic review and meta-analysis by Suraev and colleagues at the University of Sydney, published in Sleep Medicine Reviews — examined thirty-four studies on cannabinoids and sleep. Their conclusion was measured: cannabinoids, particularly those containing THC, showed “preliminary evidence” of improving sleep quality, but the authors noted significant limitations. Most studies were small, many lacked placebo controls, and few extended beyond four weeks. The review specifically cautioned that evidence for long-term use remained insufficient.
What individual studies suggest is more granular and more interesting than the meta-analyses capture. A 2023 randomized controlled trial out of the University of Western Australia, led by Walsh and published in Sleep, tested a proprietary THC-CBD combination in adults with chronic insomnia. Participants reported improved sleep onset and fewer nighttime awakenings over two weeks. But the study used a specific formulation at specific doses, and its duration was too short to address tolerance — the concern that regular THC use may diminish sleep benefits over time.
Tolerance is the question that hangs over every conversation about cannabis and sleep. A 2008 study by Gorelick and colleagues at the National Institute on Drug Abuse found that daily cannabis users showed reduced slow-wave sleep — the deep, restorative stage — compared to non-users. Whether this represents tolerance, adaptation, or an unrelated effect remains contested. What is not contested is that abrupt cessation after regular use frequently produces rebound insomnia, often worse than the baseline, lasting days to weeks. Patients considering cannabis for sleep deserve to know this before they start, not after they stop.
The dose question is equally unresolved but practically urgent. Low-dose THC — generally defined in the literature as five to fifteen milligrams — appears to promote sleep in several studies, while higher doses have been associated with next-day grogginess and, in some patients, increased anxiety that undermines sleep quality. A 2022 observational study by Vigil and colleagues at the University of New Mexico, published in Medical Cannabis and Cannabinoids, found that flower products with moderate THC and some CBD presence correlated with the best self-reported sleep outcomes, though the study relied entirely on patient self-report through a tracking app.
CBD alone, despite its reputation as a sleep aid, has weaker evidence than most patients assume. A 2019 case series by Shannon and colleagues at the University of Colorado, published in The Permanente Journal, found that anxiety scores improved in most patients over three months, but sleep scores improved in only the first month and then fluctuated. The authors themselves characterized the sleep findings as “not robust.”
For the retired electrician outside Minot, this landscape of partial evidence is not an abstraction. It is the difference between trying something that might help and trying something he understands. The research supports cannabis as a plausible short-to-medium-term sleep aid for some patients, particularly at low THC doses, particularly when the underlying sleep disruption involves pain or anxiety. It does not yet support cannabis as a long-term solution, and it raises real questions about what happens when you stop.
That gap between plausible and proven is where most of medicine lives. The honest answer — the one worth driving ninety minutes to hear — is that cannabis may help you sleep, and we do not yet fully understand the cost of relying on it.