How to think about/alter my relationship with Marijuana.
September 16, 2023 12:54 AM   Subscribe

I have a severe illness and getting enough sleep is very important to preventing flares. After weaning off Xanax and Clonazepem, I use marijuana every night and sometimes multiple times during the night in order to sleep. I feel really weird about this. I'm not sure 1) if I should be feeling weird 2) How to safely make changes (if that is a good idea.)

I have an immune disorder and post viral illness that are seriously exacerbated by lack of sleep. I have always struggled with sleep. My doctor prescribed Xanax and Clonazapem which I used nightly for about a year. Eventually, I was no longer comfortable with this and weaned myself off.

In order to sleep, I began using marijuana right before bed. I use about .5 grams a night of flower vaped from a Pax. This allows me to fall asleep basically at will. It feels like magic. However, it's been three years now and I recognize that I am deeply habituated and unable to go to sleep without it. In order to sleep I need to be fairly high. And when things are rough on the health front I sometimes smoke once or twice in the night if I can't get back to sleep. I never use marijuana during the daytime.

Last year, I had a stretch of good health and started working with a CBT-Insomnia trained therapist to try to develop better coping strategies. It worked fairly well, but I already have pretty good sleep hygiene. And I can't lean too far into letting the sleepiness build up without triggering a health flare. This is in fact what happened-- I came down with a virus and the therapist no longer felt comfortable continuing treatment.

I don't really know how to think about this. My partner thinks that this isn't an issue. That the marijuana allows me to sleep and that that is a gift. That we are wrestling with so many more serious things health-wise, that I should just accept that this is where I am and let it go.

But I worry that the nightly marijuana use is contributing to cognitive fog. And I hate the idea of being addicted and unable to sleep without it. I often come up with plans to try to wean myself off, but then another health crisis arises and it all goes by the wayside.

My questions are 1) Given these factors, would you consider this use of marijuana to be a problem that needs to be addressed? 2) If you were to make changes, what changes would you make?

(In case it's not clear, I feel a significant amount of shame over all of this.)
posted by anonymous to Health & Fitness (22 answers total) 6 users marked this as a favorite
I'm on Team Your Partner here.

Cannabis has been stigmatized since a vicious racist got his hands on a lever of power in the 1930s. That doesn't make cannabis any less of a medicinal chemical than, say, sertraline.

Every medicinal chemical has effects and side effects. If the effects of this substance work for you, and you can tolerate the side effects, then it seems to me that you'd be better off transmuting any shame you feel about using it into rage against the fuckheads who have fucked your culture to make doing so emotionally difficult for you rather than continuing to let it fester.
posted by flabdablet at 1:47 AM on September 16 [18 favorites]

It sounds like you are dependent but not addicted. You need the drug to sleep, you recognize the risks and side effects, and you are able to stop if needed, although it's unpleasant to do so. You don't use during the day, so you're still able to set the timing and dosage. You tried pharmaceutical solutions but they didn't meet your needs.

Perhaps some part of you thinks shame will keep you from losing control? Tipping over the line?

I don't know what strain you're using, but I tried a few in this calculator and it looks like you're hitting the desired range for someone with high tolerance. Not too much, not too little.

I suspect marijuana will be even more effective if you believe you deserve it! Maybe fully enjoying the power of placebo would let you cut back. Pain is mysterious that way.

What if you try something practical, and set a monthly check-in with yourself to see how your relationship with weed is going. Your partner could join too. Just the basics: are you addicted yet? Is weed causing more problems than it solves? Has your dosage gone up? Is it still worth it?

If you have a place to put your anxious energy, maybe it won't trouble you so much! I think you're making the best out of a hard situation. You have at least one good person in your life who's helping to keep an eye on things. Do what you need to rest!
posted by lloquat at 2:20 AM on September 16 [4 favorites]

It is unclear why you weaned yourself off the other meds in the first place. Perhaps there were worse side effects than the marijuana, but maybe it’s a similar feeling of shame or stigma about being dependent on any kind of drug at all, and you have just shifted to one with cultural baggage that lends it a different vibe. So maybe try thinking of this less as an issue of how can you stop taking anything at all and more an issue of finding acceptance with using external help to maintain your quality of life.

Unfortunately the big problem with marijuana as a medicine is that it is so understudied. Things are a little better now, but there is still almost no good data about things like drug interactions or contraindications. I do wonder if you might be able to find a doctor who would take the marijuana into consideration and offer some possibilities for things like occasional meds to take on your especially difficult nights, advice about dosage and things to take note of. Depending on where you are this could either be kind of hard or impossible, though. I think that if you can approach marijuana as just a different medication rather than some kind of vice that you will have an easier time with the content of your question, and recruiting some medical professionals seems like a way to do that. Maybe a psychiatrist? Anecdotally they tend to know a lot about drug combinations people with a lot of anxiety usually take.

It seems like every day we get more and more evidence showing that enough and regular sleep is the most important thing (I say typing this at three in the morning…) If you have found a method to achieve that sleep then consider yourself a winner. It’s probably one of the best ways to help your body handle all the other stuff it has to deal with. Why would you give that up because a bunch of racists have prevented proper study and distribution of the method you’ve found works for you? You aren’t harming anyone, it doesn’t sound like it’s endangering you, and you have the support of your partner.
posted by Mizu at 3:24 AM on September 16 [6 favorites]

You have nothing to feel ashamed about. Cannabis is medicine and you are using it for legitimate medical reasons*.

I believe that it's recommended to have a "THC break" occasionally. Some people lean on CBD or other cannabinoids during these breaks.

I think it would be worth trying some other products to see whether they are effective for you and whether the brain fog improves.

I personally find that a good quality CBD oil with terpenes helps with relaxation, though full effect can take several weeks. No brain fog here.

* But even if you were using it recreationally, there would also be no shame!
posted by kinddieserzeit at 3:29 AM on September 16 [2 favorites]

I worry that the nightly marijuana use is contributing to cognitive fog. And I hate the idea of being addicted and unable to sleep without it.

One of these worries is sensible. The other less so. It doesn't matter that you are dependent on a drug to help you sleep. Other people are dependent on drugs to help them breathe, or help them eat, or help them move. Sleep is absolutely essential and if you are not able to sleep by yourself and you have found meds that work for you, then there is no problem. If you cannot live with the brain fog and it is worse than the side effects of the other drugs that you have tried, then you will want to try something else. However, cognitive fog is also a side effect of lack of sleep.
posted by plonkee at 3:34 AM on September 16 [16 favorites]

Hi, I am a cannabis educator! (No really, I am certified and continue to garner as many cannabis science-based accreditations as I can.)

There's no shame in using cannabis for sleep; honestly, it's one of the primary reasons many do. I do so myself.

If you are feeling foggy and groggy in the morning, you've exceeded what we call your Goldilocks dose. Through trial and error, folks who use cannabis regularly for health issues, find the dose that works perfectly for them (with some wiggle room up and down on the scale, accounting for additional stressors). If you're worried you're jacking up your tolerance too high, good news! Even abstaining for a little as a week to three days can help reset your tolerance. (Heavy heavy users should probably try for a month. I do a tolerance break once a month for a week myself.)

If you decide to wean yourself off for a week (or less), slowly introduce cannabis back into your life with smaller doses. Keep track. You might find with the right products--focus on terpenes like myrcene and linalool; these have sedative properties--you need less to get the same effect. Are you sleeping through the night when you dose? Or do you have to "top up" during the night? Flower has a duration of 1.5-3 hours, so if you're sleeping through the night with just a .5 gram of flower in your Pax, you are definitely on the right track. Cannabis is biphasic; sometimes it feels like if this is good, then more is better. Alas, it is not. Too much cannabis can trigger anxiety and give you the opposite of what you want to happen.

There is no shame in using weed. I know it's hard because we've got over a century of racist prohibition to deal with despite its legality in certain states and one country (Canada, where I reside). Don't make yourself feel guilty for finding a product/plant that works for me. If you have any questions, feel free to MeMail me. (In fact, I'm holding a Cannabis 101 workshop today in my city for folks who are curious and want to be informed.)
posted by Kitteh at 5:13 AM on September 16 [31 favorites]

First, don't feel shame - as others have already pointed out, you have a serious problem (difficulty sleeping) and you're finding cannabis is helpful in solving that problem. There is nothing shameful about it.

But I worry that the nightly marijuana use is contributing to cognitive fog.

Cannabis, like alcohol, can make it easier to fall asleep but then can lead to your sleep being shallower, hence the brain fog. Perhaps it's a matter of dose, as Kitteh points out, but I have personally found the key is when I consume THC, and making sure I consume balanced THC, i.e. strains that are 1:1 THC:CBD. If I eat a 1:1 gummie at 6pm, my quality of sleep is going to be very different than if I eat a pure THC gummie at 10pm.
posted by coffeecat at 5:51 AM on September 16 [5 favorites]

I've been taking cannabis nearly nightly since 2014, when I moved to a state where I could obtain it legally. I also have an autoimmune condition with chronic pain issues, and let me tell you, a little bit of morning brain fog is nothing compared to how it used to be when I couldn't sleep at all.

I might recommend trying edibles if you're waking up throughout the night - they have a much longer half-life and I find they keep me asleep pretty well.
posted by restless_nomad at 6:04 AM on September 16 [12 favorites]

Another vote for taking breaks. I have breaks enforced because I travel to places where it's not legal and don't want to carry the stuff around. If nothing else, I find the breaks help with any temptation to let the dose creep up. I do think THC is somewhat addictive for me and I need to make sure I stay at the same dose.

Personally, I much prefer tinctures (taken sublingually) to edibles. I take 5 mg of tincture in two doses and go to bed very relaxed but not high. With edibles, if I take a 5 mg gummy, I can go to bed just sleepy and wake up later high as balls, which to me is not a nice feeling. Really, smoking or vaping is probably ideal for titrating the dose but I don't like smoking or vaping.
posted by BibiRose at 7:09 AM on September 16 [2 favorites]

It sounds like you've found something that is really working for you after trying various options. You have a loved one who can give you honest feedback. You are self-aware and trying different ways to manage your illness and live your best life. (The phrase is so cheesy but it's a great for everyone and especially those of us dealing with extra health challenges.)

It sucks that we live in an ableist society -- tbh that's most societies on earth, sadly -- where we are expected to be impossibly high-functioning in every way while also eschewing anything deemed as support, be it cannabis or a pharmaceutical or even physical mobility aid. We have to try everything else first and then when we accept it, we must admit our defeat and act like this is our only option for the rest of our lives. Or constantly try to "get better" so we can go without. But isn't it beautiful and cool that we have ways to help us better cope and, again, live our best lives in this harsh world? Hell yes. I take a very low (25mg) daily dose of generic Zoloft to help manage my OCD symptoms as well as 180mg of generic Allegra for my allergies that can get so bad that I am miserable all day. I have done lots of therapy (amazing results), often eat well, usually exercise, sometimes sleep enough, and seek a good work-life balance. However, unless I'm living in the wilderness and basing my life around seasons and sunrise/sunset, having those medical supports will vastly improve the quality of my life. I have done the nature thing before and it was incredibly effective for managing symptoms; of course, it is not really an option for every day life for most people. I am no better or worse than someone who takes a much higher dose nor than someone who takes none of those pills. Don't get me started on the people who claim that people like me are weak for using it and should just "do more yoga/eat more veggies/get more sunlight" as if I were an idiot who hadn't already tried that. (And even if I hadn't, fuck them because that's unfortunately a privilege in this unfair world!) Ironically, those people are big on talks but rarely seem to truly have it together underneath, which is really too bad for them.

Marijuana isn't the right choice for me -- I've tried and it's not for me; also not looking for suggestions from commenters -- BUT I see it as this wonderful option with many more benefits and fewer side effects than many other treatment approaches. I hate that it has been so criminalized in the past, which more than lingers today in terms of people so unjustly incarcerated and so often largely in part for racist reasons. I hate that this all makes people hesitate or question themselves but it makes sense because stigma is huge. Fortunately, you are ready and willing to fight against that! Exploring alternatives or additional options is always worth considering, not because what you're doing is "bad" (it sounds good!) but because life changes and we change; sometimes our go-to options are best and sometimes it's good to mix it up. Sometimes as break is a perfect reset, proof that we'd best find other options or simply a gentle reminder that what we have been doing is exactly right. I wish you luck and I'm glad you asked! It's really cool and heartwarming to see all these supportive, knowledgeable, and encouraging responses here.
posted by smorgasbord at 7:30 AM on September 16 [2 favorites]

don't feel shame

Just wanted to push back gently on that point.

You're going to feel shame for quite some time because cultural conditioning works, and you don't need that experience made more unpleasant than it already is by being persuaded that feeling shame is something you ought to be able to control but can't.

Feelings cannot be controlled; they just turn up uninvited. Trick is to learn to notice what feeling shame is leading you to think, then wielding your bought-and-paid-for CBT skills to dispute such portions of that thought as are unreasonable. That will help the shame episode pass as quickly as it possibly can instead of hanging about.

If spurious shame is a ripe fart, CBT-informed shaming-disputation skills are a rapidly opened car window.
posted by flabdablet at 7:55 AM on September 16 [5 favorites]

My sleep has gotten so bad since 2020--melatonin does nothing, Benadryl stopped doing much, I could go on but I won't--specifically waking up too damn early too many times and I can never go back to sleep. Falling asleep at the designated time but waking up in the middle of the night still tired but not being able to lose consciousness again is a worse problem than just not being tired at all until late. "Sleep hygiene" did fuckall for that. I've never had any interest in smoking weed in my life and I still don't have any, but this year per my old therapist, I resorted to pot gummies. There's been some trial and error as to which versions of Wyld work for that or not (strawberry does NOTHING, elderberry works a bit, mostly pomegranate/pear has gone great), but that's actually eventually worked, especially combined with a Unisom.

I feel pretty stoopid being a "pothead" (am I?!?!) after an entire lifetime of zero interest in drugs and I worry about what happens if I ever end up working somewhere that drug tests, but for fuck's sake, it just makes me calm/sleepy at night and I mostly stay asleep now and that's it, and the conventional stuff for that wasn't doing it.

I'm not going to repeat all of the "you need good sleep!" stuff that we're all guilted and bludgeoned about with all the time. If this works for you, it works for you. I don't think you're in Michael Jackson territory here. The one concern is if you go to a pot-unfriendly state.
posted by jenfullmoon at 8:19 AM on September 16 [1 favorite]

Taking a slightly different tack, have you had a medical professional rule out any "mechanical" reasons for your sleep issues, like sleep apnea for instance? I read through your question a couple of times and you mention you have pretty good sleep hygiene, but that's it. It may be the way to cut the Gordian knot and improve or fix your sleep patterns, which would allow you to delink your cannabis use from your need to sleep.

Full disclosure: I have never used cannabis and because of my personal moral beliefs, will never do so.
posted by fortitude25 at 8:29 AM on September 16 [1 favorite]

I have had profound insomnia for 20 years, which has had massive negative effects on my physical and mental health. If marijuana worked for me I would be down on my knees thanking every god I could think of.

So I recommend you reframe the situation; just as people need to take daily meds for clotting disorders, you need to take this daily med for your health difficulties.

RE your concern about brain fog: is there any way to test your theory? This is not a perfect option, but you could try intentionally using a slightly lower dose one week and a slightly higher one the next and see if a higher dose increases the problem. If it seems to, that could suggest it might be an issue and you can consider experimenting with different strains or other drugs to see if that helps. But given the brain fog caused by sleep loss, it may still be the best option even if it is correlated.

(And if what you were trying with your therapist was sleep restriction, I tortured myself with it for weeks on end on four separate occasions with zero benefit. So while it helps some people, don't assume it would benefit you if you could just stick it out.)
posted by metasarah at 9:52 AM on September 16 [3 favorites]

CBT-I is an effective intervention for insomnia. This free app from the VA is one implementation.
posted by metatuesday at 10:23 AM on September 16

So I don’t have a chronic disease, but I do have insomnia I have treated with medication and CBT-I.

In your shoes, I think you have made a great choice to wean off the benzos and replace them with marijuana. Marijuana is much safer - so you should feel good about this, not ashamed! You made a healthy choice.

If the marijuana side effects are too much, then I think you could cautiously take another look at CBT-I together with your doctors. I wonder if your doctors also think that sleep restriction during CBT-I is too risky, or if a bad night sleep is risky enough to justify the continued use of marijuana.

I also wonder if you could use CBT-I to reduce your use of sleep meds. It doesn’t have to be all or nothing. You could still have them to use periodically defined situations, like if you have had 2-3 bad nights in a row. There are also non-addictive meds like trazadone you can use periodically that might have a better side effect profile.

Lastly- if your insomnia is caused by anxiety you might consider treating it with an SSRI.
posted by haptic_avenger at 10:28 AM on September 16 [1 favorite]

I find marijuana makes me a little groggy and mentally fuzzy the next day. The same thing happens when I take sleep medication. I’m not saying you should ignore your feelings and observations, but maybe think about how you’d look at this if the only thing that helped you sleep was a nightly dose of trazodone, and the trade-off for getting enough sleep to prevent flares of your chronic illness was next-day grogginess and brain fog caused by the trazodone. Would you want to look for alternatives? Or would that medication side effect be tolerable? (There isn’t an objective right answer here, I’m just encouraging you to think about this as an effective medical intervention with tough side effects, rather than a more morally fraught habit.)
posted by theotherdurassister at 12:25 PM on September 16 [2 favorites]

I am a daily cannabis user (daily flower and edibles as special treats) and can honestly say that it has changed my life for the better in so many ways. I try to be very open about my cannabis use to help break the stereotypes of the lazy pot head. I am able to work 70+ hour weeks, get a massive amount of quality work done, train for my second marathon this year, and be in a really good place mentally and emotionally. While sleep was never a huge problem for me, I used to be a very light sleeper with lots of tossing and turning. Cannabis at night not only helps me go to sleep very quickly, but I sleep much deeper now and don’t move around much. I believe the cannabis relaxes my body in a way I wasn’t fully able to do before. I am getting the same amount of sleep I used to get before I started using cannabis, but even with the longer work hours and more mileage, I am waking feeling more rested and recovered than I ever did before. The only times I have morning brain fog are when I have a particularly restful night of sleep and I believe it has more to do with coming out of a state of deep relaxation than it does to being high.

I would suggest trying it in the daytime, even just once, without sleep as a goal, to actively experience the effect it has on you. Does it give you a cognitive fog that feels like the one you get in the morning? If it does, then maybe you are just stoned. Sometimes hydration can help that pretty quickly, especially in the morning. If it doesn’t feel the same, then there might be other causes for the cognitive fog, and you can feel better about using cannabis to help you get the sleep that you need.
posted by August Fury at 7:24 PM on September 16 [1 favorite]

Here’s the Sleep Foundation on cannabis and sleep:
posted by cotton dress sock at 6:21 AM on September 17

Cannabis, like alcohol, can make it easier to fall asleep but then can lead to your sleep being shallower, hence the brain fog.

I believe it actually suppresses REM sleep, more than deep sleep. One of the best known cannabis discontinuation effects is a rebound increase in REM sleep manifesting as intense dreams. The bigger factor in next-day fogginess is probably just that the active constituents have a pretty long half-life in the body. But benzos have well-established cognitive side effects, too, and a far worse dependence and withdrawal syndrome, so I think the case for cannabis as the first line sleep medication between the two is pretty clear.
posted by atoxyl at 11:00 PM on September 17 [1 favorite]

THC is better overall than benzos.
If you really want to sleep without THC, can your doc give you trazodone? It's good for sleep and doesn't need to be taken daily.
posted by luckynerd at 3:56 PM on September 19

Kitteh seems to have the good stuff here, but would add:

-- .5g seems like a non-trivial amount to me. i defer to Kitteh on it, but it might be worth trying to ramp down -- maybe your sweet spot that Kitteh mentions is lower than that, and you still get the benefits with less.

-- might be worth trying a different delivery system, although i too have read that gummies can be great for falling asleep but mess with your REM sleep. but maybe flower does too, just not as significantly; that seems to be what cotton dress sock's link is saying. this could contribute to or even just be the reason for the fog.

-- if you do try gummies, many dispensaries now have products with different components to aid sleep; i've seen melatonin- and valerian- and other-infused products, and at least one cannabinoid -- CBN? maybe something else too? -- is also said to aid sleep. and it would seem worth exploring strains that add CBD to the equation.

-- agree wholly that there's no reason for shame. however, if i needed something else to sleep -- say melatonin -- for years and years, i wouldn't love that either. it can also be impractical; what if you want to travel abroad, and don't want to still be high when the plane lands, or to 'smuggle' anything into whatever country you're visiting?

add in the possibility that this is contributing to or causing your brain fog, and i wouldn't discourage you from exploring other options, including the sleep study fortitude25 alludes to, although i don't know how those work when you need cannabis to fall asleep. but i would accept the reassurance being offered here about the shame, then add up the remaining concerns, then weigh them against the drawbacks of whatever plans B and C might be.
posted by troywestfield at 12:17 PM on September 22 [1 favorite]

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