Therapeutic Uses of Cannabis on Sleep Disorders and Related Conditions: ERRATUM

In the article that appeared on page 39 of the January 2020 issue of the Journal of Clinical Neurophysiology, there was incorrect characterization of cannabis plant components and relevant formularies in Fig. 1 and relevant reference text in introductory paragraph, as well as incorrect map legend labeling in Fig. 4, and an incorrect inclusion of a Ware et al. reference in Table 3. The corrected introduction, figures and table are below.

FIG. 1.: The main components of the cannabis plant.

FIG. 4.: Cannabis legalization policies for each individual state.^18–46 */***Policy information for each state obtained from government agency web sites of the respective state governments. **Note that these conditions serve as a general list that may vary somewhat state by state and are subject to change. Therefore, please refer directly to the state agency for the most current listing.

Table 3. - Therapeutic Uses of Cannabis for Sleep Disturbances Caused by Other Medical Conditions

Reference Paper	Form of Marijuana	Treatments Effect on Sleep
Chronic pain
Toth et al., 201264	Nabilone	Flexible-dose nabilone 1–4 mg/day improved overall quality of sleep as defined by an 11-point NRS, for patients with diabetic peripheral neuropathic pain.
Narang et al., 200865	Dronabinol	Two phase study on patients suffering from chronic noncancer related pain. Patients receiving dronabinol reported less sleep-interfering pain, as measured by the Brief Pain Inventory.
Blake et al., 200666	Sativex	Increased sleep quality (dose effect was unclear), for patients suffering from pain caused by rheumatoid arthritis.
Portenoy et al., 201267	Sativex	Decreased sleep disruption on low dose (1–4 sprays per day) and medium dose (6–10 sprays per day). No effect seen with high dose (11–16 sprays per day). Patients had cancer and were on opioid treatment, and suffered from chronic pain.
Notcutt et al., 200468	Oral spray dose of THC or CBD alone, or THC combined with CBD	Percentage of “good” nights favored THC with CBD (55.4%), over THC (42.9%), CBD (36.9%), and placebo (17%). THC:CBD, THC, and CBD were all significantly more than placebo.
PTSD
Fraser et al., 20096	Nabilone	Reduction or cessation in nightmares in the nabilone condition for majority (72%) of patients. Some patients reported subjective improvement in sleep duration and quality of sleep, and reduction of daytime flashbacks and nightsweats.
Roitman et al., 20147	Orally absorbable THC (dissolved in olive oil), as an add-on treatment for patients already on other medication	Reduction in nightmares and improvement in sleep quality after THC treatment
Multiple sclerosis
Collin et al., 20108	Sativex	Study conducted on patients suffering from spasticity due to multiple sclerosis. 61% of patients who reported a greater than or equal to 30% improvement in spasticity also reported a greater than or equal to 30% improvement in sleep. Improvement characterized by 0–10 NRS score.
Novotna et al., 20119	Sativex, as an add-on therapy	Increased sleep quality (dose effect was unclear), for patients with refractory spasticity caused by multiple sclerosis
HIV
Bedi et al., 201010	Dronabinol	Sleep efficiency increased in first 8 days of dosing. Study noted that HIV-positive marijuana smokers may require higher doses of dronabinol than approved by FDA because they develop tolerance to it over time.
Parkinson's disease
Chagas et al., 201411	CBD	REM sleep behavior disorder events decreased with use and without significant side effects
Mental disorders
Cameron et al., 201469	Nabilone	Sleep quality reportedly improved.
Primary anorexia
Gross et al., 198370	Graduating doses of THC capsules	Increased sleep disturbance on THC compared to placebo (dose effect was unclear)

CBD, cannabidiol; MS, multiple sclerosis; NRS, numerical rating scale; PTSD, posttraumatic stress disorder; RBD, REM sleep behavior disorder; REM, rapid eye movement; THC, tetetrahydrocannabinol; FDA, Food and Drug Administration.

The Cannabis plant contains over 100 known chemical compounds called cannabinoids. The two cannabinoids of greatest interest include cannabidiol (CBD) and tetetrahydrocannabinol (THC). CBD is a major cannabinoid that does not exhibit any known psychoactive effects, whereas THC, the other primary cannabinoid, does have psychoactive properties. In addition, medications have been manufactured to resemble one or more of these naturally occurring cannabinoids. Examples are Dronabinol (synthetic analog of THC), Nabilone (synthetic cannabinoid similar to THC) and Sativex (THC and CBD mixture in an oral-mucosal spray) (Fig. 1).