Does CBD help or hinder sleep?
What most of us wouldn’t give for a good night’s sleep. Without it, we can’t function at peak emotional, physical, and mental levels, yet in today’s high-stress, plugged-in world, so many of us don’t get decent sleep.
Ailments like insomnia, sleep apnea, narcolepsy, and excessive daytime sleepiness cause consumers to turn to over-the-counter and prescription pharmaceuticals for relief, yet many of these medications have their own serious side effects and adverse risks.
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For that reason, many consumers are exploring natural sleep aids like cannabis. We know THC-rich varieties can help people achieve sleep, but what about those sensitive to or afraid of its intoxicating effects?
Can cannabidiol (CBD), a non-intoxicating cannabis compound, also offer sleep benefits?
CBD and sleep: What does the research say?
As CBD has exploded onto the market, consumers are turning to the cannabinoid to treat many ailments, including insomnia. The insurgence of CBD has also prompted a sizable uptick in the number of preclinical and clinical studies looking at CBD’s value in treating a whole host of disorders. However, very few studies center on CBD and sleep.
In a recent Consumer Reports survey on CBD, 10% of respondents report using CBD as a sleep aid. The majority of them said it worked, but that evidence is anecdotal. Without controlled studies, it is difficult to tell whether CBD is truly acting alone to induce sleep. There are several complicating factors.
First, high-CBD strains often contain myrcene , a terpene that is said to be sedating. Although controlled studies on humans are lacking, myrcene’s sedative effects are well established in the animal literature, and for centuries, herbalists have been using hops as a human sleep aid. As it turns out, hops have high myrcene levels.
Therefore, if a person uses a high-CBD strain and says it helps them sleep, it is hard to tell whether CBD, myrcene or the two working in combination is the active agent. However, it’s worth noting that most people aren’t smoking or vaporizing myrcene-rich CBD flowers for sleep. Rather, most are using a CBD concentrate that contains little to no myrcene whatsoever.
Very few researchers have looked at isolated CBD as a sleep aid. Instead, researchers have looked at CBD in conjunction with other cannabinoids like THC. In a 2017 extensive literature review entitled Cannabis, Cannabinoids, and Sleep: a Review of the Literature, the research team found that CBD and THC were indeed the two cannabinoids most often cited as sleep-inducing aids.
Multiple cannabinoids muddy the waters
THC has a sedative effect and can reduce the time it takes to fall asleep. Some research shows that the entourage effect , or harmonized interaction between cannabis compounds like CBD and THC, seems to carry over to sleep.
Sulak explained that CBD may just be reducing symptoms like anxiety, which allows the person to relax so that their natural sleep mechanism can take over.
However, THC does not put a person in a sleep state. Neither does CBD. Instead, THC is a sedative and has other properties helpful to sleep. For example, THC makes a person feel comfortable while remaining still, called catalepsy.
Because CBD doesn’t alter consciousness in the same way that THC does, is it even possible that CBD can work alone as a sleep aid?
Dr. Dustin Sulak, DO, is the founder of Healer.com and Integr8 Health, a Maine medical practice that uses medical cannabis as a treatment for a variety of ailments. Sulak explained that CBD may actually just be reducing symptoms like anxiety, which allows the person to relax so that their natural sleep mechanism can take over.
To demonstrate Sulak’s point, here is one such published example, where a Colorado research team looked at outcomes of psychiatric patients who received CBD in a clinical setting to help with anxiety and sleep complaints. CBD was given as an adjunct to usual treatment. Within the first 30 days of CBD use, anxiety decreased in nearly 80% of patients and sleep scores improved by nearly 70%. CBD was well tolerated by the vast majority of patients.
But was CBD directly responsible for this outcome? And, given that a fairly large group of people with insomnia also have depression and anxiety , what exactly is CBD working on? This is where the waters become even more muddied.
Sulak’s practice has over 8,000 patients, so he sees the connection between sleep and chronic disease every day. “Sleep is extremely important,” he said. “Almost all of our most prevalent chronic diseases require healthy sleep for the patient to get better.”
Sulak said that if he can fix a patient’s sleep disturbance, it serves as a unifying treatment that can help multiple patient conditions like diabetes and chronic pain. While Sulak does treat sleep disorders, he very rarely does so with CBD in any form, whether pure CBD or a CBD-dominant cannabis strain.
Instead, Sulak often uses THC with a sedating terpene profile. He achieves excellent results, even when using low doses.
The dosing dilemma
Depending on who you ask, CBD has been reported as having either a stimulating or a calming effect, thus adding confusion to the overall equation. While there is very little published evidence regarding dosing, research to date indicates that at higher doses, CBD has a calming effect; yet at lower doses, CBD has a stimulating effect.
In a 1977 animal study, the “ hypnotic-like effects ” of CBD were first studied. Since then, very few CBD dosing studies have been performed, but the evidence seems to indicate that the effectiveness of CBD depends on whether the person has a normal sleep rhythm or whether the person has a sleep disorder.
In a 2018 study on 27 healthy subjects , a high CBD dose (300 mg) qualifying as a clinically anxiolytic dose had no effect on the sleep-wake cycle. CBD was given 30 minutes prior to bedtime and sleep recordings were made for eight hours thereafter.
In a similar study, very high CBD doses (600 mg) had a sedative effect, but in subjects with insomnia, much lower doses of 160 mg reduced sleep disruption and increased total sleep duration. Conversely, very low doses of 25 mg had no effect.
CBD and REM sleep
CBD has been found to help with certain sleep anomalies that occur during rapid eye movement (REM) sleep. There are two types of sleep: non-rapid eye movement sleep (NREM) and rapid eye-movement (REM) sleep. NREM sleep progresses through a 90-minute cycle leading up to REM sleep, in which brain wave activity increases and dreaming occurs. REM sleep is also the time when previously learned is solidified into a memory.
In normal REM sleep, the limb muscles become temporarily paralyzed so that a person cannot act out dreams. In Parkinson’s disease as well as REM behavior disorder , people are able to flail and act out vivid and violent dreams. CBD at doses ranging from 75 to 300 mg was shown in a preliminary study to help these patients, and in an early case study, high-dose CBD helped a pediatric PTSD patient .
Low-dose CBD formulations seem to keep people awake and not alter the sleep cycle. However, this may one day prove beneficial for circadian rhythm disorders like excessive daytime sleepiness and narcolepsy because they may help people stay awake during daylight hours.
So, should you be using CBD for sleep?
Every individual’s body is unique, and therefore the effect of CBD will be highly individualized. Sulak explained that he would be open to using CBD in his own practice if a patient had not responded well to THC. Some patients are extraordinarily sensitive to THC and have symptoms during the night or still feel impaired in the morning. Sulak said he would likely select CBD strains that contained high levels of myrcene (luckily, there are plenty of options ).
Sulak said that CBD may offer benefit for people with sleep disturbances, and he feels it is important to move forward with pragmatically designed clinical trials, meaning a trial that does not provide every patient with the same exact treatment. Instead, an algorithm type approach would be used, starting with one treatment and moving to others if the previous ones are unsuccessful.
Sulak also stated that Americans are desperately in need of education on understanding sleep hygiene and the critical importance of sleep for health and happiness. “Most people don’t know that sleep disturbances are associated with decreased analgesic (pain-relieving effects) of opioids and antidepressant drugs, so it’s such a vicious cycle,” he said. “It’s wonderful to use cannabis to break that cycle,” Sulak said.
CBD is safe, even at high doses
Sulak said that he ensures his patients that CBD is extraordinarily safe, so if it is not effective at low to moderate doses of 10 to 50 mg, CBD is safe to try at higher doses of 100 to 200mg. In a 2018 study , single doses of 1,500 mg, 3,000 mg or 6,000 mg were administered to healthy subjects daily for six days. While the study was not aimed at researching CBD’s effects on sleep, it demonstrated that CBD is indeed safe.
However, it’s important to note that research has a long way to go in establishing drug interactions associated with cannabinoids. While CBD appears to be safe on its own, consider consulting a medical professional before adding CBD or other cannabis products to your regimen.
Despite the overall lack of CBD sleep studies, the National Academies of Sciences, Engineering and Medicine concluded in a 2017 report that moderate evidence exists for cannabinoids to improve short-term sleep outcomes in a variety of conditions. As more research is conducted, CBD may well benefit patients who have ailments like obstructive sleep apnea, fibromyalgia, chronic pain, and anxiety.
They say cannabis helps with sleep, but what if you'd rather not get high? Learn more about the differences between THC and CBD for sleep, with expert weigh-in on strains to try out.
CBD oil and insomnia
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- Research overview
- The studies
- Patient perspectives
- Bottom line
Each night, millions of individuals in the United States have difficulty falling asleep or staying asleep. While for some this is a temporary problem, for others insomnia can become a chronic issue that detrimentally affects day-to-day life. An estimated 10% of American adults experience insomnia, which occurs at least three times per week.
According to The 2018 National Sleep Foundation Sleep in America Poll, only 46% of those who identified as having poor sleep patterns felt that they were very effective in getting things done during the day, compared with 89% of those who identified their sleep patterns as excellent.
Restful, nourishing sleep is not only essential to getting things done and performing at one’s best, it also supports optimal functioning of the immune system, mood stability, improved energy and motivation levels, and enhanced overall well-being.
Unfortunately, the quest to achieve a good night’s sleep can lead to those with insomnia becoming addicted to sleeping pills, which comes with a range of potentially dangerous side effects such as dizziness, daytime drowsiness, and a higher risk of mortality.
Anecdotal reports indicate that CBD oil may help to induce somnolence or sleepiness, with no known adverse side effects. Photo by: Gina Coleman/Weedmaps
Anecdotal reports indicate that CBD oil may help to induce sleepiness, with no known adverse side effects.
There is conflicting evidence about the efficacy of CBD to support healthy sleep regulation. Some studies show that although CBD oil may help some individuals to fall asleep and stay asleep, it can cause wakefulness or disturbed sleep in others.
At present, there is also a lack of knowledge about the mechanisms by which CBD modulates sleep. It has been theorized that it may change dopamine levels, or exert effects over the body’s cannabinoid system, including the sleep-wake cycle.
Chronic insomnia is often closely linked to anxiety. Those who experience sleeplessness, or have trouble staying asleep, are often anxious about aspects of their waking life or anxious about their poor sleep patterns.
A 2019 retrospective case study in the Permanente Journal investigated the use of CBD for anxiety and sleep. Twenty-five of the 72 patients surveyed reported poor sleep as a primary concern, while 47 reported anxiety as a primary concern.
At the first monthly assessment following the beginning of CBD treatment (25-175 milligrams per day), 66% of patients experienced an improvement in sleep, while 25% experienced worse sleep. At the two-month mark, 56% reported an improvement in sleep compared with the previous month, while 26% reported worsening problems associated with their sleep. The patients demonstrated a more sustained response to CBD as a treatment for anxiety than sleep and experienced a more marked reduction in their anxiety than their insomnia.
The authors also noted that the CBD was well-accepted and well-tolerated by the patients in the study, with minimal side effects.
A 2006 study published in the journal of the Federation of European Biochemical Societies Letters, found that CBD increased wakefulness and decreased REM sleep in rats during their inactive cycle (when the lights were on). REM sleep refers to rapid eye movement, the phase of sleep in which dreaming occurs. No changes in sleep were observed during darkness, when rats are typically active. CBD appeared to increase activity in waking-related areas of the brain. The study also found that CBD induced an increase in dopamine release. Dopamine is one of several neurotransmitters involved in wakefulness.
One animal study suggests that despite CBD’s popularity to aid sleep, it may, in fact, promote wakefulness by decreasing REM sleep. Photo by: Gina Coleman/Weedmaps
This animal study suggests that, despite CBD’s popularity to aid sleep, it may in fact promote wakefulness by decreasing REM sleep. However, for those individuals with a REM sleep disorder, this could be beneficial. In fact, a 2014 study in the Journal of Clinical Pharmacy and Therapeutics, researchers reported several case studies where Parkinson’s patients with REM behavior disorder experienced marked improvement when using CBD.
Similarly, patients with post-traumatic stress disorder (PTSD) also often have sleep disturbances and nightmares, which occur during REM sleep. In a 2019 study in the Journal of Alternative and Complementary Medicine, cannabidiol improved the sleep quality of 38% of the patients with PTSD, and reduced nightmares.
A 2018 randomized controlled trial with human participants published in Frontiers in Pharmacology investigated the effects of CBD on the sleep-wake cycle of normal, healthy volunteers. Twenty-seven research participants received either CBD or a placebo over two nights. The study found that CBD did not produce any significant effect, nor did it interfere with the normal sleep cycle of these healthy individuals.
Insomniacs who ingested daily doses of 40, 80, or 160 milligrams of CBD reported having a better night’s sleep and less dream recall than those who took a placebo. Photo by: Gina Coleman/Weedmaps
Insomniacs who ingested daily doses of 40, 80, or 160 milligrams of CBD reported having a better night’s sleep and less dream recall than those who took a placebo. The authors of the study hypothesized the CBD may decrease REM sleep capacity, or decrease the frequency of periods of wakefulness during the night, which helps with remembering dreams.
For a long time, chronic insomnia severely affected Paul Miller’s waking life. “I had tried melatonin and various herbal teas, but nothing worked. I was stressed out and exhausted, and it was a vicious cycle. The more I couldn’t sleep, the more stressed I became about it.”
When a friend gave Miller a 500 milligram tincture of CBD oil to help with his sleeplessness, he initially set it aside.
“I knew nothing about it and was hesitant to even try it because I had no idea what the side effects might be,” Miller explained to Weedmaps News.
One restless night, however, Miller was so desperate for sleep he took the CBD oil down from the shelf and tried it.
Further research into appropriate dosages and more randomized clinical trials in the future may offer greater insights and understanding into the use of CBD as a sleep aid. Photo by: Gina Coleman/Weedmaps
“It worked so well that I started researching more about it, and that’s what led me to starting our company, Lokus Nutrition, a CBD company. The reason we exist is because of my insomnia.”
Daniel Robbins turned to CBD as an alternative to other sleep medication. “I have a hard time falling asleep and used to take melatonin or Sleep Aid, but would have side effects like a racing heart, or waking up very groggy and unable to go back to sleep.”
He started experimenting with CBD gummies, taking 10-20 milligrams before sleep, with no other medication. “At first I noticed a feeling of relaxation and then I would begin to feel sleepy. “I fall asleep faster, with zero side effects. It has done wonders.”
Robbins notes that the CBD also helps to manage his anxiety. “Additionally, I take it in the morning and feel calm when I start to have anxiety coming on as I often get very stressed and anxious.”
Studies show that CBD may support healthy sleep in some individuals, but it can potentially increase sleeplessness in others. Further research into appropriate dosages and more randomized clinical trials in the future may offer greater insights and understanding into the use of CBD as a sleep aid.
CBD oil and insomnia Copy article link to clipboard. Link copied to clipboard. Contents Research overview The studies Patient perspectives Bottom line Each