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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.

Catching zzz’s with CBD?

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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.

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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.

CBD products are everywhere. But do they work?

By now, you’ve probably run into a product containing cannabidiol, also known as CBD. It’s in everything from drinks and pet products to lotions and chewable gummies. Even major drugstore chains have announced they will start carrying CBD products in certain states.

But many people still don’t really know what CBD is. Is it marijuana? Is it legal? Does it actually work? Is it safe?

The answers to those questions aren’t necessarily straight­forward. The only thing that is clear at this point: The marketing has gone way ahead of the science and the law when it comes to CBD products.

That said, CBD is thought to be a safe and effective option for certain conditions. Below, we sort through the confusion by answering some of the most common questions about CBD.

Is CBD marijuana?

Yes and no. Cannabidiol is one of the two best-known active compounds derived from the marijuana plant. The other is tetrahydrocannabinol, or THC, which is the substance that that produces the “high” from marijuana.

CBD does not get you high, but the idea that it’s not psychoactive is something of a misconception in his opinion. It does change your consciousness. You may feel mellow, experience less pain, and be more comfortable. In addition, some CBD products do contain small amounts of THC.

While CBD can come from marijuana, it can also be derived from hemp. Hemp is a related plant with 0.3% or less of THC. This plant is often used to make fabrics and ropes. As of 2018, Congress made hemp legal in all 50 states, and consequently CBD derived from hemp is also legal. The rules around marijuana-derived CBD, however, are far less clear.

Is marijuana-derived CBD legal?

Again, yes and no, depending on where you live. In some states marijuana is legal for both recreational use and medical use. In other states, it’s legal only for medical use. And in some areas, it’s not legal at all.

When it comes to CBD products, the FDA is still trying to get its arms around the issue. The agency is just starting the process of hashing out some rules regarding CBD sales. Officials recently formed a working group to create guidelines that could allow companies to legally market CBD products. Currently, CBD products are considered supplements, which aren’t FDA-regulated, and it is illegal for companies to make health or therapeutic claims about the products in their marketing. In announcing its effort to set CBD marketing rules, the FDA also signaled that it is cracking down on CBD companies that are using “egregious and unfounded claims” to market their products to “vulnerable populations.”

Currently, there is only one CBD product that has FDA approval: a prescription medication called Epidiolex, used to treat some rare severe seizure disorders in children. The bottom line is that in order to understand whether CBD is legal where you live, you’ll need to consult your state health department website or professionals in your community.

Does CBD work?

Yes, there is evidence that CBD works for some conditions, but certainly not all the conditions it is being promoted for these days. There’s no evidence, for example, that CBD cures cancer. There is moderate evidence that CBD can improve sleep disorders, fibromyalgia pain, muscle spasticity related to multiple sclerosis, and anxiety.

People report that oral CBD helps relieve anxiety and pain and also leads to better sleep. However, the same may not be true for a host of other CBD products on the market today, in particular those that are rubbed on the skin. It’s hard to know whether these have any clinical benefit, because they haven’t been tested sufficiently.

Testing also shows that many products don’t contain what’s claimed on the label. For example, they may have less CBD than advertised. So, buyer beware.

Where should you purchase CBD products?

If you are interested in trying a CBD product, it’s best to seek one through a dispensary, which is an establishment legally licensed to sell marijuana, if they are available in your state. Dispensary products must be labeled so you can see exactly how much CBD is in the product and whether it also contains THC. A small amount of THC in a CBD product isn’t typically problematic. But larger amounts could cause a “high” and may present a risk if you are going to drive.

Also, keep in mind that CBD products aren’t standardized and will vary. It helps to keep a journal recording what type of CBD product you took, how much, and your response to it. This will help you track what works and what doesn’t for your condition.

Is CBD safe?

The safest way to take CBD is orally, as a tablet, chewable, or tincture (a concentrated liquid typically administered with a dropper). Steer clear of any illegally sold synthetic CBD products, sometimes called “spice” or “bath salts.” These products have induced psychotic reactions in some people and pose a major health risk.

For adults, CBD appears to be a very safe product. CBD does produce side effects for some people, including nausea, fatigue, and irritability. It may also interact with certain medications, so always check with your doctor before use.

But for children under age 21 it’s a different story. It’s also not clear if any amount of CBD is appropriate for children.

Evidence regarding CBD is still building. Now that some states have legalized recreational and medical use of marijuana products, including CBD, scientists are finding it easier to conduct research. More will be known in the next 5 to 10 years, including whether there are yet undiscovered problems associated with long-term use.

Image: Vanessa Numes/Getty Images

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