Dr. Abhinav Singh
Dr. Singh is the Medical Director of the Indiana Sleep Center. His research and clinical practice focuses on the entire myriad of sleep disorders.
A good night’s sleep is essential to your overall health and wellbeing. Experts recommend adults sleep seven to nine hours each night. Proper sleep ensures you feel well-rested and have energy for the next day. A good night’s rest also contributes to memory formation, helps grow and repair muscle and tissue, and prevents sickness.
Unfortunately, falling asleep or staying asleep can be difficult for certain types of sleepers. As many as 70% of Americans report not sleeping the recommended hours, and nearly one-third of American workers sleep less than six hours per night. Solutions for better sleep and avoiding sleep debt vary. Possible approaches include improved sleep hygiene, prescription sleep aids, and natural sleep aids.
One increasingly popular strategy for sleeping better is taking cannabidiol (CBD), a derivative of cannabis. CBD is commonly used to improve sleep and decrease anxiety. However, the regulation of CBD in the United States is limited, and much more research must be done to determine the exact effects CBD has on sleep and other physical and mental health concerns.
While there are many different slang terms for the green, narrow-leafed plant you may recognize, the plant is scientifically called Cannabis sativa. The word “cannabis” can be used to describe any products made from the plant. Cannabis plants contain multiple chemical compounds, including a group referred to as “cannabinoids.” Out of more than 100 cannabinoids, researchers have primarily studied two that appear to have the greatest impact on humans: tetrahydrocannabinol (THC) and CBD.
Most commonly known effects of cannabis, such as “getting high,” are caused by the cannabinoid, THC. The term “marijuana” specifically refers to parts of the Cannabis sativa plant that contain THC.
Cannabis plants and derivatives that contain less than 0.3% THC are classified as “hemp.” As of 2018, hemp is no longer defined as a controlled substance by the U.S. federal government. As a result, there has been an influx of hemp-related products in the American market. These products are generally marketed as CBD products.
CBD, the other commonly known cannabinoid, can be legally sold in the U.S. when extracted from hemp and marketed according to relevant regulations. CBD does not have psychoactive properties and does not bring about the same effects as THC. Also, CBD does not have effects that would lead to potential dependency or risk of abuse.
CBD is an increasingly popular substance in the U.S. While many health benefits have been attributed to CBD, in most cases, scientific validity of its effectiveness is still unclear.
Only a few cannabis-derived or cannabis-related drug products are FDA-approved in the U.S.:
The FDA has not approved any other CBD drug products. The agency has not determined the safety and effectiveness of cannabis or CBD in the treatment of any particular conditions or disease.
There are several common forms of CBD:
Outside of Epidiolex, the FDA doesn’t regulate dosing of non-drug CBD products. As a result, the amount of CBD in products varies widely among forms.
Research shows 300-mg oral doses of CBD can be taken safely on a daily basis for up to six months. One scientific review showed that taking up to 1,500 mg daily was well-tolerated by participants. A subsequent review confirmed that use of 1,500 mg daily for four weeks showed no negative effects.
Unfortunately, the indicated CBD content on a product label is not necessarily the amount that the product actually contains, which may lead people to take more or less CBD than intended. One analysis of 84 CBD products sold online showed that 26% of the products contained less CBD than the label said. The same analysis showed nearly 43% of the products were underlabled, meaning they contained substantially more CBD than the label said.
While CBD at higher doses does not appear to have serious negative consequences, these products may also contain higher levels of THC than reported on the label. Other CBD products may contain THC that is not reported on the label at all. The THC in these products can produce intoxicating effects, which may or may not be desired.
Research shows that CBD has a calming effect on the nervous system. CBD can also alter mood because it affects the serotonin system. Outcomes vary among people and depend on the product type and dose.
Unlike THC, CBD does not induce a feeling of being “high.” Even large doses of CBD do not produce THC-like effects. Additionally, a few studies have demonstrated that CBD reduces the psychoactive effects of THC.
Studies of short-term CBD use show that patients do not experience withdrawal.
So far, CBD’s effectiveness in the treatment of epilepsy is well-supported by research. Other early research suggests that CBD may also help treat schizophrenia and substance use disorders.
Currently, there is insufficient research to determine the effectiveness of CBD in treating other health conditions. However, preliminary research suggests CBD can help with a number of sleep disorders, including insomnia REM sleep behavior disorder, and excessive daytime sleepiness disorder. Additional preliminary research suggests CBD can also help patients improve sleep and reduce anxiety.
Most negative effects of CBD medications and products are mild. For example, patients who use Epidiolex may experience diarrhea or other gastrointestinal issues. Some people may experience drowsiness when they take CBD. Other negative effects experienced with CBD may be due to an interaction between the CBD and other medications the patient is taking.
Research on the effects CBD has on sleep disorders is still preliminary. Some people who use CBD for chronic pain report sleeping better. Currently, it is unclear whether these patients sleep better because of the pain relief or because CBD directly affects their sleep.
Other initial studies of CBD and sleep disorders suggest positive outcomes. However, not everyone experiences the same sleep benefits with CBD use, and different doses might lead to different effects. Research suggests that low doses of CBD are stimulating, while high doses of CBD are sedating. Discrepancies in experience can also be attributed to the method of CBD administration and dose. Additional research is needed to deepen our understanding of CBD as an intervention for sleep disorders.
While not a sleep disorder itself, anxiety can contribute to poor quality sleep, insufficient sleep, and sleep disorders. Because CBD calms the nervous system, early research indicates that CBD can be used to treat anxiety-related disorders. One study showed that nearly 80% of participants who used CBD to treat their anxiety reported lower anxiety levels within a month. Sleep initially improved in more than 65% percent of participants, followed by fluctuating results.
People who suffer from insomnia experience difficulty falling asleep or staying asleep at night. This disorder affects daytime wakefulness, ability to concentrate, and mood. Because of their history of poor sleep, people with insomnia may suffer from anxiety about getting inadequate sleep, which can then increase sleeplessness at night.
Given the potential positive outcomes of CBD treating anxiety, it is speculated that CBD may also help reduce the anxiety associated with insomnia. Additionally, a new pilot study of CBD and THC use in humans with physician-diagnosed insomnia is underway. The results of the study will offer more insight into the effects CBD has on insomnia.
In REM sleep behavior disorder, patients verbalize and make aggressive movements during their rapid eye movement (REM) stage of sleep. The disorder is most common in older patients with neurodegenerative diseases, such as Alzheimer’s disease and Parkinson’s disease.
In a limited study of four patients with Parkinson’s disease, CBD helped manage the REM sleep behavior disorder symptoms. Before taking CBD, the patients experienced disorder symptoms 2–7 times per week. After taking CBD, the symptoms occurred 0–1 times in a week. Further studies are necessary, but these initial results suggest CBD as a possible treatment for REM sleep behavior disorder.
Those who have excessive daytime sleepiness disorder struggle to stay awake during typical daytime hours. One solution for waking up on time and staying wake may be CBD. Initial research on animals shows that CBD functions as a wake-inducing drug. However, other studies suggest CBD functions as a sedating drug. Further research is needed to determine what doses and methods of CBD use affect wakefulness and sleepiness.
CBD can interact with other prescriptions a person takes. In particular, CBD can slow the liver’s ability to break down certain medications. Additionally, using CBD as well as herbs or supplements can make the patient too sleepy.
Before using any CBD product, consult your doctor. Let your doctor know of any medications, herbs, or supplements you are taking, so they can assess if CBD might cause a negative interaction. Your doctor will be able to inform you if CBD is a viable option to meet your health goals.