CBD and SLEEP
CBD and SLEEP
By Jason Wilson, MS
There is nothing that quite compares to a good night of sleep. In our hustle and bustle culture of overworking and overindulgence of information and social media, sleeping well has become a problem for many people. Additionally, there are many people who suffer from one or more different medical conditions that either directly or indirectly impact sleep quality. For instance, insomnia is a still misunderstood condition characterized by a lack of ability to either fall asleep or stay asleep. Narcolepsy is a sleep condition characterized by falling asleep at undesirable and sometimes spontaneous moments. Beyond these kinds of direct sleep conditions, many mental health conditions like depression, anxiety, or PTSD also affect sleep in profound ways.
There are many ways to tackle sleep disorders. Prior to jumping to pharmaceutical interventions, many healthcare professionals will attempt to teach patients various relaxation or mindfulness techniques to help quiet the mind or gain control over racing thoughts that keep the body stimulated. There are also various forms of therapy that can help a person reduce their response to stimuli, potentially increasing the likelihood that the person may fall asleep more easily. However, in more serious cases, these techniques are not enough, which then leads to pharmacological interventions – whether they be pharmaceuticals or herbal and nutritional supplements.
Many conventional Western pharmaceutical treatments for sleep problems involve the use of sleep aids, if the problem is an inability to sleep, or stimulants, if the problem is that someone is sleeping too much. Some of the types of drugs often prescribed to help people sleep include antidepressants (like trazodone), benzodiazepines (like emazepam or triazolam), antihistamines and histamine receptor blockers (like doxepine), or hypnotics (like zolpidem, aka Ambien).
While some people respond quite well to any of these medications, others either find them ineffective, or they are not comfortable with the side effects - not to mention that some of them, like benzodiazepines, can be addictive. Some of these drugs can make a person feel drowsy the following day, or they may help you fall asleep but increase the risk of waking up. Some of these drugs cause dissociation or intoxication-like effects in sensitive individuals. Others can produce life-threatening withdrawal symptoms if someone ever tries to stop taking them.
Because of these issues, many people suffering from sleep disorders are searching for an alternative to help them sleep, and lately cannabidiol, or CBD, has been touted as that potential solution. But what do we actually know about how CBD affects sleep? The first thing that is important to point out is that there is very little clinical research that has been performed to date in humans. That being said, there are a variety of in vivo rodent studies, as well as anecdotal consumer reports, that may help us understand how CBD influences sleep. (Murillo-Rodriguez, 2006) (Chagas, 2013).
How Does CBD Affect Sleep?
Pre-clinical evidence seems to indicate that CBD may assist sleep through several primary mechanisms including direct somnolescence, anxiety relief, pain relief, cardiovascular effects, and dream manipulation. Through the rest of this article we will explore the research around each of these effects which have been attributed to CBD.
At lower doses it has been shown that CBD can exhibit stimulating effects, but at higher doses CBD may cause sedative effects. One study found that 15mg of CBD appeared to be stimulating and counteracted the sedating effects of THC. (Nicholson, 2004) A separate study examining the effects of 40mg/kg of CBD on wakefulness in rodents found that the rodents were less wakeful and did not experience disruptions to their sleep cycles. (Monti, 1977) While these results are certainly not enough to draw serious conclusions from, it does highlight that CBD is a biphasic compound, exhibiting unique effects in low doses versus larger doses. If someone is taking CBD and experiencing stimulating effects, they may find that higher doses will have a different, and possibly more sedating, effect.
Anxiety and Stress Relief
As mentioned previously, many people struggle with sleep disruptions because of mental health conditions like depression or anxiety. It may be possible to positively impact sleep in these instances by addressing those feelings of stress, anxiety, or depression. When it comes to CBD and anxiety, there is actually a bit of human clinical data to draw from. A 2019 study examining anxiety and sleep in a cohort of 72 patients found that CBD decreased anxiety in 80% of patients while improving sleep within the first month of the study in 67% of study participants. (Shannon, 2019) A separate study that sought to understand how CBD affected wake-sleep patterns found that doses of 300mg of isolated CBD did not disrupt sleep, which likely highlights CBD’s biphasic nature of being more sedative at higher doses. (Linares, 2018)
But not everyone struggles with sleep because of anxiety or a sleep condition. Others may struggle with sleep because they are in pain. People with chronic pain often report that they also struggle with sleeping through the night. According to the Sleep Foundation, 65% of people with no pain report getting good or very good sleep, while only 45% of people that have experienced acute pain recently, or 37% of people with chronic pain report getting high quality sleep. (Sleepfoundation.org) Given that chronic pain affects at least a fifth of the US population of 300 million people, that means approximately 22 million people with chronic pain report getting good sleep, while the other 40 million people with chronic pain suffer from poor sleep on a regular basis.
To complicate matters, there are different kinds of pain, such as neuropathic pain (nerve pain) vs. inflammatory pain (like arthritis, sites of injury, etc). CBD and other cannabinoids may be able to provide sleep relief to chronic pain sufferers by attacking both of these forms of pain. Cannabinoids are already well known as potent anti-inflammatory compounds, which is why the United States held a patent on cannabinoids for several decades on the antioxidant, anti-inflammatory and cytoprotective (cell protecting) properties of cannabinoids. (Hampson, Axelrod, Grimaldi, 1999) Additionally, some cannabinoids have been found to influence signaling in the brain associated with pain responses. By “turning down the volume” of pain signaling in the brain, chronic pain sufferers may find some relief – which is particularly important for anyone suffering from neuropathic pain.
Previously we mentioned how high doses of CBD seem to be sedating and do not interrupt normal wake-sleep cycles. This is generally what you want with most sleep disorders – however there are uncommon cases where the stimulating effects of CBD might actually help with sleep.
There are some situations where people have trouble sleeping because of intense nightmares or night terrors which continuously wake them up. This is particularly common among people with post-traumatic stress disorder, or PTSD. They often become averse to sleeping, for fear of re-entering these unpleasant dreams that crop up during the REM cycle of sleep. But what if the REM cycle could be disrupted so as to prevent the person from dreaming?
In these cases, lower doses of CBD might be beneficial, as CBD has been shown to disrupt REM cycles by activating areas of the brain associated with wakefulness. (Murillo-Rodriguez, 2008) This essentially keeps the brain from entering a deep sleep, and prevents – to some degree – the formation of dreams.
The final aspect of how CBD may affect sleep that we will cover involves the heart. Cannabidiol has been shown to reduce blood pressure in doses as high as 600mg. (Jadoon, Tan, O’Sullivan, 2017) In addition, this study found that CBD not only reduced blood pressure acutely, but it also seemed to result in reduced blood pressure after being presented with a stressful stimulus. Although CBD reduced blood pressure in these patients, it also increased heart rate. Other research has shown that CBD may reduce heart rate while under stress. (Resstel, Tavares, Lisboa, Joca, Corrêa, Guimarães, 2009) (Bergamaschi, Queiroz, Chagas, etc., 2011) However, currently there is not enough clinical research to conclude exactly how CBD affects heart health. But we do know that blood pressure and heart rate are correlated with feelings of anxiety and stimulation – so CBD may influence sleep, one way or another, by influencing blood pressure and heart rate.
To summarize, there is a lot of promising pre-clinical and clinical data that suggests that CBD may positively impact sleep in some people. Through a dynamic interaction with multiple systems in the body, CBD may be able to provide sedative effects, anxiety relief, pain relief, dream manipulation, and cardiovascular effects that can contribute to a better sleep – depending on the situation. It should be noted that with chronic use, tolerance to CBD’s effects on sleep is likely to develop. Research has shown that after 15 days of chronic use, it is possible to become tolerant to CBD’s effects on wakefulness and sleep. (Monti, 1977) In general it is always a good idea to track the products and doses that are being taken, along with notes on how those products and doses affected one’s experience so that it is easier to work with a healthcare professional to determine if CBD is an appropriate tool to use in a quest toward better sleep.
About Jason Wilson, MS
Jason is a science educator and natural products researcher living in Southern Oregon. He is the author of Curious About Cannabis: A Scientific Introduction to a Controversial Plant and is the host of the Curious About Cannabis Podcast. Curious About Cannabis is a learning initiative by Natural Learning Enterprises, a mission-driven company dedicated to enhancing critical thinking skills and scientific literacy about the natural world.
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- Monti JM. Hypnoticlike effects of cannabidiol in the rat. Psychopharmacology. 1977. 55(3): 263-265