sleep studies for cbd oil

CBD for Sleep – March 2022

The human sleep cycle comprises four stages of non-rapid eye movement (NREM) sleep and rapid eye movement (REM) sleep. The first three stages are NREM sleep, followed by the fourth stage, REM sleep.

A good night’s sleep or a healthy sleep cycle experiences all four stages of sleep. NREM stages account for 75% to 80% of sleep time, while REM accounts for 20% to 25% of sleep time (7 ) .

An individual with insomnia may have trouble sleeping and maintaining a regular sleep- wake cycle . Some may even have difficulty getting to the first two stages of sleep.

The disruption of this cycle may lead to many health issues, such as hypoxemia (low oxygen) and dyspnea (shortness of breath), pain conditions, and neurodegenerative diseases (8 ) .

A 2017 study published in Current Psychiatry Reports mentioned that CBD might have therapeutic potential for treating insomnia and other poor sleep conditions. The study continued by acknowledging that CBD may hold promise for excessive daytime sleepiness and REM-sleep behavior disorder (9 ) .

A crossover study compared CBD with nitrazepam (a hypnotic drug). The authors found that a dose of 160 mg of CBD increased sleep duration among human subjects (10 ) .

REM-sleep behavior disorder (RBD), a parasomnia, is defined by undesired events during sleep. Parasomnias are disruptive sleep disorders .

An individual may suddenly wake between stages two to four in the sleep cycle . This condition often involves confusional arousal (disorientation of time and place), sleep terrors, loss of muscle atonia, and sleepwalking (11 ) .

RBD is prevalent among men over 50 years old and among patients with Parkinson’s disease. A study described the beneficial effects of CBD in reducing RBD symptoms among patients with Parkinson’s (12 ) .

Researchers treated four patients with CBD during the study, which resulted in the reduced frequency of RBD-related events. Upon discontinuation of the treatment, RBD complex movements and symptoms returned (13 ) .

The study stated that although positive results have been observed among patients, the mechanism of therapeutic action remains unknown. More research is needed to confirm the efficacy and implications of CBD.

CBD Oil vs. Anxiety-Related Sleep Disorders

Post-traumatic stress disorder (PTSD) develops after a traumatic event. PTSD is frequently associated with night terrors and disturbed sleep (14 ) .

A study posted in the Journal of Alternative and Complementary Medicine has demonstrated how CBD treatment (of over two months) decreased the severity of PTSD symptoms in healthy human subjects. The study showed examples of how CBD dosage of 12mg and 32mg have decreased anxiety symptoms and sleep disturbances in patients (15 ) .

Another study found that out of 72 subject patients with anxiety, 57 experienced improvements during the first month of taking CBD (16 ) .

The Frontiers of Pharmacology also published a recent study that experimented on how CBD affects children with autism spectrum disorder (ASD). Children with ASD often suffer from comorbidity of symptoms, including anxiety and sleep disorder .

Parents have reported that CBD may have improved ASD symptoms. Among the 53 children (ages 4-22 years old), sleep problems improved in 71.4% and worsened in 4.7%, while anxiety improved in 47.1% and worsened in 23.5% (17 ) .

CBD Oil vs. Restless Leg Syndrome

Restless Leg Syndrome (RLS) is a neurological disorder wherein the individual feels pain or discomfort when the legs are at rest. Moving the legs or walking may temporarily relieve the pain.

A recent study posted in Sleeping & Breathing discussed the potential benefit of cannabis use among patients presenting with refractory RLS. The study added that patients had reported total remission of RLS symptoms following cannabis use (18 ) .

The author proposed more clinical trials to study the effect and implications of cannabis use for RLS symptoms.

How CBD Oil Works to Help With Sleep

The endocannabinoid system (ECS) is made of G-protein receptors located throughout the human body, such as cannabinoid receptor one (CB1) and cannabinoid receptor two (CB2).

These receptors are found mostly in the central nervous system , the immune system, and the peripheral nervous system.

It has been mentioned in a study from Pharmacological Reviews that modulating the ECS might lead to therapeutic promises in a wide range of conditions and diseases (19 ) .

A review posted in Elsevier discussed the role of the CB1 receptor in the regulation of sleep. The author mentioned how the localization of the CB1 receptor in sleep-inducing areas might be a potential mechanism for sleep promotion (20 ) .

According to a study, CBD activity on G-protein receptors might drive its neuroprotective, antidepressive, and anxiolytic benefits (21 ) .

Moreover, a study released in Current Neuropharmacology discussed how CBD microinjections into the lateral hypothalamus (next to the pituitary gland) led to the enhancement of dopamine to increase wakefulness during daylight hours (22 ) .

The endocannabinoid system modulates pain signals in the body. The cannabinoid receptors may be found in pain circuits (from sensory nerve endings to the brain) (23 ) .

Clinical trials seemed to indicate that the compounds of hemp plants ( Cannabis sativa ), such as CBD and THC , may be promising treatments for difficult to treat painful conditions (24 ) .

Risks of CBD

Although legal in the United States, CBD remains highly unregulated. Individuals are encouraged to research which brands are safe and legitimate.

CBD may present a few side effects , such as dry mouth, diarrhea, sleepiness, drowsiness , and reduced appetite (25 ) .

Another study published in Molecules discovered that extremely high doses of CBD might cause liver injury (26 ) .

It is also not advisable to take CBD in conjunction with other medications. Individuals must first consult with a licensed physician before taking CBD, which might create an interaction with pharmaceutical drugs.

There are many different hypotheses on CBD’s potential effects on sleep. Some studies said that CBD might induce wakefulness, while other studies suggested CBD might cause sleepiness (27-28 ) . Generally, higher amounts of CBD cause sedation.

CBD vs. Other Alternative Sleep Aids

Melatonin is a popular sleep aid that is marketed as a dietary supplement. Melatonin is a natural hormone in the brain responsible for the body’s sleep response to darkness. The body’s ability to produce melatonin is crucial in maintaining the circadian rhythm.

Although highly marketed, melatonin has produced conflicting results in clinical studies (29 ) .

The American Academy of Sleep Medicine did not include melatonin in the list of treatments for insomnia, although they’ve acknowledged that the dietary supplement produced better results compared to placebo (30 ) .

CBD is considered a natural alternative approach in treating insomnia. Like melatonin , CBD’s health benefits with regards to insomnia remain a hypothesis.

Around 40% to 80% of individuals with autism spectrum disorder (ASD) may present with sleep problems . In 2019, doctors conducted an experiment on children and adolescents with ASD. They have found that melatonin improved sleep problems in 60% of the patients, while CBD improved sleep in 71.4% of the patients (31-32 ) .

Chamomile tea is another alternative treatment for insomnia. The traditional herb has been a staple among wellness enthusiasts. However, there is a lack of study on chamomile ’s effectiveness in treating insomnia.

CBD teas are also recommended for individuals who wish to widen their options and achieve overall wellness .

Cannabinoids and CBD

Cannabinoids are naturally occurring compounds present in the cannabis plant . According to research, the cannabis plant contains roughly 80 to 100 cannabinoids and 300 non- cannabinoid compounds (33 ) .

Cannabidiol (CBD) and delta-9- tetrahydrocannabinol ( THC ) are two of the main cannabinoids in the cannabis plant . CBD is non- psychoactive , while THC is the main psychoactive compound of the plant.

Other cannabinoids present in the cannabis plant include cannabinol ( CBN ), cannabigerol (CBG), and cannabidiolic acid (CBDA).

CBD has gained popularity over the years after medical researchers found that it possesses medicinal properties.

Research posted on the National Institutes of Health ( NIH ) website discussed that CBD had analgesic properties and helped treat chronic pain in adults (34 ) . Another research found that CBD might help improve the health of patients with panic disorder, obsessive-compulsive disorder (OCD), social anxiety disorder, and post-traumatic stress disorder (PTSD) (35 ) .

Meanwhile, a 2016 study concluded that CBD helped reduce pain and inflammation in arthritis patients (36 ) .

Another research discovered that CBD might help prevent seizures in animals (37 ) .

Some CBD brands infuse their CBD products with terpenes and flavonoids. CBD brands provide CBD in the forms of gummies , tinctures , hemp extracts , vapes, and hemp oils .

Most brands also offer their CBD gummies or CBD tinctures in various flavors to attract more customers.

Individuals looking for joint or muscle pain relief may opt for a transdermal approach, such as CBD topicals, CBD creams, CBD lotions, or CBD patches.

CBD brands use different extraction methods to extract CBD from industrial hemp plants . Some brands use solvent -based extraction methods, while others use the Supercritical Fluid Extraction (SFE) or the CO 2 extraction process.

Most CBD brands offer high-quality CBD products in three forms: whole-plant or full-spectrum CBD , broad-spectrum CBD, and CBD isolate .

Full-spectrum CBD or whole-plant CBD contains the full chemical profile of the raw hem plant material. Full-spectrum hemp products contain various phytocannabinoids, including CBD and THC .

Other compounds retained in whole-plant CBD products include terpenes , flavonoids, and fatty acids.

Most customers purchase full-spectrum CBD extracts for the “ entourage effect ,” an effect caused by the cannabis compounds working synergistically with each other for better results.

Meanwhile, broad-spectrum CBD contains various cannabinoid compounds from hemp plants . However, it is different from full-spectrum hemp extracts because THC is removed from broad-spectrum CBD products .

Much like broad-spectrum CBD products , CBD isolate or pure CBD products are also THC -free. CBD isolate contains only CBD and no other cannabinoids .

CBD vs. Marijuana

Marijuana defines the flowers of cannabis plants derived from strains high in cannabinoids , especially THC . Meanwhile, the term hemp is the fibrous, seed-bearing plants that possess a high amount of CBD.

To avoid confusion between CBD and marijuana, remember that marijuana is a cannabis plant harvested for its high THC content. Meanwhile, CBD is a non- psychoactive cannabinoid usually derived from hemp plants .

Although hemp and marijuana are both cannabis species, they are genetically different. Hemp plants are rich in CBD, while marijuana plants are rich in THC .

Is CBD Safe?

Some CBD brands use organic and non-genetically modified organism ( non-GMO ) ingredients to ensure product safety. Some brands also have gluten-free or vegan options.

Most brands also offer CBD oils with measured droppers for accurate and safe dosing.

CBD brands rely on third- party testing to gain the confidence of customers. With third-party lab tests, customers may be informed whether the products are free from contaminants, including pesticides , additives, and residual solvents .

However, CBD is still unregulated by the US Food and Drug Administration ( FDA ). Under FDA regulations, CBD companies are not allowed to make health claims or sell CBD as a food supplement.

Currently, there is only one pharmaceutical drug that contains CBD. Epidiolex is the first FDA -approved CBD drug used to treat rare forms of epilepsy (38 ) .

Is CBD Legal?

Derived from agricultural or industrial hemp, CBD is legal at the federal level in the US under the 2018 Farm Bill (39 ) .

Manufacturers are allowed to transport, produce, and sell CBD as long as the concentration contains 0.3% or lower THC levels.

However, it is recommended to read up on state laws before purchasing CBD products . CBD is still illegal under state laws in Idaho and South Dakota as of 2020 (40 ) .

Conclusion

Studies have shown that CBD might hold therapeutic benefits in achieving restful sleep by improving mental health, such as reducing anxiety and PTSD symptoms among human subjects (41-42 ) .

Existing studies have shown promising results. However, more studies are needed to confirm CBD’s effectiveness in achieving better natural sleep.

Clinical Challenges: Cannabis Gains Ground as Sleep Aid

— But efficacy of CBD, THC products to treat sleep disorders remains largely untested

by Salynn Boyles, Contributing Writer November 11, 2019

Cannabis products are having a moment — according to one recent market projection, the U.S. cannabidiol (CBD) market could reach $20 billion by 2024, up from $238 million in 2018.

In addition, sales of CBD and legal tetrahydrocannabinol (THC) products combined are projected to reach $45 billion by 2024.

Celebrities are on board with CBD, with Kim Kardashian West having a CBD-themed baby shower, while Whoopi Goldberg, Willie Nelson, and, of course, Snoop Dogg have all launched lines of CBD or THC products.

CBD and THC in the form of commercial oils, creams, lotions, and edibles are marketed for a wide range of ailments, from anxiety to chronic pain to post-traumatic stress disorder (PTSD).

They are also widely touted for improving sleep and for treating sleep disorders like obstructive sleep apnea (OSA), although their efficacy remains largely untested.

In a recently published position statement, the American Academy of Sleep Medicine (AASM) concluded that, “based on the available evidence” medical cannabis should not be used for the treatment of OSA, and the statement advised regulators and policymakers not to include OSA in their list of indicated conditions for medical cannabis programs.

OSA Tx ‘Overreach’

The AASM position statement was published after Minnesota became the first and, so far, only state in the U.S. to approve medical cannabis for the treatment of OSA.

“Further research is needed to better understand the mechanistic actions of medical cannabis and its synthetic extracts, the long-term role of these synthetic extracts on OSA treatment, and the harms and benefits,” the AASM position statement read.

Bhanu Prakash Kolla, MD, of the Mayo Clinic Center for Sleep Medicine in Rochester, Minnesota, told MedPage Today that the Minnesota Health Department based its OSA approval on minimal scientific evidence: two animal studies, a proof of concept study involving just 17 adults, and a phase II study of the THC cannabinoid drug dronabinol (Marinol, Syndros) that enrolled 73 adults.

Dronabinol is approved by the FDA for the treatment of nausea symptoms in patients on chemotherapy and anorexia associated with HIV and AIDS.

“I believe it is a significant overreach to say that these studies show that [THC products] are useful in the treatment of OSA,” he told MedPage Today.

Kolla said increased daytime sleepiness may be a potential downside to THC as OSA treatment because daytime sleepiness is already a common symptom of the sleep disorder.

In a 2004 study, the combined use of THC and CBD was found to increase daytime sleepiness in healthy young adults.

Cannabis use is also associated with increased calorie intake, and this could also represent a potential pitfall for OSA patients, Kolla said.

“We know that THC increases appetite and that sleep apnea gets worse with weight gain,” he said.

“From a sleep apnea standpoint, the evidence for the efficacy of THC products is very tenuous. There are the potential downsides, and there are much better treatment options. So go with treatments that are evidence-based, ” Kolla added.

“As for CBD products, there just isn’t much evidence one way or another, but people may be spending a lot of money on something that may not work,” he pointed out. “These are substances that are not regulated by the FDA. They are sold as supplements, and it is hard to tell what you are really getting.”

Available Data

A single placebo-controlled, crossover study in 2018 compared the effect of 300 mg of CBD to placebo on sleep in healthy adults.

The study showed little evidence of an impact on several variables of sleep, including total sleep time, sleep efficiency, and stages of sleep, reported Ila Linares, PhD, of the University of Sao Paulo, and colleagues. They concluded that CBD did not appear to change normal sleep architecture.

“Different from anxiolytic and antidepressant drugs such as benzodiazepines and selective serotonin reuptake inhibitors, acute administration of an anxiolytic dose of CBD did not seem to interfere with the sleep cycle of healthy volunteers,” they wrote.

A retrospective case series study by Scott Shannon, MD, of the University of Colorado Denver, and colleagues was conducted at a large psychiatric outpatient clinic, and examined the impact of CBD at doses of 25 mg/day to 175 mg/day on anxiety and sleep problems when given as an adjunct to usual treatment.

The study included 72 adult patients complaining of anxiety, sleep problems, or both. Anxiety scores decreased within the first month of the study, and remained decreased during the 3-month study duration. Sleep scores improved within the first month in 48 patients (66.7%), but they fluctuated during the course of the study.

More research has been done on THC and sleep, but the findings are far from conclusive.

A 2019 review of trials evaluating the use of cannabis products for sleep concluded that while many studies showed CBD and THC to have a positive impact on sleep, study limitations included small sample sizes, the evaluation of sleep as a secondary study outcome, and a the lack of validated measures of sleep quality and quantity.

Nirushi Kuhathasan of McMaster University in Montreal, and colleagues, identified 18 clinical trials evaluating sleep and THC derivatives (dronabinol and nabilone [Cesamet]). Sleep was a secondary outcome in most of the trials, but the majority showed subjective evidence of improvements in sleep. Seven of the 18 studies reported subjective decreases in sleep disturbances and nightmare frequency.

The researchers concluded that while the available evidence suggests a benefit for THC and THC-derivatives, alone or in combination with CBD, in terms of improved sleep, additional studies to confirm this are “urgently needed.”

“Although ‘sleep’ remains one of the main reasons people seek medicinal marijuana, to date there is a surprising lack of placebo-controlled trials examining the use of cannabinoids specifically for treatment of sleep disorders,” they wrote. “In addition, many available studies used nonstandardized, non-validated questionnaires and the use of validated objective and subjective sleep measures is strongly encouraged in future research.”

‘Minimal Impact’

Timothy Roehrs, PhD, directs the Sleep Disorders Research Center at Henry Ford Health System in Detroit. His own, unpublished research suggests that controlled delivery of THC may increase nighttime wakefulness among regular marijuana users.

When Roehrs and colleagues studied the impact of alcohol as a sleep aid among patients with insomnia, they found that while alcohol improved sleep during the first few nights, greater alcohol doses were needed to maintain the effect over the course of the week-long study.

“Our study showed an almost immediate risk for dose escalation among people with insomnia using alcohol as a sleep aid, and I suspect the same thing may be true in people using cannabis products for insomnia,” he told MedPage Today. “My guess is that these products have minimal impact on sleep. And we don’t yet know to what extent tolerance develops.”

The study by Linares’ group was supported by Conselho Nacional de Desenvolvimento Científico e Tecnológico of Brazil (CNPq). Linares and co-authors disclosed CNPq fellowships. STI-Pharm provided CBD for the study group.

Kolla disclosed no relevant relationships with industry. Co-authors disclosed relationships with ResMed, AASM, UpToDate, Axovant, the NIH, the Michael J. Fox Foundation, and Wiley Blackwell.

CV Sciences provided cannabidiol products for the study by Shannon’s group. Shannon disclosed support from the Multidisciplinary Association for Psychedelic Studies, and serving as principal investigator for a phase III study of MDMA-assisted psychotherapy for severe posttraumatic stress disorder.

Kuhathasan and a co-authors disclosed support from the Michael G. DeGroote Centre for Medicinal Cannabis Research Master’s Studentship.

CBD and sleep: Promising but preliminary

Depending on who you ask, cannabidiol (CBD) is either a miracle cure or a placebo, a stress reliever, mood booster, pain killer, or inflammation fighter. For troubled sleepers, however, it’s a possible reprieve as research, though limited, gains steam. “Currently, there is not enough research on CBD’s effectiveness with sleep disorders, but preliminary studies are suggesting there is some connection,” says Laura Fuentes, chief officer of science and innovation at Green Roads (Deerfield Beach, FL), especially as anecdotal evidence suggests that CBD might create a sense of calm, and “a calm mind and relaxed body create a better night’s sleep,” she says.

Though researchers do not know the exact mechanism of action for CBD as it relates to sleep, the ingredient’s effects on the endocannabinoid system (ECS) might be a jumping off point, as the ECS is known to modulate circadian rhythms and is involved in the regulation of sleep-wake cycles—and CBD is a modulator of the ECS. 1

“To the extent that pain or anxiety interferes with sleep, CBD may facilitate sleep by reducing pain or anxiety—this would be an indirect mechanism,” adds Jamie Corroon, ND, MPH, medical advisor at CV Sciences (San Diego, CA, maker of PlusCBD) and founder and medical director at the Center for Medical Cannabis Education. Indeed, research shows that blocking CB1 receptors in the ECS (as CBD does) can cause neurochemical changes similar to those caused by antidepressants. 2 “The evidence in support of CBD as a sleep aid is mixed and fairly limited,” Corroon admits. “To be fair, this is more a reflection of federal regulation related to researching cannabis and FDA’s current position on CBD as a dietary ingredient, than a reflection of interest or efficacy.”

Early Findings

Research linking CBD with a more restful night’s sleep is still underway and very much in its infancy; however, some findings do point to the ingredient’s potential ability to help involuntary night owls.

“As with many novel compounds which are publicly accessible, the evidence starts with anecdotes,” says Corroon, and cross-sectional studies have confirmed that not only do many people use CBD for sleep (roughly 42.5% of CBD users, according to one study 3 ), but they also report efficacy. A 2019 randomized controlled trial funded by CV Sciences reported improvements in sleep quality (+22.0%, p=0.009) and sleep quantity (21.3%, p=0.02) after six weeks of daily supplementation with 60 mg of PlusCBD Extra Strength Hemp Extract Oil (15 mg hemp-derived CBD). 4 Researchers in this study also found that hemp supplementation improved measures of perceived stress response and life pleasure.

That said, much more research is needed, and brands operating in this space must remain aware of that. “Companies need to keep an open mind about the science related to CBD as it is in constant flux,” says Corroon. “Most importantly, sleep-related claims for their CBD-containing products should be highly conservative, if not avoided altogether.”

Combined Cannabinoids

Researchers examining CBD’s effect on sleep are turning their attention to how it can work in tandem with other cannabinoids. “Recently, there has been a lot of talk about cannabinol’s (CBN) promotion of sleep,” says Fuentes. “It is believed that since CBN comes from the degradation of tetrahydrocannabinol (THC), this could explain its sleep-inducing potential.”

Fuentes says there is room for research to determine whether combining CBD with CBN can yield a better night’s sleep, as the clinical evidence is currently lacking. In fact, one recent review found that clinical and preclinical research investigating the effects of CBN is dated and limited, with most human studies occurring in the 1970s and 1980s, and those that specifically address the effects associated with sleep incredibly rare. Ultimately, researchers concluded there is “insufficient published evidence to support sleep-related claims” for CBN. 5 Again, they called for randomized controlled trials to substantiate claims through polysomnography or validated sleep questionnaires.

“Other cannabinoids may be more effective [than CBD] at promoting sleep,” agrees Corroon, “but it is not clear at this point.” Compounds like delta-8 and delta-9 THC do have sedation properties, he says, but they also have intoxicating properties, which can be a detriment for many consumers (CBD does not have these intoxicating properties). And, as Corroon points out, a comparison study investigating individual cannabinoids for sleep has not yet been published. “A combination may prove to be most effective,” he says, “but the evidence is too preliminary to draw firm conclusions.”