David Baxter PhD
Does CBD Help With Insomnia?by Rachel Rabkin Peachman, The New York Times
August 30, 2022
If you’re like many adults around the world who have found themselves tossing and turning during the pandemic, you may have been tempted to try a sleep aid, like CBD, to get a better night’s rest. Unlike the cannabis plant’s other famous — and psychoactive — compound THC, CBD does not get users high and is touted for relieving a range of conditions, including pain, anxiety and, yes, sleep problems.
While it’s not entirely clear how CBD works in the body, it’s thought to reduce inflammation, which may help alleviate pain, and it can calm the central nervous system, which may ease anxiety, said Mitch Earleywine, a professor of psychology at the University at Albany in New York, and an advisory board member of the nonprofit National Organization for the Reform of Marijuana Laws.
(CBD’s calming effects have also been shown to treat certain types of seizures; an anti-epileptic medication called Epidiolex is the first and only CBD prescription approved by the Food and Drug Administration.)
What do we know about CBD’s effect on sleep?When it comes to CBD helping with sleep, though, the research is sparse. “To this day, there’s no study that has used CBD on its own in any trial of insomnia,” said Anastasia Suraev, a doctoral candidate and research fellow at the Lambert Initiative for Cannabinoid Therapeutics at the University of Sydney. There are studies that have found that CBD used in combination with THC holds promise as a treatment for sleep disorders like insomnia, sleep apnea, restless legs syndrome and nightmares related to post-traumatic stress disorder. But there are no large placebo-controlled clinical trials (the gold standard for scientific research) that have investigated how CBD alone might help with sleep problems.
Ms. Suraev, along with the other experts we spoke to, noted that CBD itself does not have sedating effects. While some studies on CBD for seizures found that a side effect of the treatment was drowsiness, that may have been because of “CBD interacting with other medications” like anti-epileptic drugs, Ms. Suraev said.
Still, CBD may indirectly help you sleep by alleviating other conditions, said Ryan Vandrey, professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine and principal investigator at the university’s Cannabis Science Laboratory. For example, he said, if pain is keeping you awake at night and CBD helps lessen your discomfort, you may be able to sleep better. Similarly, if you can’t sleep because you’re anxious, he added, “CBD may reduce anxiety,” which in turn may promote sleep.
In one case series, researchers looked back at the medical charts of 72 people with anxiety or sleep problems who were treated in the same clinic with 25 to 175 milligrams of CBD per day for three months. Based on the patients’ self-reports at follow-up appointments, the researchers found that CBD was most helpful for anxiety, not sleep. But “ultimately, even if they weren’t sleeping better, they were less anxious about it and felt maybe more rested,” said Dr. Scott Shannon, a psychiatrist in Fort Collins, Colo., who led the study.
Dr. Vandrey cautioned that the available studies, like this one, are limited and there isn’t enough data to determine what dose to take, what form to choose or what brands to purchase for anxiety or any other condition. Epidiolex is the only CBD product regulated by the F.D.A., so there is a lot of variety (including a range in formulations, purity and labeling practices) in products like oils, gummies, creams, patches and vape pens. “There’s state-level regulation, but it’s different from one state to the next,” Dr. Vandrey said. “And none of those states have the right infrastructure, resources or level of enforcement that the F.D.A. does.”
In a study published in 2017 in JAMA, for example, Dr. Vandrey and his colleagues analyzed the contents of 84 different CBD products purchased from 31 companies online — including oils, tinctures and vape liquids — to see if their labels were accurate. They found that just 26 of the products were accurately labeled in terms of their CBD content — 36 products had more CBD than advertised, and 22 had less. They also found that 18 of the products contained undisclosed THC, in some cases at high enough doses to cause intoxication.
“So you can order CBD oil, but CBD oil is not CBD oil is not CBD oil,” Dr. Vandrey said.
How to take CBD safelyDespite the lack of clarity, the experts we spoke to said that it’s not unreasonable to try CBD if you’re having trouble sleeping. But keep these tips in mind.
Discuss it with your doctor first. “CBD as a chemical entity is a very safe molecule with very low toxicity,” Dr. Vandrey said. But it can interact with some medications, like warfarin (a blood thinner), tamoxifen (a breast cancer medication), some anti-seizure medications and certain antidepressants, so make sure your doctor is aware of the drugs and supplements you’re currently taking.
Make sure the brand is credible. The best way to find a high-quality CBD product is to buy it from a state-regulated cannabis dispensary, Dr. Vandrey said. “If you can’t do that,” he added, “look for national brands that have a good reputation.” Credible brands should have websites that offer a certificate of analysis for each individual product batch. This document — which can be found on the company’s home page under “F.A.Q.,” “Questions,” “Lab Results” or simply “Certificate of Analysis” — shows that their product was tested by an independent laboratory for its levels of CBD, THC and other cannabis compounds, as well as for possible contaminants like pesticides or heavy metals. If you can’t easily find a certificate of analysis on the website, choose another brand. Some companies may also indicate that they use good manufacturing practices (G.M.P.), meaning their products have been manufactured in ways that are in line with F.D.A. standards.
Start with a low dose and increase slowly. Because there is no consensus on how many milligrams of CBD a person should take, or in what form (except for with Epidiolex), the experts we spoke to suggested that you start with a low dose to make sure you tolerate it well. Then, gradually increase the amount you take until you begin to feel an effect. While many of the clinical studies on CBD involve doses of 200 to 800 milligrams daily, Dr. Shannon recommended starting closer to 15 to 20 milligrams each day, and using trial and error to figure out what works for you.
Don’t forget about good sleep hygiene. Dr. Earleywine said that if you’re finding that your sleep is improved with low doses of CBD, that may actually be a result of the placebo effect, not the CBD itself. Though that’s not necessarily a bad thing, you might find it just as effective — and less expensive — to tackle your insomnia with behavioral modifications, like reducing your caffeine intake and avoiding screens too close to bedtime.