Can CBD Help with Insomnia and Sleep Disorder?

If you have ever had insomnia or any other sleep disruption, you probably know how difficult it can be. “Excessive daytime drowsiness” is one of the main symptoms, but that doesn’t really even begin to describe it! Other symptoms include brain fog, mental dullness, irritability, mood changes, fatigue, difficulty with learning and memory….and then there’s the lack of interest in sex, increased risk of accidents and the increased risk of serious health problems like obesity, heart disease, high blood pressure, stroke and diabetes.

Research on CBD and its effects on sleep has been varied and inconclusive over the years. Studies so far do support CBD’s potential to interact with the sleep cycle. They reinforce the knowledge that CBD works on the body’s endocannabinoid system, which plays a role in sleep regulation. However, more research is needed to verify the benefits of CBD oil and other CBD products.

Normal Sleep: Some Basics

Before we can understand how CBD and other supplements can help with sleep, let’s go through what is understood about normal sleep.

Brains Areas and Chemicals Involved with Sleep

There are several areas of the brain involved with for healthy sleep. These include:

• The Hypothalamus is a small structure located deep within the brain. It contains specialized nerve cells that receive information about light exposure and is involved with a normal sleep cycle based on light-dark cycles
• The thalamus is important in processing information from the environment, with fluctuating activity during sleep. During a phase of sleep called REM (Rapid Eye Movement), the thalamus gets active again providing some of the sounds and images that we dream about.
• The pineal gland is a tiny gland and is often called the “third eye”. It sits deep within the brain between the right and left hemispheres and secretes the sleep hormone, melatonin. Melatonin increases as the sun sets—signaling that it is time to sleep. It can decrease with aging, causing older people to have trouble falling asleep. Melatonin decreases wakefulness rather than helping you fall asleep—it’s a subtle difference, but melatonin promotes rather than induces sleep. Melatonin can be increased by decreasing light in the environment, avoiding electronic screens (the blue and green light neutralizes melatonin), getting enough sun during the day and by taking a hot shower about an hour or two before bedtime. Melatonin can also be increased by snacking on foods like Goji berries, walnuts, almonds, pineapple, bananas and oranges before bedtime.
• The brain stem is located at the base of the brain and is one of the more ancient areas of the brain. Cells in the brain stem secrete and respond to a neurotransmitter called GABA (gamma aminobutyric acid) that calms the brain and allows sleep to occur—muscle-relaxing signals are sent out also.

Sleep Neurotransmitters

There are several other brain chemicals—neurotransmitters and hormones—besides melatonin and GABA that are important for healthy sleep. These include:

• Orexin which is also known as hypocretin. Orexin functions to control waking up, wakefulness and…appetite.
• Cortisol is a stress hormone produced by the adrenal glands but it is also important in regulating the sleep-wake cycle. Cortisol begins to increase during the pre-dawn hours and helps wake you up and get you ready for a new day. If you are living a high-stress-life, this cycle is easily disrupted.
• Serotonin or 5-HTP acts both as a neurotransmitter and a precursor or building block for melatonin. Serotonin helps to regulate sleep, mood, appetite, memory and libido. While serotonin is found in many nerve and brain cells, the highest levels are found in the digestive system.

We are also finding that there are “clock genes” that help control sleep—many of these are clock genes influence the release of melatonin (as it becomes darker) or cortisol (as it becomes lighter).

Sleep Mechanisms

There are two main ways that the body uses to keep us on a healthy 24-hr wake-sleep cycle. These are:

1. Circadian rhythms include the melatonin and the cortisol cycles. Circadian or daily rhythms help control your sleep cycle, body temperature, your base metabolism and the release of certain hormones.

2. Sleep-wake homeostasis. Homeostasis is a term used to describe a balance. The sleep-wake homeostasis makes you want to sleep when you are tired, getting stronger and stronger the longer you stay awake. It also helps to regulate how deeply you sleep and how restful your sleep is.

Both circadian rhythms and sleep-wake homeostasis can be affected by your overall health, stress levels, your sleep environment and by your diet.

Phases of Sleep

Sleep can be either REM (Rapid Eye Movement) sleep or non-REM sleep, both of which are critically important. There are three stages of non-REM sleep that cycle with REM sleep. Most dreaming occurs during REM sleep while both REM and non-REM sleep are important for memory and processing the events and experiences of the day.

CBD and Sleep

Medical and recreational cannabis has been investigated for its effect on sleep more than many other effects, but many of the studies have used THC along with CBD—or synthetic cannabinoids.[1]^{, [2],[3],[4]} Some studies (You can read more here, here and here) have examined CBD directly, but we are still in the very early stages of research.

The Endocannabinoid System and the Sleep-Wake Cycle

The endocannabinoid system (ECS) is centrally involved in the sleep-wake cycle, but it is far from clear exactly how it is involved. The ECS is a system of neurotransmitters (endocannabinoids) that interact with receptors (CB1 and CB2) to regulate the sleep cycle, appetite, reproduction, the immune system, body temperature, mood, pain perception, inflammation and learning. Endocannabinoids through the CB1 receptor appear to make non-REM sleep more stable.[5]^{, [6]} Overall, endocannabinoids function under circadian control and, depending on the specific endocannabinoid, may either promote sleep or promote wakefulness. Some endocannabinoids promote non-REM sleep. In a rat model system of insomnia, endocannabinoids can restore sleep.[7] Once again—there is a lot to learn—we know that some endocannabinoid levels are affected when sleep is disrupted and we know that stress, pain and inflammation can all disrupt both sleep cycles and the ECS—but we don’t understand exactly how all these factors interact.

Studies on Cannabis and Sleep

Recent studies have indicated that the effect of cannabinoids on sleep may depend on the ratio of THC to CBD, the dose, the timing and the delivery method (ie. oral or by inhalation).[8]

Oral CBD given in a low dose may have a stimulating effect while higher doses (greater than 160mg) increases total time asleep and decreased the number of times a person wakes up during the night. [9] Much of the research has been done in animal models and much has used cannabis or synthetic cannabinoids and shows somewhat mixed results.

The number of studies using CBD alone are rare. One case study in a 10- year old girl with PTSD showed reduced insomnia and sleep disturbances with 25mg CBD plus a 3mg spray.[10] Another small study in patients with a sleep disorder related to Parkinson’s disease showed an improvement in sleep with 75-300 mg of CBD a day. [11]

Overall, CBD appears to act as an anxiolytic, reducing anxiety or as a hypnotic (defined as sleep-inducing). A sedative, on the other hand, reduces excitement or the “irritability” of the central nervous system (CNS). Medium to higher doses of CBD appears to increase total sleep time, at least in rats. [12]^{, [13]}

A case series review was recently published which examine the effects of CBD in anxiety and in promoting sleep.[14] Patients with anxiety or poor sleep were given 25mg of CBD per day, in the morning if they were experiencing anxiety or in the evening if they were experiencing sleep issues. Some patients received up to 175mg per day. Sleep was scored using the Pittsburg Sleep Quality Index. Sleep scores indicated that sleep was improved for up to 3 months. Interestingly, anxiety scores improved more significantly that sleep scores, again indicating that improved sleep after CBD use may be related to decreased anxiety levels.

In summary, there are few studies directly examining the effects of CBD on sleep. The pre-clinical (animal) and clinical studies that do exist seem to indicate that CBD may promote sleep by reducing anxiety and acting as a hypnotic, promoting sleep.

Supplements Combined with CBD to Promote Sleep

There are a variety of supplements that can be used along with CBD to aid in sleep—but with the proviso that none of these has been tested with CBD. There is no reason to think these additional substances would not be helpful, but the fact is that there is no evidence that they are.

Melatonin

Melatonin is the most commonly added substance.

Melatonin is a natural hormone produced deep within the brain in the pineal gland. Melatonin levels rise as the day darkens and prepares you for sleep. Melatonin has been shown to be a safe and effective way to:[15]

• Fall asleep faster
• Sleep longer and more deeply

Melatonin does work for the young and the elderly—but generally works better in some conditions including primary insomnia. You can increase melatonin naturally by turning down the lights during the evening, avoiding electronic screens and by taking a hot shower. Melatonin is also used to treat jet lag and Delayed sleep-wake phase disorder (DSWPD). It should not be used by pregnant or breastfeeding women or in elderly patients with dementia. If you are on any medications for a seizure disorder or are taking blood thinners (anti-coagulants or anti-platelet medications), talk to your physician about possible interactions with melatonin. Possible side effects include:

• Headache
• Dizziness
• Nausea
• Sleepiness

The recommended dose of melatonin varies, but it is usually effective to take 1-3 mg about 1 hour before you want to sleep.

The only company on our list with ingredients other than melatonin is cbdMD. Their sleep product also contains in addition to CBD and melatonin:

• Valerian root
• Passionflower
• Hops
• Chamomile
• Lemon balm

All the herbs are traditionally used to aid in sleep. The blend is proprietary, so there is no way of knowing how much of any herb is included—but, given the number of ingredients, it is doubtful than any adverse effects would occur because the amounts of each herb is likely to be too low. However, this is an educated guess and no more—caution should always be used and you should always consult a knowledgeable healthcare provider before using any supplement.

Valerian

Valerian is a mild sedative and can ease tension and anxiety. It has been traditionally used, but modern scientific evidence has been somewhat contradictory.[16] There are few side effects reported but it should not be used by pregnant or breastfeeding women or people on sedative medications such as barbiturates or benzodiazepines.

Passionflower has also been used traditionally to help people relax, to ease anxiety and for pain. It is generally considered to be very safe, but still should not be used by pregnant or breastfeeding women-there are no safety studies in these groups.[17]

Hops

Hops has long been used in making beer but has a parallel history in medicine to help induce sleep and reduce restlessness. Hops may make depression worse, but this is rarely seen. People with hormone-sensitive cancers or other conditions such a breast cancer, endometriosis should avoid hops. Hops has some estrogenic properties as well and can cause breast growth in men, though it is unlikely in small doses. It can also interact with contraceptives and other estrogen-containing medications.

Chamomile

Chamomile acts as a very mild sedative and is commonly used for insomnia and other sleep disorders. Chamomile has been used probably almost as long as cannabis—and for similar reasons.[18] Its effects on sleep may be due to the actions of apigenin which binds to benzodiazepine receptors in the brain. Chamomile should not be used by anyone allergic to the aster plant. Safety has not been tested in small children, pregnant or breastfeeding women.

References

[1] Linares, Ila MP, et al. “No acute effects of cannabidiol on the sleep-wake cycle of healthy subjects: a randomized, double-blind, placebo-controlled, crossover study.” Frontiers in pharmacology 9 (2018): 315.

[2] Linares, I. M. P., J. A. S. Crippa, and M. H. N. Chagas. “Beneficial effects of cannabis and related compounds on sleep.” Handbook of Cannabis and Related Pathologies. Academic Press, 2017. 877-882.

[3] Ferguson, G., and M. Ware. “Review article: sleep, pain and cannabis.” Journal of Sleep Disorders & Therapy 4.2 (2015): 191.

[4] Russo, Ethan B. “Cannabidiol claims and misconceptions.” Trends in pharmacological sciences 38.3 (2017): 198-201.

[5] Pava MJ, Makriyannis A, Lovinger DM.,Endocannabinoid Signaling Regulates Sleep Stability. PLoS One. 2016 Mar 31;11(3):e0152473. doi: 10.1371/journal.pone.0152473. eCollection 2016.

[6] Pava MJ, den Hartog CR, Blanco-Centurion C, Shiromani PJ, Woodward JJ. Endocannabinoid modulation of cortical up-states and NREM sleep. PLoS One. 2014 Feb 10;9(2):e88672. doi: 10.1371/journal.pone.0088672. eCollection 2014.

[7] Prospéro-García O, Amancio-Belmont O, Becerril Meléndez AL, Ruiz-Contreras AE, Méndez-Díaz M. Endocannabinoids and sleep. Neurosci Biobehav Rev. 2016 Dec;71:671-679. doi: 10.1016/j.neubiorev.2016.10.005. Epub 2016 Oct 15.

[8] Babson, KA., Sottile, J., Morabito, D., Cannabis, Cannabinoids, and Sleep: a Review of the Literature. Curr Psychiatry Rep (2017) 19: 23

[9] Carlini EA, Cunha JM. Hypnotic and antiepileptic effects of cannabidiol. J Clin Pharmacol. 1981;21(8–9 Suppl):417S–27S

[10] Shannon S, Opila-Lehman J. Effectiveness of cannabidiol oil for pediatric anxiety and insomnia as part of post- traumatic stress disorder: a case report. Perm J. 2016;20(4):108–11.

[11] Chagas MH, Eckeli AL, Zuardi AW, Pena-Pereira MA, SobreiraNeto MA, Sobreira ET, et al. Cannabidiol can improve complex sleep-related behaviours associated with rapid eye movement sleep behaviour disorder in Parkinson’s disease patients: a case series. J Clin Pharm Ther. 2014;39(5):564–6.

[12] HsiaoYT, Yi PL, LiCL, Chang FC.Effect of cannabidiol on sleep disruption induced by the repeated combination tests consisting of open field and elevated plus-maze in rats. Neuropharmacology. 2012;62(1):373–84. 33.

[13] ChagasMH, et al. Effects of acute systemic administration of cannabidiol on sleep-wake cycle in rats. J Psychopharmacol. 2013;27(3):312–6.

[14] Shannon S, Lewis N, Lee H, Hughes S. Cannabidiol in Anxiety and Sleep: A Large Case Series.

Perm J. 2019;23:18-041. doi: 10.7812/TPP/18-041.

[15] Xie, Z., et al, A review of sleep disorders and melatonin. NeuroRes, 39(6) https://www.tandfonline.com/doi/full/10.1080/01616412.2017.1315864 (accessed 11/19)

[16] Stevinson C, Ernst E: Valerian for insomnia: a systematic review of randomized clinical trials. Sleep Medicine 1: 91-99, 2000.

[17] Miroddi M, Calapai G, Navarra M, et al. Passiflora incarnata L: ethnopharmacology, clinical application, safety and evaluation of clinical trials. Journal of Ethnopharmacology. 2013;150(3):791-804.

[18] Srivastava, J., Shankar, E., Gupta, S. Chamomile: A herbal medicine of the past with bright future. Mol Med Report. 2010 Nov 1; 3(6): 895–901.