As CBD has exploded onto the market, consumers are turning to the cannabinoid to treat many ailments, including insomnia. The insurgence of CBD has also prompted a sizable uptick in the number of preclinical and clinical studies looking at CBD’s value in treating a whole host of disorders. However, very few studies center on CBD and sleep.
In a recent Consumer Reports survey on CBD, 10% of respondents report using CBD as a sleep aid. The majority of them said it worked, but that evidence is anecdotal. Without controlled studies, it is difficult to tell whether CBD is truly acting alone to induce sleep. There are several complicating factors.
First, high-CBD strains often contain myrcene, a terpene that is said to be sedating. Although controlled studies on humans are lacking, myrcene’s sedative effects are well established in the animal literature, and for centuries, herbalists have been using hops as a human sleep aid. As it turns out, hops have high myrcene levels.
Therefore, if a person uses a high-CBD strain and says it helps them sleep, it is hard to tell whether CBD, myrcene or the two working in combination is the active agent. However, it’s worth noting that most people aren’t smoking or vaporizing myrcene-rich CBD flowers for sleep. Rather, most are using a CBD concentrate that contains little to no myrcene whatsoever.
Very few researchers have looked at isolated CBD as a sleep aid. Instead, researchers have looked at CBD in conjunction with other cannabinoids like THC. In a 2017 extensive literature review entitled Cannabis, Cannabinoids, and Sleep: a Review of the Literature, the research team found that CBD and THC were indeed the two cannabinoids most often cited as sleep-inducing
THC has a sedative effect and can reduce the time it takes to fall asleep. Some research shows that the entourage effect, or harmonized interaction between cannabis compounds like CBD and THC, seems to carry over to sleep.
However, THC does not put a person in a sleep state. Neither does CBD. Instead, THC is a sedative and has other properties helpful to sleep. For example, THC makes a person feel comfortable while remaining still, called catalepsy.
Because CBD doesn’t alter consciousness in the same way that THC does, is it even possible that CBD can work alone as a sleep aid?
Dr. Dustin Sulak, DO, is the founder of Healer.com and Integr8 Health, a Maine medical practice that uses medical cannabis as a treatment for a variety of ailments. Sulak explained that CBD may actually just be reducing symptoms like anxiety, which allows the person to relax so that their natural sleep mechanism can take over.
To demonstrate Sulak’s point, here is one such published example, where a Colorado research team looked at outcomes of psychiatric patients who received CBD in a clinical setting to help with anxiety and sleep complaints. CBD was given as an adjunct to usual treatment. Within the first 30 days of CBD use, anxiety decreased in nearly 80% of patients and sleep scores improved by nearly 70%. CBD was well tolerated by the vast majority of patients.
But was CBD directly responsible for this outcome? And, given that a fairly large group of people with insomnia also have depression and anxiety, what exactly is CBD working on? This is where the waters become even more muddied.
Sulak’s practice has over 8,000 patients, so he sees the connection between sleep and chronic disease every day. “Sleep is extremely important,” he said. “Almost all of our most prevalent chronic diseases require healthy sleep for the patient to get better.”
Sulak said that if he can fix a patient’s sleep disturbance, it serves as a unifying treatment that can help multiple patient conditions like diabetes and chronic pain. While Sulak does treat sleep disorders, he very rarely does so with CBD in any form, whether pure CBD or a CBD-dominant cannabis strain.Instead, Sulak often uses THC with a sedating terpene profile. He achieves excellent results, even when using low doses.
Every individual’s body is unique, and therefore the effect of CBD will be highly individualized. Sulak explained that he would be open to using CBD in his own practice if a patient had not responded well to THC. Some patients are extraordinarily sensitive to THC and have symptoms during the night or still feel impaired in the morning. Sulak said he would likely select CBD strains that contained high levels of myrcene (luckily, there are plenty of options).
Sulak said that CBD may offer benefit for people with sleep disturbances, and he feels it is important to move forward with pragmatically designed clinical trials, meaning a trial that does not provide every patient with the same exact treatment. Instead, an algorithm type approach would be used, starting with one treatment and moving to others if the previous ones are unsuccessful.
Sulak also stated “Most people don’t know that sleep disturbances are associated with decreased analgesic (pain-relieving effects) of opioids and antidepressant drugs, so it’s such a vicious cycle,” he said. “It’s wonderful to use cannabis to break that cycle,” Sulak said.