On a quest for a good night’s sleep, you may have tried everything from melatonin and magnesium to herbal supplements, meditation, and yoga. One of the newest and trendiest additions to the sleep market is CBD, which is increasingly being studied and used for its purported beneficial effects on sleep, mood, chronic pain, and more. 

Over 200 ongoing trials have begun examining CBD’s use for alleviating a variety of disorders and illnesses. Meanwhile, retail sales of CBD are projected to exceed more than $646 million by 2022, according to one source

Although the research is still in its infancy due in part to the legal obstacles surrounding cannabis, CBD in mid- to high-doses may be a promising addition to anyone’s nightly sleep ritual. 

In this article, we will examine what CBD is, how it is taken, common dosages for sleep, and what recent research says about its therapeutic potential for helping attain high-quality, restful sleep.

What is CBD?

CBD stands for cannabidiol. It is a non-psychoactive compound found in the cannabis plant, and so does not produce a high. Instead, its effects are mostly described in terms of what you don’t feel (whether that be reductions in anxiety, pain, seizures, etc.). 

The cannabis plant contains over 100 chemical compounds called cannabinoids. CBD and THC (which is short for delta-9-tetrahydrocannabinol), are by far the most well-known and researched cannabinoids found in the cannabis plant. CBD is often taken alongside psychoactive THC for managing pain, anxiety, depression, and certain sleep disorders. 

Although the evidence is currently limited, the full spectrum of these compounds are thought to act synergistically to boost treatment efficacy, often referred to as the entourage effect. In essence, CBD modulates the negative psychoactive effects of THC by opposing its action while small amounts of THC are thought to help CBD work optimally in the brain and body.[4]  

Low dose CBD is generally stimulating and used to counteract the sedative effects of THC, while mid- to high-dose CBD by itself is sedating and may have sleep-promoting effects.  

Both of these cannabinoids act on the endocannabinoid system, a biological system found in all animals that is thought to be critical for various physiological and neurological processes.

Our body produces its own version of cannabinoids as well, called endocannabinoids, which bind to various receptors around the body and central nervous system to exert their regulatory effects. 

CBD and THC work by mimicking these endocannabinoids to produce effects on appetite, memory, immunity, sleep, pain management, inflammation, and more.

CBD and its effects on sleep: What the research is saying

The available studies evaluating the effects of CBD and CBD/THC combinations on sleep quality and quantity showed mixed results. Some studies show it has a direct regulating action on sleep, while other studies show it indirectly alleviates conditions that prevent restful sleep such as anxiety and pain. 

Animal studies have shown promising results for the use of CBD in the treatment of sleep disorders. It’s important to note, however, that these studies have limited translational value to humans because of the differences in physiology, behavior, dosage, and routes of administration.

How does CBD and THC work to promote sleep?

It is thought that cannabinoids like CBD and THC directly promote and maintain sleep by their modulating effects on sleep-wake cycles, a circadian rhythm process that’s closely interconnected with the endocannabinoid system.[1] 

Studies from the mid-1970s demonstrated that THC increases slow-wave sleep and decreases REM sleep, the stage of sleep associated with dreaming. Later studies have demonstrated its sedative properties, namely, that THC may decrease sleep onset latency, similar to alcohol, but may also reduce sleep quality in the long term by reducing slow-wave sleep, specifically stage 3 of NREM.

The latter finding is in conflict with the older studies, signaling that THC’s effects on sleep are not well understood. Additionally, in the studies that showed THC enhances deep sleep, the finding was limited to short-term use only. Chronic use was associated with habituation to the slow wave sleep-enhancing properties.

CBD may improve sleep in insomnia patients

CBD is commonly marketed towards insomnia sufferers and roughly 10% of CBD consumers use it as a sleep aid. 

In a study of 15 individuals with insomnia, 160/mg of CBD increased total sleep time and decreased arousal frequency during the night compared to placebo. Low-dose CBD, on the other hand, increased alertness and may attenuate the effects of daytime sleepiness associated with insomnia. 

The study found that the higher dose group reported reductions in dream recall, which could indicate either less time spent in REM or just fewer REM awakenings. For this reason, CBD is sometimes used for relief from nightmares in individuals with PTSD.

Rodent studies have supported these findings. Medium to high doses of CBD have been shown to increase total sleep duration and decrease sleep onset latency compared to placebo. 

CBD and THC may treat symptoms of other sleep disorders 

CBD may help reduce REM sleep behavior disorder in Parkinson’s patients, wherein patients physically act out their dreams due to a disruption of muscle paralysis in REM sleep.

Additionally, several rodent studies indicate the endocannabinoid system may play an integral role in attenuating the symptoms of obstructive sleep apnea (OSA). Synthetic forms of THC like dronabinol have been shown to reduce symptoms of sleep apnea in preliminary trials and animal studies.   

CBD may improve anxiety symptoms which can disturb restful sleep

CBD can help alleviate anxiety and promote relaxation through its interaction with serotonin receptors in the brain. This may indirectly help improve sleep quality in those suffering from insomnia related to affective disorders like anxiety or post-traumatic stress disorder. 

Many people have reported that CBD in mid to high doses relaxes the mind and calms anxious thoughts. Lowered anxiety can make it easier to fall asleep and stay asleep. 

In a 2019 study of 72 adults in an outpatient psychiatric center, researchers found that within the first month of CBD administration, anxiety scores decreased in nearly 80% of patients. Sleep scores improved in nearly two-thirds of patients, but this trend was not steadily maintained over time.[5] 

In rat studies, CBD prevented anxiety-induced REM sleep suppression, a common sleep disturbance in anxiety and PTSD sufferers. 

How is CBD taken?

CBD is extracted from either the cannabis or hemp plant using either ethanol or carbon dioxide as a solvent. Supercritical carbon dioxide extraction is generally the preferred (but more expensive) method that involves filtering the plant through a series of high pressure and temperature chambers. 

From here, the extracted product is essentially an amber-colored crude oil that can be further refined with different filtration and distillation methods. This separates the cannabinoids from the waxes and fats that aren’t desired into CBD isolate, which can be used for a variety of different products. 

Types of CBD products

CBD is taken in extracts with carrier oils, tinctures, capsules, sprays, inhalers, vaporizers, patches, teas, and a wide range of food products such as gummies, chocolates, and cookies. The current products on the market are unregulated, except for the FDA-approved pharmaceutical Epidiolex used to treat seizure frequency in rare forms of epilepsy. 

Hemp-derived CBD products are available in just about every state, with THC levels that do not exceed 0.3%. Marijuana-derived products with higher THC levels are available in the states with legal medicinal or recreational marijuana (currently nine and 30 states, respectively). 

The products discussed above can be found in either CBD isolate form, containing just the extracted CBD, or in a full-spectrum, whole-plant extract which contains CBD along with various other cannabinoids, including THC. 

Federal legality and oversight

CBD derived from marijuana is still considered illegal at a federal level, while CBD derived from hemp is legal as of the passage of the 2018 Farm Bill. 

Currently, few quality control requirements from the federal level. Regulation and oversight is mostly left to manufacturers and sellers, so consumers can't be sure that they're getting what a product label says.

This includes childproof packaging, third party or internal testing, and more. However, future regulatory paths are being discussed and likely implemented in the near future. 

While CBD products are typically marketed as a dietary supplement, according to the FDA, these products do not currently fit the definition proposed by the Federal Food, Drug, and Cosmetic Act.

The Federal Trade Commission states that it’s unlawful to advertise a product that can prevent treat or cure any human diseases unless there is reliable evidence (i.e., clinical trials) to substantiate the claims. 

The FDA has been known to go after some cannabis product companies who make health and wellness claims that they find misleading, or companies that mislabel their products. 

Over the past few years, the FDA has issued warnings to several CBD oil companies. They found that some companies marketed products that contain little or no CBD and illegal amounts of THC. 

A 2017 study from a Penn Medicine researcher of CBD purchased online found that 70% of CBD extracts were mislabeled. When the products had been accurately labeled, the researchers found the doses tended to be lower than what was being advertised. 

How THC interacts with sleep

THC may increase deep sleep and reduces sleep latency

Although THC, and more generally marijuana, has a long history of being used as a sleep aid, the research studies are mixed as to its benefits on sleep. Studies dating back to the 1970s, such as this one indicate THC increases NREM stage 3 (deep sleep). 

Other studies point towards reduced sleep onset latency due to THC’s sedative effects. In a more recent, supportive study of 147 individuals with and without sleeping difficulties, cannabis use was associated with a decrease in time until sleep for both groups.

THC decreases REM sleep

Nearly all the studies in the available literature indicate that THC reduces eye movement activity during REM sleep and the duration of REM sleep itself. 

In one study where the subjects ingested THC every four hours in substantial doses for twenty days, withdrawal from the drug (after elimination from the body) produced significant REM rebound effects, which involved a mucher higher density of eye movements in REM sleep and an increased duration of REM sleep. 

This is usually a tell tale sign of the body trying to make up for a lack of REM sleep and is common in cases of sleep deprivation.

CBD and THC combination products

When taking CBD alongside THC, products will list the ratio of CBD to THC. This can range from 1:1 all the way to 16:1, the latter of which has little to no psychoactive effects. 

Based on the available literature and anecdotal reports, high CBD to THC ratio products (such as 16:1, or 8:1) are commonly used in sleep-related disturbances, seizures, and mood disorders, while those suffering from pain and neurodegenerative disorders like Multiple Sclerosis benefit from a more balanced ratio. 

Long term use can result in a tolerance, where the user requires more of the drug for the same effects. This can, in turn, habituate the user to the sleep-promoting effects and increases the chances of cannabis dependence. In dependent users, one of the most common symptoms of cannabis withdrawal is sleep disturbances.

How is CBD dosed?

The precise CBD dosage for sleep hasn’t been standardized across the available studies. Anecdotally, CBD (especially with THC) can have very different responses depending on the individual. In general, mid- to high-dose CBD is thought to be more sedating, while low-dose CBD is thought to be more stimulating.[1] 

Doses ranging anywhere from 5mg per day to more than 150mg per day are common. When used for sleep, taken 1-2 hours before bed is a common time of dosage both anecdotally and in the available literature. 

Safety of CBD

Generally speaking, CBD is well-tolerated and has a low addiction potential, even in doses upwards of 1,500mg per day according to one review. Some reported side effects include sleepiness, fatigue, nausea, diarrhea, and changes in appetite and weight. 

CBD by itself doesn’t carry as many adverse side effects that may accompany THC. This includes dry mouth, increased heart rate, as well as impaired memory, coordination, and judgement. There is some evidence that THC may exacerbate some psychiatric conditions like schizophrenia. No lethal overdoses have been reported for either CBD or THC. 

Little is known about the safety of CBD in pregnant women, children, and the elderly. Long-term safety is essentially unstudied. It’s always best to consult with a medical professional before using CBD, especially if you’re taking medications, which may interact with CBD and/or THC. 

Final Thoughts

While there are relatively few human trials to date, CBD is exploding in popularity and the studies that do exist show it has potential for treating symptoms of some sleep disorders and anxiety and pain-induced sleep disturbances. However, further well-designed clinical trials with large sample sizes and long-term assessments will have to be conducted to confirm the beneficial effects of CBD on sleep.

Currently, nearly a third of adults in the United States get poor sleep. Many turn to pharmaceutical anti-histamines and sedatives when natural solutions don’t pan out, but these options carry adverse side effects and health risks. 

As with any natural supplement, it’s important to figure out if it works for you. 

At Remrise, we believe that no one supplement is the silver bullet solution for solving your sleep problems.  

We believe that improving your sleep is a holistic process that involves personalized, rotating supplementation alongside behavioral changes like sleep hygiene, instituting a pre-sleep routine, and tracking what works and what doesn’t.

Check out the Remrise app to start tracking your sleep.

Glossary

Non-psychoactive: Non-psychoactive compounds do not create noticeable changes in states of mind, such as alterations in perception or behavior.

Entourage effect: A mechanism that states cannabis compounds, including the cannabinoids and terpenoids, exert synergistic effects which allows the compounds to exert optimal effects on the brain and body. 

Endocannabinoid System: A cell-signaling system discovered in the mid-1990s composed of endocannabinoids and their receptors. The system is involved in homeostatically regulating many important processes, including mood, appetite, sleep, memory, pain, metabolism, immunity, and reproduction function.

Sleep onset latency: The time it takes to transition from wakefulness to sleep, normally the lightest stage of NREM sleep. 

References

  1. Babson K., Sottile J., Morabito D. Cannabis, cannabinoids, and sleep: a review of the literature. Curr Psychiatry Rep. 2017;19:23. 
  1. Russo EB, Guy GW, Robson PJ. (2007) Cannabis, pain, and sleep: lessons from therapeutic clinical trials of Sativex, a cannabis-based medicine. Chem Biodivers 4:1729–1743 
  1. Russo E. B. (2008). Cannabinoids in the management of difficult to treat pain. Therapeutics and clinical risk management, 4(1), 245–259. doi:10.2147/tcrm.s1928
  1. Russo E. B. (2011). Taming THC: potential cannabis synergy and phytocannabinoid-terpenoid entourage effects. British journal of pharmacology, 163(7), 1344–1364. doi:10.1111/j.1476-5381.2011.01238.x
  1. Shannon, S., Lewis, N., Lee, H., & Hughes, S. (2019). Cannabidiol in Anxiety and Sleep: A Large Case Series. The Permanente Journal, 23, 18-041.