CBD For Sleep: How It Works, Benefits And Risks

Understanding the endocannabinoid system (ECS) is essential to understanding the effect CBD may have on sleep. The word “cannabinoid,” contained within the name of the system, refers to the active constituents of the cannabis sativa plant that impact the ECS.

“The endocannabinoid system is a complex neurochemical network in the body that regulates various bodily functions, including emotions, pain and sleep,” says Chantel Strachan, M.D., a board-certified internal medicine physician and headache specialist at Columbia Doctors and Columbia University Irving Medical Center in New York. While the body naturally releases endocannabinoid molecules, external sources of cannabinoids, such as CBD, can affect the body via the ECS, she adds.

The hypothalamus—which plays a significant role in the ECS—impacts sleep regulation, says Daniel Whitelocke, M.D., owner and CEO of Ozark MMJ Cards, an Arkansas service that helps qualified patients obtain medical marijuana cards. “The hypothalamus, a peanut-sized structure buried deep in the brain, is enriched with cannabinoid receptors and governs the circadian rhythm of our sleep-wake cycle,” he says. Circadian rhythms are 24-hour cycles that, among other functions, help our bodies fall asleep at night and wake up in the morning, and research suggests the ECS factors into that cycle.

CBD is the second most abundant compound in the cannabis sativa plant, and many studies suggest it may indirectly benefit sleep. In fact, CBD—which doesn’t cause the intoxicatingly psychoactive “high” associated with delta-9 tetrahydrocannabinol (THC)—might help people with different sleep disorders, including insomnia and restless leg syndrome, as well as other conditions known to negatively impact sleep, according to research.

For instance, CBD may help people relax by easing anxiety and pain, two factors that may make it difficult for someone to fall or stay asleep, says Dr. Strachan.

Insomnia

The hypothalamus plays a role in several sleep-related functions, including regulating body temperature and synchronizing sleep patterns. CBD can help people with insomnia because it works with the hypothalamus to regulate stress, says Dr. Whitelocke. “Insomnia results from an overactive stress reaction that’s spilling into a rest time when we’re not trying to process conscious trauma,” he adds. “CBD can suppress this dysregulated cycle of stress hormone overactivation and equalize the sleep and wake rhythm through counteracting hormones.”

In a study examining the effects of cannabis on insomnia, researchers found CBD more effectively decreased symptoms of insomnia than delta-9 THC, which is the most abundant active constituent in the cannabis sativa plant that has an intoxicatingly psychoactive effect^[2]Vigil JM, Stith SS, Diviant JP, Brockelman F, Keeling K, Hall B. Effectiveness of Raw, Natural Medical Cannabis Flower for Treating Insomnia under Naturalistic Conditions. Medicines (Basel). 2018;5(3):75. .

Circadian Rhythm Disorders

Circadian rhythm disorders, also known as sleep-wake cycle disorders, occur when the body’s internal clock, which dictates when you fall asleep and when you wake up, is misaligned with your environment. Circadian rhythm disorders can develop when there are changes in sleep habits, often due to travel or work, or as a byproduct of a medical condition, aging or genetics.

CBD may improve both the quality and quantity of sleep by ensuring the body progresses through the normal stages of sleep and REM sleep without undue interruption, which would help people with circadian rhythm disorders, says Dr. Whitelock. “CBD’s action on cannabinoid receptors initiates a cascade of events that culminates in a more natural timing of sleep relative to the diurnal rhythm of night and day,” he explains. However, more research is needed.

CBD can be especially helpful for people like nurses who experience circadian rhythm disorders due to shift work, where sleep windows change depending on a person’s work schedule.

Anxiety

Many studies have found CBD to be a potential treatment for anxiety disorders. While more research is needed, studies link CBD use to improved sleep due to its ability to decrease anxiety.

“CBD’s well-established role in reducing anxiety—without causing stony lethargy that can accompany THC products—makes it an ideal tool to calm intrusive thoughts before laying down to sleep,” says Dr. Whitelocke. More specifically, CBD acts on the endocannabinoid receptors in the limbic system—a set of brain regions known to play a role in many important functions, including the regulation of emotions, storage of memories, sexual arousal, olfaction (or our sense of smell) and forming of learning patterns. When the limbic system is out of equilibrium, such as when an intrusive memory leads to anxiety and insomnia, CBD activates the ECS to help repress that memory and, consequently, facilitate sleep. “By restoring hormone balance,” says Dr. Whitelocke, “CBD acts as the great equalizer.”

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Restless Leg Syndrome

CBD may treat restless leg syndrome (RLS), a neurological condition that can affect sleep quality and quantity by causing an unpleasant and uncontrollable urge to move the legs. Early research suggests CBD can reduce the frequency of abnormal nerve firings that lead to involuntary muscle twitching, which is the hallmark symptom of RLS, says Dr. Whitelocke. “For a person who is prone to waking as a result of limb movement in sleep, this can come as a great benefit,” he says.

Many preliminary findings connecting CBD use and improved RLS symptoms are based on patients’ self-reported experiences, and further research is needed to confirm CBD’s efficacy as a treatment method for RLS.

Chronic Pain

Studies show CBD has promising pain-relief potential. Researchers find that by applying products with CBD oil to painful areas, study participants report reduced pain and swelling often associated with inflammation.

Dr. Whitelocke says that for people who cannot tolerate the intoxicating effects of THC, CBD—ingested or used topically—offers an alternative for analgesia (or pain relief). “With regards to sleep, having adequate pain control is crucial to being able to relax both body and mind without the worry of addictive or toxic effects of other analgesic alternatives,” he says.

While Dr. Whitelocke and Dr. Strachen both say CBD is a low-risk intervention and drug interactions with CBD products are rare, it’s important to talk to your doctor before starting a CBD regimen, as it may increase liver enzymes in people who take medications metabolized by the liver.

Such medications include:

• Statins
• Anti-inflammatories (including ibuprofen and naproxen)
• Certain anti-hypertensive medications
• Blood thinners

Also, some research suggests that THC may cause sleep disturbances. Because many CBD products do contain THC, even at low levels, this is something to consider when speaking with your doctor.

Legality

The 2018 Farm Bill made hemp-derived CBD products containing less than 0.3% THC by dry weight legal. However, ease of access to CBD varies depending on where you live. In some states, CBD is available to purchase and possess, but in others, CBD products are less accessible.

“CBD-containing products are increasingly available without a prescription,” says Dr. Strachan. “However, they are not regulated by the FDA for sleep.” While the FDA does attempt to monitor for companies illegally marketing and selling CBD, over-the-counter CBD products do not need to be FDA-approved.

Lack of Regulation

“The best idea when purchasing a new CBD product is to do a thorough background check on the source,” says Dr. Whitelocke. “Checking the label for actual CBD content is a good idea, as well as ensuring that the product was independently tested by a third-party laboratory for quality and purity.”

Many CBD products come with a certificate of analysis (COA), which guarantees that a third-party laboratory tested the product for accurate potency. The COA also ensures the product is free of harmful contaminants, including pesticides, molds and heavy metals.

You can find a product’s COA by scanning a QR code available on its label or by checking the manufacturers website. If you can’t find a product’s COA, you may request it by contacting the company.

Ultimately, the choice to use CBD for sleep is between you and your health care provider. Some reasons to consider CBD for sleep include wanting to try a plant-based option or seeking an alternative to conventional treatments that haven’t been effective, says Dr. Strachan.

CBD is a safe alternative to prescription sleep medications, adds Dr. Whitelocke. “Especially when you consider the relatively low toxicity of CBD products,” he says, “using CBD for sleep is a wise alternative for almost anybody seeking to improve the quality and quantity of restorative rest.”

You can find CBD in several delivery forms, including capsules, gummies or edibles, tinctures and topical products like patches, sprays, creams and more.

“A person should always speak with their doctor before starting any CBD regimen,” says Dr. Strachan.

Similarly, Dr. Whitelocke says it’s important to keep your doctor in the loop regarding any treatments you undertake so they can advise you effectively based on your specific health concerns and other medications you use.

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