Thinking about trying CBD or other cannabis compound to help you sleep? Here’s what you need to know. They say cannabis helps with sleep, but what if you'd rather not get high? Learn more about the differences between THC and CBD for sleep, with expert weigh-in on strains to try out. CBD (cannabidiol) is commonly used to treat sleep symptoms like insomnia. Learn more about cannabinoids, how CBD works, its forms & effects on the body.
Cannabis, CBD, and Sleep
If you’re one of the millions of people who have trouble sleeping, you may have considered a cannabis compound, such as CBD. Some say cannabis compounds are helpful, but more research is needed. And they might not be legal, depending on where you live. Look up the laws to know what’s allowed.
What Does the Research Say About Cannabis?
Also known as marijuana, there’s growing interest in the health benefits of cannabis, specifically cannabis compounds. Two cannabinoids that get a lot of attention are:
- Tetrahydrocannabinol (THC). The compound in cannabis that makes you feel high. Human-made versions are used to ease nausea and vomiting from cancer treatment.
- Cannabidiol (CBD). A compound in cannabis said to have anti-inflammatory and anti-seizure properties. It does not make you feel high.
Research results on cannabis and sleep are mixed. So far, there haven’t been many controlled studies to show that THC, CBD, or a combination of both can boost sleep quality, says Bhanuprakash (Bhanu) Kolla, MD. He’s an associate professor of psychiatry and psychology and a consultant for Mayo Clinic’s Center for Sleep Medicine in Rochester, MN.
But some studies show promise. That includes a small one on dronabinol, a human-made version of medical THC. Early research shows it might help with obstructive sleep apnea. But “at this point, we do not recommend the use of cannabis products for treatment of sleep apnea or other sleep disorders,” Kolla says.
Ryan Vandrey, PhD, professor of psychiatry and behavioral sciences at Johns Hopkins University in Baltimoe, looks at how cannabis use affects sleep. He says there’s evidence that THC can help you fall asleep faster in the short-term. But “there’s a big gap in our knowledge” for how cannabis affects overall sleep quality long-term or if it can help people with sleep disorders.
Michelle Sexton, ND (naturopathic doctor), assistant adjunct professor in the department of anesthesiology at the University of California, San Diego, helps people use cannabis to manage certain health conditions. She says those who use THC to ease pain often report longer sleep time. “They’re not waking as much,” she says.
Sexton sees some real-world benefits from THC products. But when it comes to cannabis research on sleep, “the body of literature is pretty small.”
There’s some evidence that nabilone — another human-made form of cannabis — might help ease sleep problems related to posttraumatic stress disorder (PTSD). Vandrey says people with PTSD often say they have fewer nightmares when they use cannabis. “A lot of folks report not remembering dreams,” he says.
A lot more research is needed to know if CBD can help with sleep. Vandrey says people who use it to manage other health conditions — anxiety, pain, epilepsy — often say their sleep gets better. But he says we don’t know if that’s from the CBD itself or because the compound helps in other ways.
“We can try to piece together a story,” Vandrey says. “But it’s really an incomplete picture at this point.”
Risks of Using Cannabis
Your brain and body get used to the chemicals in cannabis or other drugs. You’ll have to use a higher dose to get the same effects. With repeated use, cannabis might not help you sleep as well, or you might find it hard to snooze on your own.
“What commonly happens is people get into a pattern of using cannabis — whether it’s a high THC or high CBD hemp product — on a daily basis for an extended period of time,” Vandrey says. “Then, when they go one night without it, they can’t sleep.”
You’re not likely to overdose on THC or CBD, but here are some things to think about:
- Withdrawal. Long-term cannabis use can cause sleep problems when you try to quit. Vandrey says that includes insomnia and the return of vivid dreams or nightmares.
- Dizziness or balance problems. If you have to get up to pee at night, Sexton says to give yourself a minute to see if you feel stable. If you have a walking aid, make sure you use it.
- Trouble thinking clearly. Heavy cannabis use is linked to problems with memory, learning, and attention.
- Health problems. Smoking any substance can hurt your lungs, heart, or blood vessels.
- Substance misuse. Cannabis is less addictive than alcohol or opioids. But people who use it every day might get a cannabis use disorder. Tell your doctor if you want to stop but can’t. They’ll help you quit.
Don’t use cannabis products if you’re pregnant or breastfeeding. The drug could affect your baby.
Is CBD Safe?
Kolla says it’s OK to use CBD if you think it helps your sleep. He says there isn’t any data to show that it’s harmful. But keep in mind these products aren’t regulated by the FDA. There’s no way to know exactly what you’re getting. “A lot of times, CBD can be contaminated with THC and there are potentials for drug interactions,” Kolla says.
Vandrey says CBD can interact with multiple biological systems in the body. But he says there’s no research to know how long-term use will affect those systems. Until we know more, “keep use of these products controlled in some way,” he says. “You use them for a couple of weeks and then you stop.”
How to Use Cannabis
There isn’t an official “dose” that works for everyone. Always read the product label for instructions. Even better, talk to a health care professional before you try THC or CBD. Tell them if you have other health problems or you take any other medication.
Sexton doesn’t suggest CBD as a sleep aid. She says it can have an “alerting” effect for some people. Here are some of her tips for how and when to use THC:
Look for “indica” on the label. There isn’t one “nighttime” strain. You’ll need to try different kinds to see what works best for you. Though, she says something labeled indica might be more sedating.
Start with a low dose. Sexton says a 2-milligram dose is a good place to start. If you’re new to THC, you might want to go lower. More might give you unwanted side effects. “You might wake up in the middle of the night paranoid with your mind racing,” Sexton says.
Use oral THC. Drop it in the back of your mouth and swallow. “I typically stick with the oral dose because of how long it lasts, and it comes on more slowly,” she says.
The effects kick in after 1 to 3 hours, she says, and could last for 6 to 8 hours. If you try a dose that doesn’t help, “wait it out.” Sexton says you can raise your dose by 50% the next night.
- If you have trouble staying asleep. Take an oral dose right as your “head hits the pillow.”
- If you have trouble falling asleep. Take an oral dose 1 to 2 hours before bed.
Don’t go above 10 milligrams. A larger amount might raise your odds of poor sleep. “We don’t know if (THC) is disrupting sleep architecture at those higher doses,” Sexton says.
Talk to a Doctor
Ask about nondrug ways to get a good night’s rest. “My sleep expert colleagues will always say behavioral treatments are superior to pharmacological treatments,” Vandrey says.
Sexton urges good sleep hygiene. But she also tries to find any hidden problems. Here are some questions she asks:
- Do you exercise at 8 p.m.?
- Do you drink green tea with dinner?
- Do you take your B vitamins at night?
- Are you stressed or anxious?
- Is your sleep trouble linked to hormonal changes?
No detail is too small and could help your doctor figure out what’s triggering your sleep issues.
Bhanuprakash (Bhanu) Kolla, MD, associate professor of psychiatry and psychology; consultant, Center for Sleep Medicine, Mayo Clinic, Rochester, MN.
Ryan Vandrey, PhD, professor of psychiatry and behavioral sciences, Johns Hopkins University, Baltimore.
Michelle Sexton, ND, assistant adjunct professor in the department of anesthesiology at the University of California, San Diego.
Frontiers in Molecular Neuroscience: “Cannabinoids, Endocannabinoids, and Sleep.”
CDC: “Marijuana and Public Health.”
Antioxidants: “Antioxidative and Anti-Inflammatory Properties of Cannabidiol.”
Journal of Clinical Sleep Medicine: “Medical Cannabis and the Treatment of Obstructive Sleep Apnea: An American Academy of Sleep Medicine Position Statement.”
Current Psychiatry Reports: “Cannabis, Cannabinoids, and Sleep: a Review of the Literature.”
Cannabis: “Cannabis use is associated with greater total sleep time in middle-aged and older adults with and without HIV: A preliminary report utilizing digital health technologies.”
Journal of Clinical Psychopharmacology: “Use of a Synthetic Cannabinoid in a Correctional Population for Posttrautmatic Stress Disorder-Related Insomnia and Nightmares, Chronic Pain, Harm Reduction, and Other Indications.”
Addiction: “Heavy cannabis use, dependence and the brain: a clinical perspective.”
Does CBD help or hinder sleep?
What most of us wouldn’t give for a good night’s sleep. Without it, we can’t function at peak emotional, physical, and mental levels, yet in today’s high-stress, plugged-in world, so many of us don’t get decent sleep.
Ailments like insomnia, sleep apnea, narcolepsy, and excessive daytime sleepiness cause consumers to turn to over-the-counter and prescription pharmaceuticals for relief, yet many of these medications have their own serious side effects and adverse risks.
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For that reason, many consumers are exploring natural sleep aids like cannabis. We know THC-rich varieties can help people achieve sleep, but what about those sensitive to or afraid of its intoxicating effects?
Can cannabidiol (CBD), a non-intoxicating cannabis compound, also offer sleep benefits?
CBD and sleep: What does the research say?
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 aids.
Multiple cannabinoids muddy the waters
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.
Sulak explained that CBD may just be reducing symptoms like anxiety, which allows the person to relax so that their natural sleep mechanism can take over.
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.
The dosing dilemma
Depending on who you ask, CBD has been reported as having either a stimulating or a calming effect, thus adding confusion to the overall equation. While there is very little published evidence regarding dosing, research to date indicates that at higher doses, CBD has a calming effect; yet at lower doses, CBD has a stimulating effect.
In a 1977 animal study, the “ hypnotic-like effects ” of CBD were first studied. Since then, very few CBD dosing studies have been performed, but the evidence seems to indicate that the effectiveness of CBD depends on whether the person has a normal sleep rhythm or whether the person has a sleep disorder.
In a 2018 study on 27 healthy subjects , a high CBD dose (300 mg) qualifying as a clinically anxiolytic dose had no effect on the sleep-wake cycle. CBD was given 30 minutes prior to bedtime and sleep recordings were made for eight hours thereafter.
In a similar study, very high CBD doses (600 mg) had a sedative effect, but in subjects with insomnia, much lower doses of 160 mg reduced sleep disruption and increased total sleep duration. Conversely, very low doses of 25 mg had no effect.
CBD and REM sleep
CBD has been found to help with certain sleep anomalies that occur during rapid eye movement (REM) sleep. There are two types of sleep: non-rapid eye movement sleep (NREM) and rapid eye-movement (REM) sleep. NREM sleep progresses through a 90-minute cycle leading up to REM sleep, in which brain wave activity increases and dreaming occurs. REM sleep is also the time when previously learned is solidified into a memory.
In normal REM sleep, the limb muscles become temporarily paralyzed so that a person cannot act out dreams. In Parkinson’s disease as well as REM behavior disorder , people are able to flail and act out vivid and violent dreams. CBD at doses ranging from 75 to 300 mg was shown in a preliminary study to help these patients, and in an early case study, high-dose CBD helped a pediatric PTSD patient .
Low-dose CBD formulations seem to keep people awake and not alter the sleep cycle. However, this may one day prove beneficial for circadian rhythm disorders like excessive daytime sleepiness and narcolepsy because they may help people stay awake during daylight hours.
So, should you be using CBD for sleep?
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 that Americans are desperately in need of education on understanding sleep hygiene and the critical importance of sleep for health and happiness. “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.
CBD is safe, even at high doses
Sulak said that he ensures his patients that CBD is extraordinarily safe, so if it is not effective at low to moderate doses of 10 to 50 mg, CBD is safe to try at higher doses of 100 to 200mg. In a 2018 study , single doses of 1,500 mg, 3,000 mg or 6,000 mg were administered to healthy subjects daily for six days. While the study was not aimed at researching CBD’s effects on sleep, it demonstrated that CBD is indeed safe.
However, it’s important to note that research has a long way to go in establishing drug interactions associated with cannabinoids. While CBD appears to be safe on its own, consider consulting a medical professional before adding CBD or other cannabis products to your regimen.
Despite the overall lack of CBD sleep studies, the National Academies of Sciences, Engineering and Medicine concluded in a 2017 report that moderate evidence exists for cannabinoids to improve short-term sleep outcomes in a variety of conditions. As more research is conducted, CBD may well benefit patients who have ailments like obstructive sleep apnea, fibromyalgia, chronic pain, and anxiety.
CBD Oil Keeps Me Awake At Night
In recent years, the use of marijuana and CBD for the treatment of a variety of conditions has risen significantly. Specifically, CBD has been found to have potential health benefits for symptoms like insomnia. Here’s a little background on what CBD is and how it impacts your sleep and body.
What Are Cannabinoids and CBD?
Cannabinoids are chemical compounds that bind or attach to certain receptors in the central nervous system and act as chemical messengers. Depending on the specific cannabinoid, it may have varied effects on the body.
The most well-known and probably most researched cannabinoids include cannabidiol (CBD) and tetrahydrocannabinol (THC). We know that THC is the cannabinoid that leads to the “buzz or high” from cannabis use.
CBD differs from THC and does not cause psychoactive effects or a “high.” Because it does not cause the psychoactive effects and it might help certain conditions, such as pain, anxiety, and insomnia, CBD is gaining traction as a possible treatment for several diseases.
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How Do CBD and Cannabinoids Work?
Not everything is completely understood about how cannabinoids (including CBD) work. What we do know from research is that CBD and cannabinoids interact with proteins and cells in the brain. A relatively newly discovered system may also hold some answers.
The Endocannabinoid System and Sleep
Researchers discovered that the endocannabinoid system plays a role in maintaining certain body functions, such as mood, appetite, sleep, and regulating circadian rhythms. Within the endocannabinoid system is a network of cannabinoid receptors in the brain and central nervous system.The two primary receptors identified are CB1 and CB2.
Cannabinoids attach to these cells and have various effects. As far as how they may affect sleep, some research indicates that the cannabinoid CBD may interact with specific receptors, potentially affecting the sleep/wake cycle.
Additionally, CBD may also decrease anxiety and pain, which can both interfere with restful sleep. By reducing certain symptoms, it’s also possible that sleep may improve.
What Does the Research Say About CBD?
Although more studies need to be performed, some research supports the theory that CBD and cannabinoids may improve sleep. This study published in the journal, Medicines, involved 409 people with insomnia. Data was collected from June 2016 to May 2018. Participants rated their symptoms of insomnia on a scale of 1 to 10 with 10 being the most severe. Starting symptoms were rated 6.6 on average.
The participants were treated using the cannabis flower with varied combustion methods including vape, pipe, and joint. THC potency on average was 20 percent and limited to 30 percent. CBD potency was on average 5.7 percent and limited to 30 percent. After using cannabis, participants rated symptoms on average to be 2.2, which was a decrease of 4.5.
The results indicated the cannabinoids in cannabis decreased symptoms of insomnia. But the study involved using the cannabis flower, which contains several cannabinoids. It’s difficult to determine if relief from insomnia was due to CBD or another cannabinoid.
In another study published in the Permanente Journal, 72 adults with anxiety and poor sleep were involved. The participants completed anxiety and sleep assessments at the start of the study and at the first-month follow up. Study participants were given 25 mg of CBD in capsule form. Those that predominantly had sleep complaints took the dose in the evening. Participants that had anxiety as their predominant complaint took CBD in the morning.
After the first month, anxiety scores decreased in 79 percent of the people. Sleep scores improved in 66 percent of the participants, which indicated less trouble sleeping. The results suggest that CBD decreased sleep difficulties in many of the participants. But while the decrease in anxiety symptoms remained steady for the duration of the study, the sleep scores fluctuated over time.
Several smaller studies have also supported the use of CBD oil to improve sleep. For example, a case study involving a 10-year-old girl with post-traumatic stress disorder and poor sleep was treated with CBD. A trial of 25 mg of a CBD supplement was administered at bedtime. An additional 6 to 12 mg of CBD was given via a sublingual spray during the day for anxiety. Sleep quantity and quality gradually improved over five months.
Though there is plenty of supporting evidence that shows CBD and cannabinoids can improve sleep, the results are not conclusive and more research needs to be done.
Forms of CBD
CBD is extracted from the cannabis plant and known as CBD oil. But it can be a little complicated. CBD may be extracted from either the marijuana or hemp plant, which are both strains of the Cannabis sativa plant. But they are harvested differently. Hemp comes from the seeds and stalks of the plant, which contains less THC than marijuana.
Because the THC content in CBD oil may vary, depending on the state it’s sold, there may be restrictions. For example, in some states, CBD oil is sold legally if all of the THC is removed. If CBD oil still contains THC or other cannabinoids, it may only be sold in states that have legalized marijuana use.
Depending on the laws in your state, you may need a doctor’s prescription for CBD oil. But laws continue to change quickly, so in the near future, it may be different.
CBD oil can be placed under the tongue. It may also be infused in different products including the following;
- Edibles: Various types of edibles infused with CBD oil are available including gummy bears, cakes, and cookies. Edibles usually list the concentration of CBD in milligrams.
- Vaporing: CBD extract can be used in a vaporizer or vape pen. As the extract heats up, it creates a vapor that is inhaled.
- Tinctures: CBD also comes in tinctures. A few drops of the liquid can be added to drinks.
CBD oil is available in different concentrations. Since research is ongoing, the exact dose to treat sleep issues may not be fully known. It might take some trial and error to determine what works best.
Because there are so many different ways to ingest CBD, there are tons of CBD products to choose from. If you aren’t sure where to start, here are the CBD products we recommend to try if you want to improve your sleep.
Overall, there is scientific research that supports the theory that there are CBD health benefits. While more research needs to be done, the use of CBD can potentially decrease your symptoms of insomnia and help you get more quality sleep. If you struggle with sleep issues, the best first step is to consult your doctor and learn more about causes and treatments.