cbd oil for rem sleep behavior disorder

Can CBD oil help you sleep better?

Although studies are few and far between, there is limited evidence suggesting CBD oil might improve sleep quality in certain groups.

Although the evidence is still not conclusive, studies suggest that CBD (also known as cannabidiol) can help ease symptoms of anxiety and pain. While CBD oil doesn’t cause drowsiness—as is the case for many sleep aids such as melatonin or Benadryl—it might help you fall asleep if you experience regular symptoms of anxiety and pain.

How CBD interacts with the body

Cannabidiol (CBD) is one of the dozens of cannabinoid compounds found in the cannabis plant. CBD oil can be made from both marijuana or hemp cannabis plant, and can be extracted in a number of ways. However, in order for CBD products to be considered legal, they must come from a hemp plant with extremely low (0.03%) or no THC levels. For this reason, CBD doesn’t produce a ‘high’, but research nevertheless shows that it can have some positive effects on the body.

CBD’s effects all come down to the body’s endocannabinoid system, which is a network of 5-HT receptors that are activated and play a role in maintaining homeostasis in the body. Homeostasis affects pain, mood, and appetite among others other factors. It’s a complex mechanism with far-reaching effects, and oftentimes, it’s difficult to separate the influence of individual factors. While the body already has its own set of cannabinoids, introducing CBD to the body enhances the efficacy of the endocannabinoid system.

Until not long ago, scientists used to think that CBD oil acts solely on CB1 and CB2 receptors, but new research showed that’s not really the case. Instead, the cannabinoid affects the mechanism that binds specific receptors involved in anxiety (serotonin 5-HT1A) and pain (vanilloid TRPV1).

Although more robust clinical data is needed, there is evidence that suggests CBD can relieve pain and anxiety, without the potentially dangerous side effects of the THC.

For this reason, those who have such symptoms — which are known to interfere with sleep patterns — might sleep better after using CBD oil.

A survey by Consumer Research suggests that 10% of Americans who tried CBD reported sleeping better. However, this is rather anecdotal evidence and could be explained by a psychological effect rather than a biological one.

In 2019, researchers studied the clinical application of CBD of anxiety and sleep complaints in 103 adult patients at a psychiatric clinic. The researchers found that 80% of the patients had decreased anxiety scores and 66% of patients improved their sleep.

“The results of our clinical report support the existing scientific evidence. In our study, we saw no evidence of a safety issue that would limit future studies. In this evaluation, CBD appears to be better tolerated than routine psychiatric medications. Furthermore, CBD displays promise as a tool for reducing anxiety in clinical populations, but given the open-label and nonrandomized nature of this large case series, all results must be interpreted very cautiously. Randomized and controlled trials are needed to provide definitive clinical guidance, the authors of the study wrote in The Permanente Journal.

In 2017, researchers at the National Center for PTSD-Dissemination & Training Division in Palo Alto, California investigated the association between cannabis and sleep, finding that “cannabidiol (CBD) may have therapeutic potential for the treatment of insomnia,” while “THC may decrease sleep latency but could impair sleep quality long-term.”

Specifically, this new study found that CBD could be especially helpful for people with REM sleep behavior disorder. It has been suggested that CBD could relax the airways during sleep, but this is not yet proven.

Several studies also hint at the benefits of CBD in ways that could improve sleep quality indirectly. For instance, CBD has been linked with reducing pain and tackling anxiety, with CBD behaving better than a placebo in preliminary studies. CBD has also been shown to have an antidepressant effect in animal studies, though this has not yet been confirmed on humans. However, as it’s so often the case, the studies aren’t conclusive yet, and sometimes, they can be even contradictory. The claims often go far ahead of the actual demonstrated benefits, and CBD is being promoted for many things it hasn’t even been studied for.

CBD doesn’t appear to be harmful, and there are clear, demonstrated benefits. For instance, CBD has been shown to ease the symptoms associated with some cases of epilepsy, Parkinson’s, and a few other rare disorders. When it comes to sleep, the evidence is encouraging, but more research is needed before any clear conclusions can be drawn.

These studies suggest that CBD might work as a sleep aid for people who are struggling with sleep-related problems. However, CBD oil shouldn’t make you sleepy as over-counter sleep aids do. This means that people ought to be able to take CBD during the daytime and not feel drowsy. However, the studies are few and far between and are limited in the scope. The link between CBD and improved sleep remains far from settled, however, studies so far suggest no safety issues.

The being said, the FDA says that they have “only limited data about CBD safety and these data point to real risks that need to be considered before taking CBD for any reason.” They also state on their website that CBD can cause liver injury, affect the metabolism of other drugs, and that the use of CBD with alcohol or other depressants increases the risk of sedation and drowsiness. You should always consult with a health professional. Don’t self-medicate and follow scientific and medical advice.

Can Cannabinoids Help Patients With Sleep Disorders?

Cannabinoids represent the most commonly used psychoactive substance worldwide, and rates of use have increased with the expanding legalization of products containing delta-tetra-hydrocannabinol (THC) and cannabidiol (CBD) for medicinal and recreational use. These 2 compounds are the most frequently studied and well-known of the 104 cannabinoids that have been identified in the cannabis plant. 1

Research has shown promise for the benefits of cannabinoids in alleviating symptoms of various conditions including chronic pain and multiple sclerosis, as well as side effects related to chemotherapy. 1,2 Additionally, accumulating evidence points to the potential utility of cannabinoids in the treatment of sleep disorders, although much research is still needed in this emerging area.

Cannabinoids and Sleep

In an article published in Sleep Medicine Reviews, Suraev et al conducted a systematic analysis of 12 clinical studies and 14 preclinical studies investigating the use of cannabinoids in the management of sleep disorders. 3 They concluded that while the existing data are insufficient to support the routine clinical use of cannabinoids for this purpose, preliminary “evidence provides the rationale for future [randomized] controlled trials of cannabinoid therapies in individuals with sleep apnea, insomnia, post-traumatic stress disorder-related nightmares, restless legs syndrome, rapid eye movement sleep [behavior] disorder, and narcolepsy.”

The impact of cannabinoids on insomnia (and certain other conditions such as PTSD), which may stem at least partly from their anxiolytic effects, appears to be dose-dependent. Some findings show decreased sleep latency after midrange doses of CBD and increased sleep latency after higher doses. 1

Impact on Pain and Insomnia

An earlier study of patients with fibromyalgia demonstrated the superiority of synthetic THC (nabilone) compared to amitriptyline on sleep in patients with fibromyalgia, although it is unknown whether this was attributable to the effect of nabilone on sleep quality or pain control. 1,4

Several randomized controlled trials are currently exploring the effects of cannabinoid products in patients with chronic insomnia, including the proof-of-concept CANSLEEP (cannabidiol and Δ 9 -tetrahydrocannabinol for chronic insomnia disorder) trial investigating the safety and efficacy of a combined THC-CBD product in this population. 1,5

Effect in PTSD and Sleep Apnea

In several studies of patients with PTSD, nabilone has been found to improve insomnia and sleep quality, reduce nightmare frequency and intensity, and decrease the frequency of daytime flashbacks, with some patients reporting minor side effects including dizziness and headache. 1

In sleep apnea research, interest is increasing “in the use of cannabinoids primarily due to their neuromodulatory effect on the vagal nerve ganglion,” with small studies demonstrating promising results, wrote Kaul et al in a systematic review published in Neurotherapeutics. 1 Cannabinoids were found to suppress apneas in studies with rodents, albeit with reduced sleep efficiency and REM sleep.

According to preliminary results of the Phase 2 PACE (Pharmacotherapy of Apnea by Cannabimimetic Enhancement) trial, dronabinol (a synthetic form of THC) led to a greater reduction in the apnea-hypopnea index and improvement in self-reported sleepiness compared with placebo in individuals with obstructive sleep apnea (OSA). 6

Eye on the Future

Experts emphasize the need for larger well-controlled, long-term trials to fully elucidate the efficacy and safety profile of cannabinoids in the treatment of sleep disorders. 3 In addition, despite the possible benefits of cannabinoids, it is important to note that “chronic cannabis use can be associated with habituation ultimately requiring increased usage for similar effects [and] abrupt withdrawal can yield relapse of symptoms,” wrote Kaul et al. 1

Sleep disruptive effects may also result from discontinuation of cannabinoids after chronic use, underscoring the nuanced balance of factors to be considered as this area of research advances. 7

To learn more about the potential role of cannabinoids in the management of sleep disorders, we interviewed Aleksandra M. Kwasnik, MD, a physician in the department of pulmonary, critical care and sleep medicine at Billings Clinic in Montana, who co-authored a recent review on the topic that was published in Current Pulmonology Reports. 8

What does the evidence suggest thus far about the effects of cannabinoids on sleep?

The evidence available thus far shows some promise for future use of cannabinoid compounds for primary or adjunctive treatment of sleep disorders, such as sleep-disordered breathing, insomnia, and restless legs syndrome. I do caution that the research for this particular indication is in its infancy, and it remains difficult to generalize available data.

For example, the PACE trial, which evaluated the use of the synthetic cannabinoid dronabinol in the treatment of OSA, was conducted as a phase 2 trial and may soon be expanded to include more efficacy data. 6 Other research, such as that using natural cannabis products for restless legs syndrome, consists of case reports.

What are believed to be the mechanisms driving these effects?

The mechanisms by which cannabinoid products may influence sleep disorders are not entirely understood, and they likely vary widely. Importantly, the endocannabinoid receptor system on which cannabinoids exert their activity is present throughout the human body in a variety of organ systems, including the central nervous system and immune system.

Additionally, there appears to be crosstalk between the endocannabinoid system and other cellular pathways such as the orexigenic system, which plays an important part in sleep-wake disorders such as narcolepsy.

Finally, it is important to consider that there are over 100 naturally occurring cannabinoids in the cannabis plant as well as numerous synthetic compounds in its family. That in itself can lead to an extraordinary number of possible effects, depending on molecule-receptor interaction.

What are the implications for the use of cannabinoids in the management of sleep disorders?

Sleep medicine is very complex with a variable interplay of neurologic, respiratory, psychiatric, and social factors. Cannabinoids may certainly have an effect on 1 or more of these systems in any individual.

What additional research and other developments are needed in this area?

While much remains to be determined in this field, clinicians no longer have the luxury of ignoring the general public’s interest in cannabis and its potential therapeutic effects. While maintaining an open mind with our patients, it is also important to note limitations – for example, many older studies used strains of cannabis and cannabinoid compounds that differ greatly from those found in modern products.

The perception of cannabis products being natural and therefore safer than other pharmaceutical agents used for treating sleep disorders can lead to potential harm because any agent has risks when used inappropriately.

It is unlikely that dramatic scientific advances can be made while cannabis retains its schedule I designation by the US Drug Enforcement Agency. While cannabis is increasingly used for both recreational as well as self-medicinal purposes, clinical use remains underdeveloped and relies more on patient experiences in a trial-and-error fashion than on the evidence base with which most clinicians are accustomed.

References

1. Kaul M, Zee PC, Sahni AS. Effects of cannabinoids on sleep and their therapeutic potential for sleep disorders. Neurotherapeutics. Published online February 12, 2021. doi:10.1007/s13311-021-01013-w

4. Ware MA, Fitzcharles MA, Joseph L, Shir Y. The effects of nabilone on sleep in fibromyalgia: results of a randomized controlled trial. Anesth Analg. 2010;110(2):604-610. doi:10.1213/ANE.0b013e3181c76f70

7. Kesner AJ, Lovinger DM. Cannabinoids, endocannabinoids and sleep. Front Mol Neurosci. 2020;13:125. doi:10.3389/fnmol.2020.00125

8. Kwasnik A, Abreu A, Chediak A. Cannabinoids and sleep: helpful or harmful? Curr Pulmonol Rep. 2020;9:96-101. doi:10.1007/s13665-020-00254-y