Is CBD Oil Good for Insomnia

CBD oil

CBD_Sleep

Figure 1.http://cbdsleep.net/

What is CBD

CBD is the decarboxylated (heated up) form of CBD-A or cannabidiol carboxylic acid.  When heated, this acid becomes CBD.  CBDA occurs naturally in cannabis Sativa, cannabis Indica, and cannabis Ruderalis (hemp with low thc).  CBD is the second most abundant cannabinoid in pot, second only to THC.  Though similar to THC in structure, it does not produce a high.  Instead, it helps moderate the stimulant effect of THC.  It has also been found to work as an antipsychotic, reducing the psychotic effects of THC in marijuana and reducing psychosis in research patients when used without THC and other cannabinoids.  In the US, it can be found in the form of a Rx pharmaceutical named Epidiolex for seizures in children.  During research for Epidiolex, researchers noted that the product can cause sleepiness.

What is CBD Oil?

CBD oil is made by using a solvent to extract CBD and evaporating to concentrate the CBD which will be suspended in the hemp oil.  CBD oil can be taken orally or applied topically.  CBD oil is not something most people will want to smoke.

How does CBD oil work?

Do you really want to know how CBD works?  Fine.  It only has weak binding ability for the CBD 1 and 2 receptors.  Is it a placebo then?  Wait.  It does bind to the GPR3 (inverse agonist), GPR6 (inverse agonist), GPR12 (inverse agonist), GPR55 (antagonist) receptors.  These receptors may be cannabinoid receptors, but this has yet to be determined.  They are G protein-coupled receptors for the time being.  CBD affects mu and sigma opioid receptors as a positive allosteric modulator.  That may have anti-pain effects.  CBD may also be an agonist at the glitazone receptor.  These mechanisms produce anti-pain, anxiolytic, antidepressant, anti-inflammatory, and sleep-inducing effects.   

The legality of CBD oil

30 states have laws legalizing and protecting CBD and marijuana for restricted medical use.  Another 17 allow the use of low or no-THC CBD preparations.  Epidiolex, your prescription CBD product, is federally recognized as a Schedule V medication.  CBD itself, however, is still federally a controlled Schedule I substance.  Lawmakers have made promises to legalize CBD federally, but this has yet to go through.  See what the marijuana laws are in your state at our site here: http://www.ncsm.nl/english/business-law/medical-marijuana-card

CBD oil disclaimers (please read, this is important):
General Medical Disclaimer: NCSM and its employees and partners do not represent the medical establishment and our information is not a replacement for your doctor’s advice. 

FDA Disclaimer:  Use of CBD products with the exception of Epidiolex and Sativex have not been evaluated or approved by the FDA.

Drug Screening Disclaimer:  While most CBD products claim to have little to no THC, it is theoretically possible to fail a drug test for THC.  This can happen because some CBD products have been tested to have far more THC than represented on the label.  Also, CBD is similar in structure to THC.

What is Insomnia (sleeplessness)?

Insomnia Facts
  1. 50 % of people report occasional insomnia.
  2. 10 % of people have chronic insomnia
  3. Happens to women more.
  4. Affects elderly at higher rates.
  5. Having children increases risk.
  6. Napping during the day can cause insomnia.
  7. Affects hyperactive people more.
  8. Alcohol and caffeine are frequent culprits.
  9. Bad sleep hygiene like having the TV running increases risk.

Insomnia is a health condition or symptom which indicated the inability to sleep.  Insomnia may be trouble falling asleep, sleeping for few hours, or a total lack of sleep.  It may also include waking up too early and being unable to fall back asleep.  These symptoms also may come with excessive daytime sleepiness.  Insomnia may be a symptom of bipolar disorder, anxiety disorder, depression, narcolepsy, and other mood, autoimmune, or endocrine disorders.

Causes of Insomnia

Can CBD Oil Help With Sleep

What is usual treatment?

Most people will have insomnia at times.  Occasional insomnia does not require treatment.  When it becomes an issue and you raise it with your primary care, you are likely to get less than a month’s worth of insomnia medication like Lunesta or Ambien.  These drugs are non-benzodiazepine in structure but bind to the same site, creating the same effective anxiolysis but also the same side effects of tolerance and addiction, that’s why your doctor gave you less than a month’s worth.  He’s not just trying to be a jerk.

One step down from that, you can get sleep-inducing antihistamines from your doctor or over-the-counter.  Drugs like Benadryl (diphenhydramine), Unisom (doxylamine), and Atarax (hydroxyzine) are sleep-inducing antihistamines.  They have the drawback of causing drowsiness upon waking that can in some cases be very hard to shake. 

How is CBD Different

CBD is not known to bind to histamine or benzodiazepine receptors.  It is also not known to produce tolerance, dependence, or excessive daytime sleepiness when taken before bed. 

Pros and cons of CBD versus Insomnia Drugs
PROSCONS
  1. No tolerance and dependence
  2. Not as heavily policed as benzodiazepines, barbituates, and non-benzodiazepine sedative-hypnotics like Ambien and Lunesta
  3. Fewer side effects than other drugs
  4. Less excessive daytime sleepiness
  5. All-natural
  6. Preliminary animal studies suggest CBD may improve sleep
  7. Produces no high or stimulant effect
  8. Treats chronic pain to affect sleep
  9. Treats mood disorders to affect sleep
  10. Reduces REM sleep behavior in people with Parkinson’s
  1. May not be as strong as prescription insomnia drugs
  2. Ambiguous legal status
  3. Federally illegal schedule 1 drug, legal at the state level in many states
  4. Not well characterized drug interactions
  5. Could increase blood levels of other drugs in an unpredictable way
  6. Elevated liver enzymes in up to 3 % of people.
  7. Some products contain THC levels greater than revealed on the label
  8. Few human studies for CBD as a sleep enhancer
  9. Some products do not contain the listed amount of CBD
  10. CBD has poor oral availability

Is CBD Oil Good For Sleep? The Research

A 2004 study in the Journal of Clinical Psychopharmacology found that 15 mg of thc had a sedative effect while 15 mg of CBD had an alertness producing effect.  However, at increased dosage, both effects reversed with THC causing a stimulant effect and CBD causing sleepiness.  Marijuana smokers know this trend again reverses, at least for marijuana, as higher doses will soon make one sleepy (Nicholson, Turner, Stone, & Robson, 2004).

At 2007 study of Sativex (2.7mg THC and 2.5mg CBD) found that this product, when used for chronic pain, significantly improved sleep quality (Russo, Guy, & Robson, 2007).

A 2014 study in the Journal of Clinical Pharmacy and Therapeutics found that cannabidiol reduced symptoms in REM sleep behavior disorder.  In this disorder, sufferers may act out dreams or attempt to do things like eat or have sex while asleep.  This can cause significant danger from falls or injury to oneself or bed partner (Chagas, et al., 2014).

Most of the studies for CBD related to sleep are animal studies.  More human studies are needed and are pending.  Many of the current human studies suffer from low sample size.  Let us review some of the animal studies.  A 2012 rat study in Neuropharmacology found that in a rat model of PTSD, anxiety relief induced by CBD blocked stress induced sleep disturbance.

An animal study from 2008 in The Open Sleep Journal revealed serotonergic mechanisms being crucial in the effects of CBD on sleep.

A 2006 rat study in FEBS Letters found that CBD can induce wakefulness by increasing dopamine release and other mechanisms.  This suggests that whether CBD will improve sleep depends on the person, the dosage, and what other substances are in the experiment’s ‘entourage’.  A replication study in Life Sciences 2011 had the same results, indicating that low doses of CBD can increase alertness.

Reviews and Success Stories

Positive Reddit review: It works!

Reviews
This reviewer has gotten good results from a product called CBDisterllay.  She used the method of titrating up which we will explain later.  She also took the product sublingually.

Success_Stories

Reviewer:  Use full spectrum, not CBD alone

This user does not get relief of insomnia from CBD alone, but it helps with pain.  However, when she switches to a product containing CBD and other marijuana-derived chemicals, she gets relief from insomnia.  Her advice is to use a full spectrum product.

Reviews_and_Success_Stories

This reddit user does not get relief of insomnia from CBD isolate, but does get relief from weed strains with high THC.  Such users may explore the use of prescription Sativex which has equal THC and CBD content.

Reviewer: Use Sativex with equal CBD and THCSuccess_Stories_and_Reviews

This user is probably prescribed Sativex, with equal parts THC and CBD, and he reports that it indeed works for insomnia. 

Can children be treated with CBD for Sleep?

Can_children_be_treated_with_CBD_for_Sleep

The case report above indicates CBD should be further studied for improving sleep in children.  In the case study, a child with PTSD from sexual abuse was treated with CBD for anxiety reduction and sleep improvement.  She experienced reduced anxiety and improved sleep.

CBD oil became popular due to a news report in the 90s showing CBD effectively treating childhood seizures.  Therefore, the first use of CBD was in children; however, it was not at that time legal.  We have discussed the legality of CBD for adults.  However, for children, the story can be more complicated.  Luckily for us, the FDA has approved Epidiolex containing CBD without THC for use in childhood seizures.  Doctors may prescribe it off-label for sleep issues or alertness issues.  Cannabidiol appears to improve alertness at low doses and induce sleep at higher doses.

Does CBD have any side effects?

CBD tends to have few side effects, that is a major draw for CBD products.  None-the-less, prescription CBD can have the following side effects:

  • diarrhea
  • drowsiness
  • elevated liver enzymes
  • fatigue
  • infection
  • little appetite
  • rash
  • sleep disturbance
  • suicidal thoughts

Dosage Of CBD Oil

A usual starting dose of CBD is 10 mg to 25 mg once or twice per day.  This is a good starting place.  However, be aware, low doses may actually increase alertness, not something you want if you are trying to sleep.  For sleep, the dose range is 40 mg to 160 mg.  You might try increasing dosage no faster than 25 mg every week, rather than going up immediately, as this could produce side effects such as dry mouth and mood disturbance.  CBD is not known to produce overdose dangers.

How do you use CBD oil?

There are many ways to use CBD for sleep.  The best way is merely to get a prescription for Epidiolex to use off label for sleep.  It is an oral formulation you need but put it in your mouth, maybe swish under the tongue, and swallow.  Other preparations such as extracts, oil, tinctures, and concentrates can be added to food or drinks.  Concentrates can be vaped or smoked, though oral use is preferable.  The digestive tract is expert at deciding what gets in the blood and what doesn’t, that’s why oral use is usually safer for many drugs.

Pure_CBDFigure 2. Pure Kanna brand CBD Oils have good reviews as a candidate for the best CBD oil on the market for sleep and other health concerns.

CBD hemp oil for sleep versus other forms

There’s some confusion about the difference between hemp oil and CBD oil.  CBD oil comes from marijuana buds and can be as much as 15 % cannabidiol.  Hemp oil comes from hemp seed and contains less than a percent of CBD.  Hemp oil can have various benefits and uses but does not have the effects of CBD oil (Jones, n.d.).  Hemp oil is legal with no grey area while CBD oil without detectable THC is unlikely to draw prosecution but can get some unlucky people in a murky legal situation.  Therefore, the observations of CBD oil causing sleepiness may not apply to hemp oil.

Conclusion: Will CBD oil help me sleep?

The answer is, YES, at the right dosage.  A low dose may actually increase alertness.  Titrate to a higher dose until it produces sleepiness.  If you are drowsy in the mornings, use a low dose to improve alertness.  You will get the health benefits of exogenous CBD without the high of THC.

Bibliography

Chagas, M. H., Chagas, M. H., Eckeli, A. L., Zuardi, A. W., Zuardi, A. W., Pena-Pereira, M. A., . . . Crippa, J. A. (2014). Cannabidiol can improve complex sleep-related behaviours associated with rapid eye movement sleep behaviour disorder in Parkinson’s disease patients: A case series. Journal of Clinical Pharmacy and Therapeutics, 39(5), 564-566. Retrieved 10 25, 2018, from https://ncbi.nlm.nih.gov/pubmed/24845114

Jones, W. (n.d.). Hemp Oil Not a Source of CBD Which Could Be Used in Epilepsy Treatments. Retrieved 10 25, 2018, from http://wkms.org/post/hemp-oil-not-source-cbd-which-could-be-used-epilepsy-treatments

Nicholson, A. N., Turner, C., Stone, B. M., & Robson, P. J. (2004). Effect of Δ-9-tetrahydrocannabinol and Cannabidiol on Nocturnal Sleep and Early-morning Behavior in Young Adults. Journal of Clinical Psychopharmacology, 24(3), 305-313. Retrieved 10 25, 2018.

Russo, E. B., Guy, G., & Robson, P. (2007). Cannabis, Pain, and Sleep: Lessons from Therapeutic Clinical Trials of Sativex®, a Cannabis‐Based Medicine. Chemistry & Biodiversity, 4(8), 1729-1743. Retrieved 10 25, 2018, from https://ncbi.nlm.nih.gov/pubmed/17712817

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