Everyday Insomnia: how CBD can help
Promising research highlights CBD's ability to promote relaxation, ease anxiety, minimize pain and help patients sleep more soundly.
It's no secret that quality, restful sleep is crucial for physical and mental well-being. Regular sleep impacts multiple physiological systems, including vital repair processes that occur most effectively during sleep stages (NREM 3 or slow-wave sleep). , and chronic insomnia is linked with an alarming range of health problems, serious diseases and premature mortality. Even so, it's a widespread issue: nearly 1 in 3 U.S. adults report not getting enough sleep, and an estimated 50 to 70 million Americans have ongoing sleep disturbances. Given the dearth of meaningful solutions, and the well-publicized dangers of pharmaceutical interventions, sleep-deprived patients are turning to CBD as a safe, sustainable alternative to encourage restorative slumber.1, 2
Known for their anxiolytic properties, cannabinoids have historically been used to promote sleep, with an estimated 50 percent of cannabis users saying they routinely take products containing TCH to help them sleep better, and 85 percent reporting improvements in their sleep. But THC is not without its risks, and more people are opting for non-psychoactive options to help them rest. In one study, over 40 percent of respondents said they were using CBD to relieve insomnia or enhance sleep, and sleeplessness is a primary reason consumers choose CBD.3, 4, 5
CBD appears to influence sleep in several ways, modulating endocannabinoid signaling through various receptor sites and offering a broad, multifaceted approach to better sleep. And while findings are mixed, new research is promising—initial evidence highlights the therapeutic potential of CBD to promote relaxation, calm anxiety, ease insomnia and increase sleep duration and quality.
The Architecture of Sleep: the ECS and CBD
Although the exact mechanisms are not entirely clear, CBD is thought to work in part by interacting with the body's endocannabinoid system (ECS), a vast and complex network of receptors involved in a range of vital functions and activities, including regulating sleep patterns. Emerging research demonstrates its prominent role in sleep physiology, with studies implicating ECS dysfunction in a variety of sleep disturbances such as insomnia, restless leg syndrome and sleep-disordered breathing.6, 7, 8
The ECS is composed predominantly of endocannabinoids, primarily 2-arachidonoylglycerol (2-AG) and anandamide; enzymes responsible for synthesizing and degrading these endocannabinoids; and cannabinoid receptors. CB1 receptors occur mainly in the brain and central nervous system, while CB2 receptors are found in the peripheral nervous system and immune cells, with the exception of those in the brainstem. CB1 receptors, particularly neuronal ones, regulate neurotransmitter release and impact synaptic transmission central to the induction of sleep. The ECS also plays a role in the serotonergic system, and CB1 receptors seem to be prominently involved in modulating sleep stability and the sleep-wake cycle. Other components of the ECS, including 2-AG, anandamide, fatty acid amide hydrolase (FAAH) and palmitoylethanolamide (PEA), also have pivotal functions in regulating the circadian rhythm and improving sleep patterns.9, 10, 11, 12, 13, 14, 15, 16
Cannabinoids are known to interact with the ECS to influence sleep, and both CBD and THC are being explored as potential therapeutic agents for managing sleep disturbances, though both have different mechanisms of action and variable effects on sleep stages. Cannabis products high in TCH are linked with a range of impacts on sleep, including negative outcomes like reduced sleep duration and suppressed rapid eye movement oscillations. While THC may initially promote sleep, long-term use can alter sleep architecture and decrease total sleep, likely due to tolerance, and is be associated with adverse consequences such as anxiety or memory impairment. Additionally, abuse potential is significant, with studies showing 22 to 30 percent of daily users develop cannabis use disorder, a type of substance use disorder. 17, 18, 19, 20, 21, 22
By contrast, CBD may improve sleep quality without psychoactive properties and no impact on cognitive or psychomotor performance. Research suggests CBD modulates endocannabinoid signaling in different ways to influence sleep physiology and encourage slumber. Though the exact mechanisms aren't fully known, several have been proposed. By inhibiting FAAH, CBD indirectly enhances concentrations of anandamide, as well as PEA and other sleep-regulating components of the ECS. Increased anandamide drives adenosine concentrations in the basal forebrain, supporting sleep. CBD has also been shown to affect corticotropin-releasing hormone (CRH), reducing cortisol levels and encouraging relaxation and sleep.23, 24, 25, 26, 27, 28
While studies are promising, notable challenges and barriers to research exist. Many trials use a combination of CBD and TCH, rather than CBD alone, making it difficult to assess the specific contributions of each on sleep quality. The biphasic effect of CBD greatly influences its activities, with findings suggesting low or moderate doses promote alertness, while higher doses are associated with increased sleep, longer total sleep time and a decrease in nighttime wake events compared to groups that received lower doses. Along with dosage, formulation and delivery systems, as well as wide individuality in responses to CBD, also impact results. Add to that inconsistencies in study design, and the data becomes that much more complicated to interpret.29, 30, 31, 32, 33, 34, 35, 36
Nevertheless, compelling evidence validates the potential of CBD for relieving insomnia and promoting restful sleep. Some clinical trials show CBD improves sleep quality in healthy people, decreasing sleep latency and reducing night wakings. In a systematic review of 34 studies using combinations of CBD and THC, researchers concluded CBD alone may be beneficial in alleviating insomnia and managing a range of sleep disturbances. Other research points to the therapeutic promise of CBD for treating insomnia, excessive daytime sleepiness and REM sleep behavior disorders.37, 38, 39, 40, 41
Stress, pain, sleep disorders and CBD.
The anxiolytic properties of cannabinoids are well-documented, with studies showing CBD reduces anxiety in healthy volunteers, compared to placebo. CBD works in part by taming cortisol levels in response to acute stress and mitigating neuroinflammation and excitotoxicity, and seven double-blind placebo controlled clinical trials all found CBD was effective in significantly blunting the stress response, similar to pharmaceutical interventions where used. Stress and anxiety are distressingly common in patients with insomnia and research suggests CBD can lessen anxiety, easing stress-related insomnia and enhancing sleep quality and duration. 42, 43, 44, 45, 46, 47, 48, 49
Given its validated analgesic and anti-inflammatory activities, CBD is also a valuable ally for managing pain and discomfort that interfere with sleep. In studies of patients with chronic pain, CBD decreased pain and lead to marked improvements in subjective sleep parameters in patients with a wide variety of pain conditions including multiple sclerosis, peripheral neuropathic pain, intractable cancer pain, and rheumatoid arthritis.50, 51, 52, 53, 54
Additionally, CBD may benefit a range of sleep issues, such as restless leg syndrome (RLS), sleep apnea, rapid eye movement sleep behavior disorder (RBD), narcolepsy and other conditions. Emerging research also hints at its potential to manage sleep impairments related to post-traumatic stress disorder (PTSD). PTSD is frequently associated with serious sleep disturbances, including insomnia, nightmares, hyperarousal anxiety and periodic limb movements. Left untreated, disrupted sleep further exacerbates PTSD symptoms. Nightmares related to PTSD are especially difficult to address, with few options other than pharmaceutical interventions, and new research suggests CBD treatment can alleviate anxiety, reduce nightmares and improve insomnia in patients with PTSD.55, 56, 57, 58, 59, 60, 61, 62, 63, 64
And while challenges in study design persist, promising preliminary findings are spurring further research. A double-blind, placebo-controlled, randomized study is evaluating CBD for participants with insomnia either as their main condition or associated with a mental disorder, including anxiety disorder. A triple-blinded, randomized, placebo-controlled trial is investigating the impact of CBD on sleep, anxiety, depression and pain in an elderly population. A recently completed open-label study aimed to determine the effect of commercially available CBD products on overall well-being, as well as sleep. Other trials are exploring CBD for managing cancer-related symptoms, including sleep disturbances. As research continues, these and future trials hint at CBD's profound potential to ease insomnia—and for sleep-deprived patients, offer hope for deep, restful sleep.65, 66, 67, 68, 69
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