From the Guidelines
Cannabidiol (CBD) is not recommended as a first-line treatment for sleep disturbances due to limited and mixed evidence, and the potential for adverse effects and interactions with other medications. Instead, cognitive behavioral therapy for insomnia (CBT-I) is recommended as the initial treatment for chronic insomnia disorder, as it has a significantly favorable benefit-to-risk ratio 1. Pharmacologic therapy, including benzodiazepines, nonbenzodiazepine hypnotics, and melatonin receptor agonists, may be considered in adults with chronic insomnia disorder in whom CBT-I alone was unsuccessful, using a shared decision-making approach to discuss the benefits, harms, and costs of short-term use of medications 1. Some key points to consider when evaluating treatments for insomnia include:
- The goal of treatment is to improve sleep and alleviate distress or dysfunction caused by the disorder
- Insomnia can be managed with psychological therapy, pharmacologic therapy, or a combination of both
- Cognitive behavioral therapy for insomnia (CBT-I) is a multimodal cognitive behavioral therapy targeted specifically to insomnia
- Pharmacologic therapy in the United States includes drugs approved by the U.S. Food and Drug Administration (FDA) for insomnia treatment, including benzodiazepines and nonbenzodiazepine hypnotics
- Complementary and alternative approaches, including acupuncture and Chinese herbal medicine, have also been used to treat insomnia, but their effectiveness is not well established 1. It's essential to consult a healthcare provider to determine the best course of treatment for insomnia, as they can help evaluate the individual's specific needs and develop a personalized treatment plan.
From the Research
Cbd and Sleep
- The use of cannabidiol (CBD) for sleep disturbances has been studied in various clinical trials, with mixed results 2, 3, 4, 5, 6.
- A double-blinded, randomized controlled trial found that chronic use of a low dose of CBD is safe and could improve sleep quality, though these effects do not exceed that of 5 mg melatonin 2.
- Another study found that CBD showed no reduction in the severity of Restless Legs Syndrome/Willis-Ekbom Disease (RLS/WED) manifestation in patients with Parkinson's disease and REM sleep behavior disorder 3.
- A randomized controlled pilot trial found that 150 mg of nightly CBD dosing was similar to placebo regarding most sleep outcomes, while sustaining greater well-being 4.
- A double-blind, placebo-controlled, randomized, crossover study found that a CBD-terpene formulation marginally increased the mean nightly percentage of time participants spent in slow-wave sleep (SWS) and rapid eye movement (REM) sleep stages 5.
- A systematic review found that CBD alone or with equal quantities of THC may be beneficial in alleviating the symptoms of insomnia, but future research is necessary to confirm these findings 6.
Key Findings
- CBD may be beneficial for improving sleep quality, but its effects may not exceed those of melatonin 2.
- CBD may not be effective for reducing the severity of RLS/WED in patients with Parkinson's disease and REM sleep behavior disorder 3.
- CBD may have psychological effects, such as improving well-being, but its effects on sleep outcomes may be limited 4.
- CBD-terpene formulations may increase SWS and REM sleep in some individuals with insomnia 5.
- Further research is needed to confirm the effectiveness of CBD for insomnia and to determine the optimal dosage and formulation 6.