What are the long-term problems associated with Cannabidiol (CBD) use for sleep?

From the Guidelines

Long-term use of CBD for sleep may lead to several problems, including tolerance development, withdrawal symptoms, and potential liver damage, as noted in a 2024 study published in the Journal of Clinical Oncology 1.

Key Considerations

• Tolerance development: increasing doses may be needed to achieve the same sleep-inducing effects
• Withdrawal symptoms: irritability, anxiety, and sleep disturbances when stopping CBD after prolonged use
• Potential liver damage: CBD presents risks for hepatotoxicity, particularly with high doses 1
• Interactions with medications: CBD can interact with many medications, including blood thinners, antidepressants, and seizure medications, by affecting liver enzymes that metabolize these drugs
• Side effects: daytime drowsiness, diarrhea, reduced appetite, and fatigue
• Quality of sleep: CBD might suppress REM sleep in some individuals, potentially impacting dream activity and memory consolidation

Recommendations

• Consult with a healthcare provider before using CBD for chronic sleep issues
• Use CBD intermittently rather than daily
• Start with low doses (10-25mg)
• Consider addressing underlying sleep problems through cognitive behavioral therapy for insomnia or other evidence-based approaches, as recommended by the American College of Physicians in 2016 1 and the American Academy of Sleep Medicine in 2017 1

Important Notes

• The FDA has not approved CBD specifically for sleep disorders, meaning dosing guidelines aren't standardized
• The long-term safety profile of CBD remains incompletely understood, with potential concerns about liver function with prolonged use, as highlighted in a 2024 study published in the Journal of Clinical Oncology 1

From the Research

Long-term Problems Associated with Cannabidiol (CBD) Use for Sleep

• There is limited clinical evidence on the use of CBD for sleep, and even fewer studies have tested the comparative effectiveness of cannabinoid formulations found within CBD products used for sleep 2.
• A study 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.
• Self-administration of CBD reduced over-the-counter (OTC) and prescription (Rx) drug usage at daily doses less than those reported in controlled studies, and CBD self-administration significantly improves self-perception of general health and decreases symptom severity 3.
• The top reasons for using CBD include self-perceived anxiety, sleep problems, stress, and general health and wellbeing, with females having higher odds of using CBD for self-perceived anxiety and insomnia 4.
• A case series found that 90.0% of testimonials claimed that CBD treated the individual's diagnosable conditions, including psychiatric conditions, orthopedic conditions, sleep conditions, and neurological conditions 5.
• A double-blind, randomized, placebo-controlled study found that 20 mg of CBN taken nightly may be helpful for improving overall sleep disturbance, including the number of times one wakes up throughout the night, without impacting daytime fatigue, but the addition of CBD did not positively augment CBN treatment effects 6.

Potential Effects of CBD on Sleep

• CBD use was effective for stress, sleep problems, and anxiety in those who used the drug for those conditions 4.
• CBD self-administration significantly improves self-perception of general health and decreases symptom severity, and as these improve, fewer OTC and Rx drugs are used 3.
• The combination of CBD and CBN may not improve the effect of formulations containing CBD or melatonin isolate 2.
• CBN demonstrated a nonsignificant but potentially meaningful effect on sleep quality and significantly reduced number of awakenings and overall sleep disturbance 6.