What are the safety and efficacy considerations for using Cannabinol (CBN) and Tetrahydrocannabinol (THC) gummies at night for an adult patient with insomnia or anxiety?

CBN and THC Gummies at Night

Current evidence does not support using CBN and THC gummies for insomnia or anxiety in adults, as high-quality data shows insufficient efficacy and concerning safety signals, particularly with THC's suppression of REM sleep and potential next-day impairment.

Evidence Quality and Limitations

The available evidence for cannabinoids in sleep management is severely limited and does not support routine clinical use:

• No guideline-level recommendations exist for CBN or THC specifically for insomnia or anxiety in otherwise healthy adults 1
• The American Academy of Sleep Medicine's 2017 insomnia guideline does not include cannabinoids as recommended treatment options 1
• Cancer-focused guidelines note that evidence remains insufficient to recommend cannabis for insomnia or anxiety even in cancer populations, where symptom burden is higher 1

Specific Concerns with THC

THC demonstrates problematic effects on sleep architecture:

• A 2025 high-quality randomized controlled trial showed that 10 mg THC combined with 200 mg CBD decreased total sleep time by 24.5 minutes and suppressed REM sleep by 33.9 minutes with increased REM latency by 65.6 minutes 2
• This REM suppression is clinically significant, as REM sleep is critical for emotional regulation, memory consolidation, and overall sleep quality 2
• Next-day sleepiness increased significantly, though objective alertness testing showed mixed results 2

Specific Concerns with CBN

CBN lacks human efficacy data despite marketing claims:

• A 2024 randomized trial found that 15 mg CBN added to CBD provided no additional benefit over CBD alone for sleep disturbance 3
• The CUPID study protocol (2023) acknowledges that "the isolated effects of CBN on sleep have yet to be systematically studied in humans" 4
• Marketing claims for CBN as a sleep aid are not supported by published human trials 4

Safety Concerns

Both compounds carry meaningful risks:

• A case report documented severe toxicity from CBD gummies (370 mg total dose) causing respiratory depression, cardiovascular compromise, bradycardia (HR 47), hypoxia (O2 78%), and altered mental status requiring intensive monitoring 5
• Common adverse effects include sedation, dizziness, disorientation, and next-day impairment 1
• Oral THC onset is 30 minutes to 2 hours with effects lasting 5-8 hours, creating risk of "stacking doses" and overdose 1
• High-fat meals significantly increase cannabinoid absorption, potentially exacerbating adverse effects 1

Drug Interactions

Cannabinoids inhibit multiple cytochrome P450 enzymes:

• THC and CBD inhibit CYP3A4, UGT1A9, UGT2B7, CYP1A2, CYP2B6, CYP2C8, CYP2C9, and CYP2C19 1
• Very high risk interactions with warfarin; high risk with buprenorphine and tacrolimus 1
• Potential interactions with many common medications metabolized through these pathways 1

Superior Evidence-Based Alternatives

For insomnia specifically:

• Cognitive Behavioral Therapy for Insomnia (CBT-I) should be first-line treatment with superior long-term outcomes compared to any pharmacotherapy 6
• If medication is needed, low-dose doxepin (3-6 mg) is the most appropriate choice for sleep maintenance insomnia in adults, with favorable efficacy and safety profile 6
• Suvorexant is recommended by the American Academy of Sleep Medicine for sleep maintenance insomnia with weak recommendation based on low-quality evidence 1
• Melatonin 5 mg performed equivalently to CBD formulations in a 2024 trial, with better established safety profile 3

For anxiety:

• ASCO guidelines note that no recommendation is possible for cannabis use in anxiety, even in cancer populations where it is commonly used 1
• Evidence-based treatments for anxiety disorders (SSRIs, SNRIs, CBT) have substantially stronger efficacy data

Clinical Bottom Line

Avoid recommending CBN/THC gummies for sleep or anxiety. Instead:

1. Start with CBT-I for insomnia (individual, group, telephone, or web-based delivery) 6
2. If pharmacotherapy needed: Low-dose doxepin 3-6 mg for sleep maintenance, or ramelteon 8 mg for sleep onset 6
3. For anxiety: Refer to evidence-based psychotherapy and/or FDA-approved anxiolytics
4. If patient insists on cannabinoids: Counsel on lack of efficacy data, REM suppression concerns, safety risks, drug interactions, and superior alternatives 2, 5, 1

Key Pitfalls to Avoid

• Do not assume "natural" or "herbal" means safe - serious toxicity has been documented 5
• Do not rely on product labeling claims - CBD/CBN products are poorly regulated with variable purity and concentration 5
• Do not ignore the 5-8 hour duration of oral THC - timing matters for next-day function 1
• Do not overlook that standard urine toxicology screens may be negative despite cannabinoid toxicity 5