Sleep, CBN + THC (part 2)
According to the US Department of Health and Human Services Office on Women’s Health, one in four women suffer from some type of insomnia symptoms, including trouble falling asleep, trouble staying asleep, or both (2). Among those at highest risk of suffering from insomnia are older women, as well as men and women experiencing chronic stress, depression, or other mental and physical health conditions. Desperate to improve sleep, and at the same time wishing to avoid addictive prescription drugs, more and more people are turning to cannabis to find relief.
There are so many cannabis “sleep aids” on the market these days that making a decision on which product to choose isn’t easy. Not only are there a myriad of THC-infused tinctures and edibles available, but there are high CBD products, high CBN products, and various combinations of them all. So when looking for a good sleeping aid, the first question to ask is whether there is any scientific evidence to support that the formulation you are considering has ingredients that might help you get a better night’s sleep. Unfortunately, it’s not all that cut and dry.
The Complexities of Cannabis and Sleep Research
Despite popular use as sleeping aids, there are mixed results in the literature on the effects of cannabis and cannabinoids on various sleep metrics such as duration, architecture, and quality (Edwards et al). Likely contributors to these mixed results include differences in study designs, small sample sizes, different types of cannabis used, and the ratios of THC to CBD used (Kaul M, et al). Moreover, cannabis can have varying effects on individuals based on their unique genetic makeups, environmental exposures and lifestyles which can influence study results in diverse populations. Indeed, the same THC cultivar can make one person drowsy and at the same time, have a stimulating effect on another, especially for someone new to cannabis. Also the doses used in studies is highly relevant. Studies show that at lower doses, THC can have calming and sleep-inducing properties, while larger doses may cause a person to feel more alert or anxious. CBD has an inverted U-shaped CBD dose-response curve. Studies not accounting for these factors are flawed.
THC and Sleep: The Variables
Much of the scientific research into the effects of cannabis on sleep are conducted with people who have other health problems which makes it difficult to know whether cannabis promotes sleep directly, or if it benefits sleep by reducing the effects of other health conditions. For example, synthetic forms of THC show potential for treating obstructive sleep apnea, reducing PTSD-related nightmares and improving sleep for people living with chronic pain. Many people use cannabis to self-treat insomnia, anxiety, and pain. Among these users, again, the effectiveness of cannabis for sleep is not clear cut, though a study conducted on individuals with insomnia found that many participants reported relief from their symptoms when using cannabis (Vigil et al).
The Largest Study of Cannabis Use and Sleep to Date: Moderation of Cannabis Use is Key to Better Sleep
Probably the largest study of cannabis use and sleep (Diep et al.) was conducted using data obtained from the National Health and Nutrition Examination Survey (NHANES), which is a cross-sectional survey designed by the National Center for Health Statistics and Centers for Disease Control and Prevention. From a sample representing ~146 million adults in the US, 14.5% reported recent cannabis use. The researchers found that in an adjusted analysis, recent users of cannabis were more likely than non-users to report both short sleep (OR 1.34, p<0.001) and long sleep (OR 1.56, p<0.001). Heavy users (≥20 of the past 30 days) were even more likely to be at the extremes of nightly sleep duration. Moderate users (<20 of the past 30 days) were more likely to have long sleep (OR 1.47, p<0.01) but not short sleep (OR 1.19, p=0.07) compared with non-users. It should be noted that this study did not distinguish what form and type of cannabis use, but was an analysis of users of all forms of cannabis. One clear message here is that moderation is key, particularly in the case of getting a more restful night sleep.
CBD is better for Anxiety than Sleep
There has recently been a big push to promote CBD for sleep, though this has not been fully substantiated based on the current literature. A recent report describes a case series of 72 psychiatric patients suffering from either anxiety or sleep disturbances who were administered 25 mg CBD/day for 3 months and followed monthly for the duration of the study (PMID: 30624194). The researchers found CBD treatment led to a more sustained response to anxiety than for sleep over time. Patient records displayed a larger decrease in anxiety scores than in sleep scores. While the sleep scores demonstrated mild improvement, the anxiety scores decreased within the first month and then remained decreased during the study duration.
The above case series lends further support to findings from a recently published literature review of the effects of administration of CBD or CBD combined with THC on sleep and anxiety across healthy and clinical populations. Based on data from 58 published studies, overall, the literature provided evidence that CBD-only treatments lead to greater anxiety-reducing benefits than improvements in sleep (Narayan et al).
Looking at THC and CBD Together for Sleep
Of interest are findings reported on a clinical trial in Australia where a CBD/THC oil (Entoura-10:15) improved both time and quality of sleep (Ried et al.). Light sleep increased by 21 min/night compared to placebo (p = 0.041). The quality of sleep improved overall up to 80% in the active group (pPhase2 = 0.003), including higher daily functioning (p = 0.032).
Conclusions About Getting a Better Night’s Sleep
Sleep hygiene is very important (I.e., cutting down on screen time, avoiding bright lights, doing “awake” activities in bed etc)
Try a mixed THC:CBD ratio, such as our Slumber tincture, which also contains other sleep enhancing herbs.
Take cannabis in moderation. This means a smaller to medium sized dose. It can also include smoking a smaller amount a few hours before bed to get into a relaxed state and not be actively high as you go to bed.
Avoid sugar before bed - this includes edibles!
Take breaks from cannabis - building up tolerance and psychological dependence on whatever is helping you sleep can ultimately be harmful to consistent sleep.
If you suffer from anxiety, consider a consistent routine that includes CBD during the daytime. Lowering anxiety levels will ultimately also help improve sleep at night. Our high CBD tincture is a great option!
References
Sateia, M.J., Buysse, D.J., Krystal, A.D., Neubauer, D.N., Heald, J.L. (2017). Clinical Practice Guideline for the Pharmacologic Treatment of Chronic Insomnia in Adults: An American Academy of Sleep Medicine Clinical Practice Guideline (PDF, 1.83 MB). Journal of Clinical Sleep Medicine; 13(2): 307-349.
Kessler, R.C., Berglund, P.A., Coulouvrat, C., Hajak, G., Roth, T., Shahly, V., et al. (2011). Insomnia and the performance of US workers: results from the America insomnia survey. Sleep; 34(9): 1161-1171.
Vigil, J. M., Stith, S. S., Diviant, J. P., Brockelman, F., Keeling, K., & Hall, B. (2018). Effectiveness of raw, natural medical Cannabis flower for treating insomnia under naturalistic conditions. Medicines (Basel, Switzerland), 5(3), 75.
Edwards D, Filbey FM, Are sweet dreams made of these? understanding the relationship between sleep and cannabis use. Cannabis Cannabinoid Res 2021.
Kaul M, Zee PC, Sahni AS. Effects of cannabinoids on sleep and their therapeutic potential for sleep disorders. Neurotherapeutics. 2021;18:217–27
Narayan et al. Cannabinoid treatments for anxiety: A systematic review and consideration of the impact of sleep disturbance. Neurosci Biobehav Rev 2022 Dec;143:104941.
Ried et al. Medicinal cannabis improves sleep in adults with insomnia: a randomised double-blind placebo-controlled crossover study J Sleep Res 2023 Jun;32(3):e13793
Diep C, Tian C, Vachhani K, et al. Recent cannabis use and nightly sleep duration in adults: a population analysis of the NHANES from 2005 to 2018 Regional Anesthesia & Pain Medicine 2022;47:100-104.