By: Dr. Min
Cannabidiol (CBD) is touted for a variety of health benefits. Several studies suggest CBD may help with acute and chronic health issues and may just be the miracle, sustainable solution that’s been missing in healthcare for too long. One of those chronic health issues is sleep. According to the American Sleep Association, 50-70 million U.S. adults suffer from a disorder of sleep and wakefulness, which can hinder daily functioning and lead to adverse health effects.
Institute of Medicine (IOM) committee reports sleep disorders are an under-recognized health problem and have been associated with deteriorating health consequences. The long-term effects of sleep disorders have been associated with a wide range of health consequences including increase risk of blood pressure (hypertension), diabetes, obesity, depression, myocardial infarctions (i.e. heart attack) and ischemic conditions (i.e. stroke). IOM concludes that increasing awareness for sleep issues should be required among the general public and healthcare professionals given the magnitude of the problem, and that a coordinated strategy is needed to ensure continued progress in this field.
Many of us turn to sleep aids to help us get through the night, but most prescriptions come with adverse-effects. The most common non-benzodiazepine (BZD1-selective) hypnotic, Ambien, has been linked to early-stage dementia. Ambien side-effects include, but not limited to, short-term memory loss, abnormal thinking/behavior changes, CNS depression (dizziness, drowsiness, headache, hallucinations, sedation) and can be habit-forming with long-term use (classified as C-5 control substances per the FDA). BZD1-selective hypnotics also include Zaleplon (Sonata) and Eszopiclone (Lunesta), which come with similar adverse-effects. Studies show Ambien and Lunesta add only 8 minutes of additional sleep per night.
Another class of prescription sleep aids include Benzodiazepines. Benzodiazepines (BZDs) are highly-addictive with long-term use and are classified as C-3 control substances per the FDA. In NYS, BZDs are treated as Narcotics, or C2 control substances, due to its highly-addictive drug properties. Benzodiazepines that have been FDA-approved for chronic insomnia include Temazepam (Restoril), Triazolam (Halcion) and Flurazepam (Dalmane). All BZDs come with CNS depressant side-effects as well. Suddenly stopping therapy after a few months of daily therapy may be associated with withdrawal symptoms. It’s extremely important not to abruptly discontinue therapy due to the possibility of producing seizures.
Some over-the-counter sleep aids (i.e. Benadryl and Tylenol PM) can cause what’s called a “hangover” feeling described as dizziness, grogginess, dry mouth and upset stomach. Melatonin seems to be a more safe and effective natural supplement used to help regulate our sleep cycle. Caveat: Melatonin’s risk assessment of continual use is unclear and, in fact, some studies suggest it may further disrupt our natural sleep cycle with long-term use. Consequently, many people are starting to look for a more natural solution to help induce sleep.
CBD may be a viable solution for sleep issues and may address anxiety / anxiety-induced insomnia. In a large retrospective case series at a psychiatric clinic, CBD has shown to decrease anxiety scores within the first month of treatment in about 80% of patients. Sleep scores also improved within the first month in roughly 68% of patients. The retrospective chart review included monthly documentation of anxiety and sleep quality in 103 adult patients. During this three-month study, anxiety levels declined and even helped those that complained of poor sleep. The reports weren’t as clear cut, but the study concludes CBD may hold benefit for anxiety-related sleep disorders.
Research on cannabis and sleep is in its infancy and has so far yielded mixed results. From what we know, sleep is often a secondary outcome measure in most of the studies. Many of the studies indirectly suggested that cannabinoids could improve sleep quality, decrease sleep disturbances, and decrease latency of sleep onset. While many studies show a positive effect on sleep, there are several limitations and outliers not taken into account. This includes the size of the study (sample size is too small) and the trial’s outcome measure (sleep is examined as a secondary outcome measure). Also, there is just a complete lack of information on the other cannabinoids, aside from THC and CBD. Interestingly enough, it’s suggested that cannabinol (CBN) –due to its mildly sedating profile– may help you fall asleep, while cannabidiol (CBD) may help you stay asleep. There is still SO much we don’t know, but what we do know is CBD has shown to be a viable option for anxiety-induced sleep disorders, and is generally well-tolerated with a low side-effect profile. As more research on CBD & sleep surfaces, we’ll be sure to update our blogs.
More suggestive studies here.
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