Are cannabinoids effective for sleep?

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May 19, 2024

By Joie Meissner ND, BCB-L

SNAP SHOT

• Products containing mixtures of THC, CBD and other cannabinoids might offer some utility when used short-term for insomnia, but there’s not enough evidence to make that determination.
• But there is evidence showing that long-term and particularly daily use of THC-containing products can harm sleep.
• There’s limited data suggesting pure CBD might hold some benefits for insomnia.
• Cannabinoids might improve sleep in some people who have sleep problems due to conditions where cannabinoids might have some efficacy such as for chronic pain or MS-related spasticity.
• But for insomnia, the question is do the benefits outweigh the risks? In products that combine THC with other cannabinoids like CBD, risk goes up with increases in the dose of THC. There’s a lot we still don’t know about cannabinoid side effects and there are a multitude of troubling reports that should be considered when weighing whether or not to take a cannabinoid product.
• Given the toxicity of typically prescribed sleep medications, cannabinoid products with very low doses of THC (such as mail-order products) might provide a safer alternative, but long-term safety studies are lacking.
• Research has shown cognitive behavioral therapy for insomnia (CBT-I) to be superior to sleeping pills for treating chronic insomnia. ^{1, 2, 3, 4} And CBT-I doesn’t have the potentially serious side effects of the sleep meds and THC-containing cannabinoid products.

Are cannabinoids effective for sleep?

The journal Sleep published a 2021 study that researchers billed as the first “to demonstrate acceptable safety and promising efficacy of a cannabinoid therapy in a randomized, double-blind, placebo-controlled manner. Twenty-four people with chronic insomnia were given a oral preparation consisting of 20-parts THC, 2-parts CBN, and 1-part CBD for two weeks. ⁵

Average time spent asleep each night increased by 33.5 minutes and the time spent awake during the night decreased by 10 minutes. Seventeen of the 24 participants experienced at least one side effect while taking the tincture, with dry mouth and dizziness being most frequently reported. ⁶

THC alone has been shown to help people fall asleep faster, but long-term use might reduce total sleep time, according to a 2013 study in a toxicology journal. ⁷

There is evidence that long-term use of THC can harm sleep—especially in daily users— according to a 2017 study in a psychopharmacology journal. ⁸

Researchers use sleep-quality measures to variously look at things like a reduction in sleep disturbance or lost sleep, and/or difficulty falling asleep, to improvements in sleep duration, daytime dysfunction due to sleepiness or fatigue, restfulness of sleep and/or ratings of overall sleep quality.

A 2023 study of 28 healthy people found that a formulation containing only CBD had no effect on sleep quantity, but did show significant improvements in sleep quality after 8 weeks in this double-blind, placebo-controlled trial. ⁹

While pure CBD might hold some benefits for insomnia, there is not enough evidence available to determine if it’s effective to treat insomnia.

There are quite a few studies investigating cannabinoids’ pain-relieving effects that also showed improvements in sleep quality, nighttime awakenings and helping people fall asleep quicker according to the National Center for Complementary and Integrative Health, a division of the National Institutes of Health. ¹⁰

Similarly, there are studies showing cannabinoid efficacy for anxiety that also showed improvements in sleep. ^{11, 12}

That raises the question as to whether these benefits for sleep were directly related to cannabinoids’ possible effect on sleep or on anxiety and/or pain, which can interfere with sleep. Because we don’t yet have an answer to that question, we can’t conclude that cannabinoids help the sleep of people who don’t have anxiety or pain.

Full-spectrum CBD includes cannabis plant extracts, such as terpenes, THC and other cannabinoids. Such formulations showed better sleep improvements compared to single-constituent cannabinoids in studies involving people with chronic pain, anxiety or other health problems.

A 2015 review of 19 placebo-controlled studies of cannabinoids for chronic pain and multiple sclerosis that also evaluated the participant’s sleep showed that cannabinoids improved sleep. ¹³

The studies investigated different types of cannabinoids including natural THC/CBD capsules and a natural, full-spectrum, oral spray containing both CBD and THC plus lesser amounts of other cannabinoids that is currently marketed in other countries as the drug Sativex. The results from all 19 studies were pooled revealing that the CBD-THC combination provided “the greatest average improvement in sleep quality.” ¹⁴

Because the study participants contended with on-going pain, it’s hard to know whether sleep benefits were due to a reduction in pain or from cannabinoids acting on sleep.

Two separate 2018 analyses of mostly randomized controlled studies investigating cannabinoids in numerous chronic pain patients found low-quality evidence of improved sleep but no clinically relevant benefits for reducing pain. ^{15, 16}

A Harvard research study that gave 14 patients with moderate to severe anxiety full-spectrum CBD that also contained THC reported that patients after four weeks had less anxiety as well as “improvements in mood, sleep, quality of life, and measures reflecting their self-control and ability to think flexibly.” ¹⁷

It is not possible at this early point in the ongoing Harvard research to conclude that the full-spectrum CBD caused these improvements. The researchers have yet to report on a second stage of the study which will be a double-blind randomized controlled trial, which can determine if the CBD causes improvements. ¹⁸

British pharmacology experts, citing limited evidence for effectiveness and concerns over the toxicity of sleep medications like Ambien, did not give a first-line endorsement to any pharmaceutical drugs. ¹⁹

There’s a lot we still don’t know about cannabinoid side effects and there are a multitude of troubling reports that should be considered when weighing whether or not to take a cannabinoid product. Given the toxicity of typically prescribed sleep medications, cannabinoid products with very low doses of THC (such as mail-order products) might provide a safer alternative, but long-term safety studies are lacking.

Research has shown cognitive behavioral therapy for insomnia (CBT-I) to be superior to sleeping pills for treating chronic insomnia. ^{1, 2, 3, 4}

And CBT-I doesn’t have the potentially serious side effects of the sleep meds and THC-containing cannabinoid products. But more to the point, CBT-I can cure insomnia. Sleeping pills and cannabinoids cannot cure insomnia. That’s why the sleep and drug experts alike, give hands down recommendations for CBT-I over drugs. “Almost all patients should receive” CBT-I, the American Academy of Sleep Medicine declared in its most recent clinical practice guideline for chronic insomnia published in 2021. ²⁴

To find out about the safety of taking cannanbinoids for insomnia, click link below:

How Safe are Cannabinoids?

Links to more information on cannabinoids (CBD & THC):

Care informed by the understanding that emotional and physical wellbeing are deeply connected

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Citations

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2. Jacobs GD, Pace-Schott EF, Stickgold R, Otto MW. “Cognitive behavior therapy and pharmacotherapy for insomnia: a randomized controlled trial and direct comparison.” Arch Intern Med. 2004 Sep 27. 164(17):1888-96. ↩︎
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