Does CBD Really Help With Sleep Disorders? Here’s What the Research Says

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Key Takeaways:

• CBD alone is likely not helpful for insomnia, but THC (with CBD or alone) is effective, whether insomnia is the main complaint or a result of anxiety.   
• There is some suggestion that cannabinoids (particularly THC) can help with obstructive sleep apnea, but evidence at present is limited.
• Case reports and anecdotal evidence support both CBD and THC as a treatment for restless legs syndrome, but THC seems more effective.

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Sleep problems are one of the most common reasons for using CBD, coming in alongside anxiety at approximately 43% of users, and it’s widely-claimed to be a major benefit of the cannabinoid.

Sleep problems are also very common, with approximately 30% of the population having symptoms of insomnia at least occasionally.

This leaves a very crucial question: does CBD actually help with sleep problems?

We’ve looked in-depth at the evidence and spoken to experts in both cannabinoids and sleep to find out what the evidence says.

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CBD and Insomnia: Does CBD Help People Fall Asleep and Stay Asleep?

Insomnia is simply defined as having trouble falling asleep or staying asleep, and is arguably the most important condition when considering CBD’s effects on sleep.

However, the evidence suggests that CBD alone is not effective, while THC (alone or in addition to CBD) is more likely to be helpful.

We spoke to Dr. Bonni Goldstein, CEO/co-founder of Goldstein Wellness and author of Cannabis is Medicine, who explained that, “This is a very complicated issue with mixed results,” adding “There is no ‘one size fits all’ with any cannabis compound.”

She drew attention to a systematic review on CBD and sleep, which found somewhat positive results (with or without THC), but noted many issues with the evidence including very few studies focusing specifically on patients with insomnia.

Dr. Goldstein told us,

Patients often report that low doses of CBD do not help with insomnia over the long term. […] It is my opinion (after treating over 15,000 patients over the last two decades) that low dose THC is significantly more effective for insomnia as a direct sleep aid when compared to CBD-dominant products. It is also less expensive. Of course, the proper formulation and dosing matters.

Adding that, “In my practice, 9 out of 10 patients under my guidance who using THC for insomnia report better sleep, feeling more refreshed in the morning, have no side effects and can afford the out-of-pocket cost.”

We also spoke to Dr. Jennifer Walsh, Director of the Centre for Sleep Science at the University of Western Australia, and author of a randomized crossover trial of a THC/CBN/CBD mixture for adults with chronic insomnia (also discussed in her TEDx talk). Her group’s study found that the treatment led to a statistically significant improvement in their scores on the Insomnia Severity Index (ISI) compared to placebo.

CBD alone is ineffective for improving sleep in those with a primary complaint of poor sleep or insomnia.

However, for CBD alone, things are not so clear, as Dr. Walsh clarified, “Based on the findings from our study alone I don’t think we can really say anything about the effect of the individual constituents as they were taken in combination. However, from a recent review of the literature (we’ve just submitted it for publication) it appears that CBD alone is ineffective for improving sleep in those with a primary complaint of poor sleep or insomnia.”

While there is a lot more evidence on this topic (see below for a reference list), the overall conclusion is pretty straightforward: CBD alone isn’t too beneficial, but combinations with THC generally show positive results.

But What About CBN?

Sleep-focused CBD products often include CBN because of its reputation as the “sleepy cannabinoid,” but as Dr. Ethan Russo pointed out to us, there is “no substantiation” for this.

As this paper details, the only supporting evidence is pretty weak, and while it’s possible based on our understanding of cannabinoid receptors, the data just isn’t there yet.

Dr. Walsh’s trial did include CBN as part of the product, but with THC and CBD in the mixture – and as she argued above – it’s not really possible to separate out the effects of any one component.

We’ll cover this in more detail in an upcoming article, but for now, just note that the current evidence for claims that CBN helps with sleep in humans is not convincing.

CBD and Obstructive Sleep Apnea

Obstructive sleep apnea is a condition where breathing stops and starts during sleep, which can have very serious consequences and is usually treated with a CPAP (continuous positive airway pressure) machine.

The American Academy of Sleep Medicine published a position statement on this issue, noting that they don’t support medical cannabis use in sleep apnea, “due to unreliable delivery methods and insufficient evidence of treatment effectiveness, tolerability, and safety.” However, they also note positive results from existing studies.

Dr. Goldstein commented to us that, “Studies suggest cannabinoids may help with obstructive sleep apnea (OSA), but robust evidence is lacking on whether they prevent the serious risks associated with OSA—high blood pressure, diabetes, heart disease, and stroke. Patients should follow their physician’s guidance, weigh risks and benefits, and consider cannabinoids as an adjunct treatment. Many of my patients report that low dose THC at bedtime improves CPAP compliance, helps them fall asleep faster and stay asleep through the night, and leaves them feeling more refreshed in the morning.”  

CBD and Restless Legs Syndrome

Restless legs syndrome is basically what it sounds like: a strong, nearly-irresistible urge to move your legs, which is commonly experienced in the evening and can interfere with sleep.

The potential impact of cannabinoids has been investigated, but currently there isn’t much evidence beyond case reports and small studies. However, the small studies conducted to date suggest that cannabinoids are beneficial for people with restless legs syndrome.

Dr. Goldstein concurred with this, noting that “Evidence is limited but promising,” and adding that:

“In clinical practice, I have seen a number of patients who report excellent results, similar to the reports in the literature. Anecdotally, many are doing well using THC as the dominant cannabinoid. One of my colleagues, Dr. Deb Kimless, reports topical CBDA to be very effective for RLS. It is my view that a trial of cannabis, especially with medical guidance, is certainly worth a try as side effects are minimal and cannabinoids are quite well-tolerated.”

The existing evidence to date tends to come in the form of case reports. For example, papers from 2017 and 2019 from the same research group in Bordeaux detail reports of patients who found smoked cannabis to be effective for restless legs syndrome.

In the 2019 paper, the authors point out that three patients switched to CBD, with two out of three still rating this as effective, but none saying it was as effective as smoked cannabis.

There is also a small trial of CBD specifically (between 75 and 300 mg) in Parkinson’s patients, but this found no difference between CBD and the placebo.

CBD for Anxiety-Related Sleep Issues

Although insomnia is common on its own, among people with mood or anxiety disorders, rates reach as high as 60%.

CBD is well-known to help with anxiety, so it seems reasonable to conclude that it would help with any associated insomnia too, and the limited available evidence does support this.

Dr. Ethan Russo, widely-published cannabis researcher and founder/CEO of CReDO Science, noted that low and moderate doses of CBD are actually alerting, and told CBD Oracle that, “If anxiety is a major factor in a given person’s difficulty sleeping, CBD might produce a benefit, but anything but a low dose may interfere with slumber.”

One study looking at cannabis for insomnia in depression and anxiety broke down the results by sativa-dominant, indica-dominant, indica-hybrid and CBD-dominant strains.

The results for people with anxiety and both depression and anxiety found that cannabis was effective (based on self reports), with no differences by age group, by oil vs. flower or by strain choice.

THC Is Better for Sleep Issues, But Combining with CBD Can Help

The scientific evidence to date suggests that CBD alone is not the best approach for most sleep issues, but that THC is effective, and full-spectrum products with a combination of CBD and THC are effective too. More evidence is still needed, though, and Dr. Walsh laid out what the next steps for research should be:  

“I think we need larger sample sizes with one or two formulations which work for the majority of people so we can demonstrate efficacy and safety – I think this is going to be crucial for cannabinoids to be considered as a first-line therapy.”