Best CBD for Sleep Apnea - November 2020

Why People Are Turning to CBD for Sleep Apnea

Currently, there are no studies on the effects of cannabidiol (CBD) on sleep apnea. However, research has shown that CBD might be promising in the treatment of sleep apnea symptoms and the complications that could arise from this medical condition.

CBD for Anxiety and Depression

According to a 2019 study, the frequency of anxiety and depression was higher in patients with obstructive sleep apnea (OSA) syndrome than in most people⁽⁶⁾.

The study published in The Permanente Journal revealed that CBD had a calming effect on the central nervous system. Seventy-two adults who had anxiety and sleep problems reported improved sleep and reduced anxiety⁽⁷⁾.

A 2019 study published in the journal Frontiers in Psychology stated that CBD might help reverse anxiety-like behaviors. In the study, 37 patients who had social anxiety disorder reported that their anxiety significantly decreased upon the administration of 300mg of CBD oil⁽⁸⁾.

Research reviewing animal studies has shown that CBD had anxiolytic (anxiety-reducing) and antidepressant properties⁽⁹⁾. Hence, it is suggested that CBD might be helpful in the treatment of disorders related to anxiety and depression.

CBD for Sleep

Sleep apnea patients may have trouble sleeping (insomnia) or experience excessive daytime sleepiness⁽¹⁰⁾.

A 2017 study published in the journal Current Psychiatry Reports suggested that CBD might have different effects on sleep quality depending on the CBD dose. High doses of CBD had a sedating effect, while low CBD doses were stimulating⁽¹¹⁾. 

In a study, patients with insomnia who were administered a high dose of 160mg of CBD reported an increase in total sleep time⁽¹²⁾.

A study published in the Journal of Clinical Psychopharmacology found that low doses of CBD were associated with increased wakefulness. Four males and four females who received 15mg of CBD reported alertness⁽¹³⁾.

A case study published in The Permanente Journal has shown that CBD oil administration might have improved the quantity and quality of the test subject’s sleep. The patient also reported a decrease in her anxiety⁽¹⁴⁾.

Another study published in the Journal of Psychopharmacology found that rodents who were administered with CBD exhibited increased total sleep time⁽¹⁵⁾.

Loud snoring is a typical symptom of sleep apnea⁽¹⁶⁾.

Currently, there is no research demonstrating how CBD directly affects snoring. However, there are studies on CBD’s potential effects on the conditions that contribute to snoring.

According to research published in The American Review of Respiratory Disease, heavy snorers snore more during slow-wave and rapid eye movement (REM) sleep⁽¹⁷⁾. 

A study published in the journal FEBS Letters reported that CBD might reduce REM sleep. The research, which was done on rodents, also found that CBD might increase wakefulness⁽¹⁸⁾. However, no clear line can be drawn between CBD, snoring, and sleep apnea.

CBD for Headaches and Pain

According to the American Migraine Foundation, sleep apnea patients experience headaches related to the condition. They are typically awakened by these headaches resulting in the patients feeling unrested even after a full night’s sleep ⁽¹⁹⁾.

Headaches are characterized by mild to moderate pain, typically in the neck or back of the head⁽²⁰⁾.

A 2020 study published in the journal Frontiers in Pharmacology suggested that CBD might also be a promising treatment for chronic pain relief in several conditions⁽²¹⁾.

A 2018 study published in Transplantation Proceedings was done on seven kidney transplant patients⁽²²⁾.

The test subjects were initially given 100mg of CBD twice a day for three weeks. The dosage was gradually increased to 150mg during the study’s duration.

Two patients reported total pain improvement, while four had a partial response in the first 15 days. Meanwhile, there was no change in one patient.

The researchers concluded that CBD administration had no severe side effects and was generally well-tolerated by the test subjects.

A study in 2020, published in the journal Current Pharmaceutical Biotechnology, stated that topically applied CBD oil might provide symptomatic relief of peripheral neuropathy of the lower extremities⁽²³⁾.

The study was conducted in 29 peripheral neuropathy patients. They reported that topical CBD oil administration reduced intense pain, cold and itchy sensations, and sharp pain.

Peripheral neuropathy refers to conditions involving damages to the peripheral nervous system. This system in the body is responsible for sending signals between the brain and the spinal cord to the other parts of the body⁽²⁴⁾.

CBD for Hypertension

A 2016 study published in the journal Current Opinion in Pulmonary Medicine revealed that sleep apnea patients are prone to developing hypertension or high blood pressure⁽²⁵⁾.

A 2017 study that was published in the journal JCI Insight has shown that a single dose of CBD might reduce blood pressure in healthy test subjects⁽²⁶⁾.

Nine healthy males were given a single dose of 600mg of CBD. The test subjects reported reduced blood pressure. The researchers suggested that CBD might have a role in treating cardiovascular disorders. It has yet to be studied in sleep apnea patients with high blood pressure.

In 2017, researchers reviewed 25 research studies examining CBD’s effects on the dynamics of blood flow. The researchers suggested that CBD might be helpful in treating several cardiovascular disorders, including hypertension, stroke, and myocardial infarction⁽²⁷⁾.

CBD for Diabetes

A 2016 study stated that obstructive sleep apnea might be associated with type 2 diabetes⁽²⁸⁾.

Type 2 diabetes is a condition that occurs when an individual’s blood sugar (blood glucose) is too high and the body cannot keep up with it. It is the most common diabetes type⁽²⁹⁾.

A study that was published in the Journal of the American College of Cardiology noted CBD’s promising effects on diabetes. The study outlined CBD’s antioxidant, neuroprotective, and anti-inflammatory properties⁽³⁰⁾.

The study, which was conducted on rodents, also suggested that CBD might have therapeutic benefits on cardiovascular disorders.

A 2016 study that was published in the journal Diabetes Care has found that CBD combined with tetrahydrocannabivarin (THCV), another cannabis compound, might help reduce blood glucose levels and increase insulin production in type 2 diabetes patients⁽³¹⁾.

Like CBD, THCV comes from the Cannabis sativa plant⁽³²⁾. Both compounds are nonpsychoactive, which means they do not get users high. 

Extensive research has been conducted on CBD and tetrahydrocannabinol (THC), which are the primary components of the cannabis plant. However, unlike CBD and THCV, THC may cause a high in users⁽³³⁾.

How CBD Oil Works to Alleviate Symptoms of Sleep Apnea

A study published in the journal Current Neuropharmacology stated that CBD might potentially modulate an individual’s sleep-wake cycle⁽³⁴⁾.

According to the National Sleep Foundation, the sleep-wake cycle, also known as the circadian rhythm or the body clock, is the body’s internal system responsible for regulating feelings of sleepiness and wakefulness over 24 hours⁽³⁵⁾.

According to a study published in the journal Sleep, the circadian system has an essential role in the prolongation of sleep apnea⁽³⁶⁾. The researchers also suggested that targeting the circadian system might help in the treatment of sleep apnea.

A 2016 study published in the journal Endocrine Reviews stated that the circadian system impacts the body’s sleep-wake cycle. The study also added that the circadian phase at which sleep occurs affects sleep duration, sleep architecture, and continuity⁽³⁷⁾.

One of the brain’s regions that responds to light controls the circadian rhythm. This responsiveness to light is why human beings are more alert during the daytime and are prepared to sleep during nighttime⁽³⁸⁾. 

Research has found that the endocannabinoid system (ECS) helps regulate the circadian rhythm sleep-wake cycle. The researchers suggested that the lack of healthy sleep resulted in dysregulation within the ECS⁽³⁹⁾.

The study also noted that the ECS becomes involved in the recovery of sleep after a person experiences abnormal sleep patterns.

The ECS is responsible for regulating body functions, such as mood, pain perception, memory, and appetite. To assist the ECS in regulating these functions, compounds, called cannabinoids, activate the cannabinoid receptors of the ECS⁽⁴⁰⁾.

The primary cannabinoid receptors are known as cannabinoid receptor 1 (CB1) and cannabinoid receptor 2 (CB2).

CBD and THC are the cannabinoids that have been researched most extensively⁽⁴¹⁾.

The Pros and Cons of CBD Oil for Sleep Apnea

The Pros

• Clinical trials, human studies, and research on animals have shown CBD’s potential benefits for symptoms of obstructive sleep apnea and other sleep apnea types, but is not an established treatment.
• CBD has an excellent safety profile⁽⁴²⁾. Hence, CBD is generally safe to use.
• The World Health Organization reports that there are no recorded cases of humans developing a physical dependence on CBD⁽⁴³⁾. Hence, sleep apnea patients need not worry about developing CBD addiction. 
• As long as state laws permit CBD use, prescriptions are not required when purchasing CBD products.

The Cons

• Research on CBD and sleep apnea is limited to CBD’s effects on symptoms and complications related to the sleep condition.
• CBD still has side effects, such as diarrhea, changes in weight or appetite, and tiredness⁽⁴⁴⁾.
• The United States Food and Drug Administration (US FDA) has not approved CBD use in treating medical conditions other than epilepsy. Thus, there is no standard dosage for treating sleep apnea with CBD.
• CBD products lack regulation. Hence, incidents involving mislabeled CBD products are rampant⁽⁴⁵⁾. Researchers tested 84 CBD products that were bought online. They have found that of the 84 samples, 26% contained less CBD than labeled. 43% contained more CBD than what the label declared, while 21% had THC amounts that were high enough to intoxicate children. 

How CBD Oil Compares to Alternative Treatments for Sleep Apnea

The most conventional treatment for sleep apnea is a mask known as a continuous positive airway pressure device (CPAP). It fits on the nose or the mouth and keeps an individual’s airway open by gently blowing into this airway as the patient sleeps⁽⁴⁶⁾.

The use of a CPAP is an effective and proven treatment for sleep apnea and its serious complications.

Surgery is another treatment option prescribed to patients. However, the most common surgical procedures, particularly obstructive sleep apnea, do not have a high success rate⁽⁴⁷⁾.

Doctors may recommend that patients implement specific lifestyle changes. Patients may be asked to do the following⁽⁴⁸⁾:

• Lose weight
• Exercise
• Avoid alcohol and medications that relax the back of the throat (they may interfere with breathing)
• Sleep on one’s side or abdomen instead of on the back
• Avoid smoking

Doctors do not typically prescribe medications as primary treatment for sleep apnea. However, particular drugs may alleviate some symptoms of sleep disorder, including daytime sleepiness or insomnia⁽⁴⁹⁾.

Conventional medications prescribed for sleep apnea either promote wakefulness, such as modafinil (Provigil) and armodafinil (Nuvigil). 

Other drugs act as a sleep aid, like lorazepam (Ativan), diazepam (Valium), and secobarbital sodium (Seconal Sodium).

However, these medications may have side effects. Wakefulness-promoting drugs may cause upper respiratory tract infection, insomnia, anxiety, nausea, nervousness, and headaches⁽⁵⁰⁾.

Meanwhile, barbiturates and other sedatives may cause drowsiness, stomach upset, grogginess, dizziness, mood or behavior changes, and headaches.

Because of these medications’ side effects, people have started seeking out natural remedies⁽⁵¹⁾. 

According to the American Sleep Apnea Association, the dietary supplement melatonin is recommended as an alternative to sleep aids⁽⁵²⁾. 

Secreted by the pineal gland during nighttime, melatonin is a hormone that causes sleepiness. Its organic origins have made this dietary supplement a go-to choice for Americans⁽⁵³⁾.

Melatonin is known for being a sleep aid. However, there is minimal research on melatonin’s effects on sleep apnea.

Research has suggested that melatonin might increase sleep consolidation in untreated obstructive sleep apnea patients⁽⁵⁴⁾.

Another study conducted on animal models revealed that melatonin might prevent hyperglycemia (high blood sugar)⁽⁵⁵⁾. 

CBD has a favorable safety profile⁽⁵⁶⁾. Hence, sleep apnea patients may use the hemp extract as a treatment in conjunction with CPAP machine use and the practice of lifestyle changes.

However, patients are discouraged from using CBD with melatonin as there might be possible drug interactions between the two. Melatonin is metabolized by the protein system cytochrome P450⁽⁵⁷⁾.

CBD may inhibit these proteins⁽⁵⁸⁾. This inhibition may result in reduced melatonin efficacy.

How to Choose the Right CBD for Sleep Apnea

Sleep apnea patients may choose from three types of CBD oils. These options include full-spectrum CBD oil, broad-spectrum CBD oil, and CBD isolates.

More experienced CBD users prefer the full-spectrum type. It uses all the ingredients of the Cannabis sativa plant, such as THC, flavonoids, terpenes, fatty acids, and essential oils.

It is suggested that these active ingredients work synergistically to generate the maximum therapeutic benefits from the plant. This mechanism is popularly known to the CBD community as the entourage effect.

The drawback of using full-spectrum oils is that its THC content, though limited to trace amounts only, may still be detected by some drug tests. 

The THC-free version of a full-spectrum oil is called the broad-spectrum oil. It has all the ingredients of a full-spectrum CBD product except for THC.

Patients seeking pure CBD may purchase CBD isolates, as they are made from isolated cannabidiol.

Before purchasing CBD products, one should first ensure that their state laws allow CBD use. 

Individuals should also look for high-quality CBD products, which are non-genetically modified organisms and certified organic hemp-derived.

One should also check the legitimacy of a CBD brand. Reading up on reviews and checking if the store is allowed by the government to sell CBD help potential buyers assess a brand’s credibility.

The steps mentioned should be taken, especially if the CBD brand only sells its products online.

CBD Dosage for Sleep Apnea

Due to the lack of FDA regulation, CBD has no standard dosage chart. Sleep apnea patients are encouraged to start with a low dose of CBD and gradually increase the dosage when no adverse reactions occur.

It is essential to note that a study in 2017 reported that high doses of CBD might have sedating effects while low doses might be stimulating⁽⁵⁹⁾.

Patients are encouraged to document their reactions to CBD through a journal they can refer to during a consultation with their physician.

Before adding CBD to their treatment, sleep apnea patients should consult with their doctor first. Properly treated sleep apnea by a medical professional is important to prevent long term complications.

How to Take CBD for Sleep Apnea

CBD products have several forms and formulations that may help sleep apnea patients keep awake or get quality sleep. However, some CBD formats may be more optimal for use than others. 

CBD vape pens allow CBD to get into the bloodstream through the lungs, not the digestive system. Hence, the effects may be observed instantaneously.

However, vaping may cause lung problems in some individuals⁽⁶⁰⁾.

It may also be challenging to determine the amount of CBD that sleep apnea patients take in each draw.

CBD tinctures may also be taken sublingually (under the tongue) for added efficacy. Patients can use the dropper to apply CBD oil under the tongue for approximately 60 to 90 seconds before swallowing. 

The main advantage of using CBD tinctures is that the dosage may be adjusted according to the sleep apnea patient’s needs.

CBD oil may also be used for headache relief. Patients may rub the oil on their temples to treat morning headaches that are associated with sleep apnea.

Patients may also use CBD oil products by mixing them with their food and drinks if they dislike CBD‘s grassy taste.

CBD also comes in formats that can be ingested, such as capsules, pills, gel caps, and gummies. The main advantages of CBD in these formats are convenience and consistent dosage.

CBD may also be bought in topical formulations, like creams, lotions, salves, and balms. However, this format may not be as useful as the others because topicals are limited to external applications.

What Is Sleep Apnea?

According to Mayo Clinic, sleep apnea is a sleeping disorder characterized by an individual’s breathing that repeatedly stops and starts⁽⁶¹⁾.

Sleep apnea may be categorized into three primary types. These include the following:

• Obstructive sleep apnea (OSA) – This sleep disorder is the most common. It occurs when the throat muscles relax. 
• Central sleep apnea – This type of sleep apnea happens when the brain fails to send the correct signals to the muscles responsible for controlling breathing.
• Complex sleep apnea syndrome – This disorder happens when an individual is diagnosed with OSA and central sleep apnea. It is also called treatment-emergent central sleep apnea.

Sleep apnea is mainly caused by a person’s physical structure or other medical conditions. These causes are⁽⁶²⁾:

• Obesity
• Large tonsils
• Heart or kidney failure
• Neuromuscular disorders (e.g., stroke)
• Endocrine disorders (e.g., hypothyroidism)
• Genetic syndromes (e.g., cleft palate and cleft lip)
• Premature birth

Symptoms of Sleep Apnea

Sleep apnea symptoms include⁽⁶³⁾:

• Snoring (loud or frequent)
• Silent pauses when breathing
• Choking or gasping sounds
• Daytime sleepiness (fatigue)
• Morning headaches
• Unrefreshing sleep
• Waking up to head to the bathroom during the evening (nocturia)
• Insomnia
• Difficulty focusing or concentrating
• Decreased sexual desire
• Memory loss
• Irritability

Sleep apnea risk factors include the following:

• Overweight or obese individuals
• Individuals with large neck sizes (large necks have more soft tissues that can block one’s airway while sleeping)
• Middle age individuals
• Males
• Hypertensive patients
• Individuals with a family history of sleep apnea

Sleep apnea patients may have the following complications⁽⁶⁴⁾:

• Daytime fatigue (including irritability, drowsiness, and difficulty concentrating while doing daily tasks, such as driving)
• Cardiovascular problems or hypertension
• Type 2 diabetes
• Metabolic syndrome (includes hypertension, high cholesterol, and blood sugar levels, and increased waist circumference)
• Surgery and medication complications
• Live problems
• Sleep-deprived partners (due to loud snoring)

Conclusion

Studies have demonstrated CBD’s potential therapeutic benefits on the symptoms and complications associated with sleep apnea. Patients with the condition may experience a lack of sleep or less than healthy sleep.

CBD may help with sleep. Studies have shown that CBD might be useful in modulating an individual’s sleep cycle.  

Sleep apnea patients are prone to developing disorders, such as anxiety and depression. Extensive research has been done demonstrating CBD’s anxiolytic and antidepressant properties.

Research has yet to be done on CBD‘s correlation with headaches or migraines. However, researchers have found that CBD might help relieve pain.

Studies have also shown that CBD might be useful in treating hypertension and diabetes. These complications may arise in sleep apnea patients. The best way to treat complications is by treating the sleep apnea under the supervision of a licensed professional.

CBD may be used safely as a complementary therapy to some conventional sleep apnea treatments, such as CPAP machine use, and alternative remedies, like lifestyle changes.

However, patients are advised to avoid using CBD with medications that are metabolized by the proteins CYP450 system. 

Drug interactions between CBD and these medicines may occur. Before using CBD in treating sleep apnea, patients should first advise their doctor.

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52. Ibid.
53. Ibid.
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56. Iffland, K. op. cit.  
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58. Yamaori S, Ebisawa J, Okushima Y, Yamamoto I, Watanabe K. Potent inhibition of human cytochrome P450 3A isoforms by cannabidiol: role of phenolic hydroxyl groups in the resorcinol moiety. Life Sci. 2011 Apr 11;88(15-16):730-6. doi: 10.1016/j.lfs.2011.02.017. Epub 2011 Feb 26.
59. Babson, K.A. op. Cit.
60. Outbreak of Lung Injury Associated with the Use of E-Cigarette, or Vaping, Products. (2020, February 25). Retrieved from https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html
61. Mayo Clinic Staff. op. cit.
62. Sleep Apnea. (n.d.). Retrieved from https://www.nhlbi.nih.gov/health-topics/sleep-apnea
63. Ibid.
64. Mayo Clinic Staff. op. cit.

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