CBD and REM Sleep - November 2024

What Research Says: Is CBD Effective for REM Sleep?

Researchers have always been interested in medical cannabis and cannabinoid products like CBD oil for their purported therapeutic potential to help with sleep. 

The Endocannabinoid System and Sleep

While the human body may not appear as active while asleep, many internal bodily functions, such as the endocannabinoid system (ECS), continue to operate.

Data from pre-clinical trials indicate that anandamide (AEA), one of the body’s two types of endocannabinoids or cannabinoids, raises the levels of adenosine, a neuromodulator in the brain that promotes sleep⁽⁴⁾. 

Physical exercise may play a role in improving AEA concentration amid studies showing an increase in circulating AEA with energy expenditure⁽⁵⁾.

Moreover, the ECS has two types of receptors, CB1 and CB2, with most of the former located in the nervous system, particularly the hypothalamus, which regulates the body’s sleep-wake cycle.

Studies suggest that CB1 receptors may activate serotonergic neurons in the brain, which modulate the sleep-wake cycle⁽⁶⁾. 

How Do CBD and Cannabinoids Work?

Plants like Cannabis sativa also contain cannabinoids, also referred to as phytocannabinoids. The most plentiful cannabinoids in these plants are cannabidiol (CBD) and delta-9-tetrahydrocannabinol (THC)⁽⁷⁾. 

According to a recent Basic & Clinical Pharmacology & Toxicology paper, CBD stops an enzyme known as fatty acid amide hydrolase from breaking down AEA. This endocannabinoid induces sleep by boosting adenosine levels⁽⁸⁾.

While findings on the impact of CBD on sleep are still limited, available data show that participants of studies involving CBD for sleep experienced its sedative effects that led to better sleep or a decline in sleep disturbances⁽⁹⁾.

Use of CBD: Can CBD Restore Natural Sleep Cycle?

Several studies indicate CBD’s potency as a sleep aid. A research paper by Scott Shannon, MD, published in the Permanente Journal, features such a study involving psychiatric patients⁽¹⁰⁾. 

In Cannabidiol in Anxiety and Sleep: A Large Case Series, more than half of the participants who took CBD for anxiolytic purposes (at least 25 milligrams per day in capsule form) experienced more restful sleep⁽¹¹⁾.

Shannon’s paper also briefly mentioned the results of two CBD crossover studies conducted earlier. 

In one study⁽¹²⁾, the CBD dosage was 160 milligrams, and participants reported longer sleep duration. 

In the other crossover study, Cannabidiol in Anxiety and Sleep: A Large Case Series⁽¹³⁾, Shannon noted that cortisol levels declined with the intake of 300 to 600 milligrams of oral CBD.

Another paper titled Cannabis, Cannabinoids, and Sleep: a Review of the Literature cites a study in which people with insomnia received 160 milligrams of CBD per day⁽¹⁴⁾.

During the trial, the participants felt CBD’s sedating properties and experienced a longer total sleep time. They also had fewer arousals during sleep.

A much older study⁽¹⁵⁾ that involved the use of CBD in the same amount (160 milligrams) noted that participants had lower dream recall, which suggests less time spent in the REM state or fewer arousals from dreams.

A 2022 study conducted by Italian researchers was featured on PubMed, a service maintained by the National Center for Biotechnology Information (NCBI)⁽¹⁶⁾. 

In the study, a group with sleep and anxiety disorders received a sublingual mixture of CBD and melatonin. The study authors reported a decline in depression, pain, and paranoia among the participants

However, further studies are necessary as one study showed no difference in the sleep quality of a group of healthy individuals who took a 300-milligram CBD capsule and a placebo for two successive nights⁽¹⁷⁾.

CBD Benefits on REM Sleep

Available studies on the effects of CBD on REM sleep behavior disorder (RBD) are still scant. The current findings show mixed results on the impact of CBD on the various aspects of sleep among patients with this disorder:

Sleep Satisfaction

In one 12-week study on 33 Parkinson’s disease patients with RBD, 17 participants received CBD while the rest received a placebo⁽¹⁸⁾. 

Both groups reported no decline in RBD events. However, those in the CBD group said they had better sleep satisfaction from the fourth to the eighth week.

Fewer RBD Episodes

In another study⁽¹⁹⁾, four patients with Parkinson’s disease received various CBD dosing for six weeks, depending on the frequency of RBD symptoms⁽²⁰⁾. 

Three patients stopped experiencing symptoms while taking 75 milligrams of CBD, whereas, before the study, they had been suffering from symptoms two to four times per week. 

Meanwhile, one of the patients only experienced one RBD episode weekly while on a 300-milligram CBD dosage for the entire study.

CBD Side Effects on Sleep

CBD has a lower addictive potential than THC⁽²¹⁾.  However, CBD users may experience some side effects. 

For example, while high CBD doses may promote sleep, low doses of CBD could increase wakefulness⁽²²⁾.

On the other hand, patients with epilepsy and psychotic disorders reported experiencing diarrhea, tiredness, and appetite changes after using CBD⁽²³⁾.

CBD: What Is It and What Are Its Forms?

CBD comes from industrial hemp, the term for cannabis plants with a THC content of 0.3% and below. It is not intoxicating or addictive, unlike THC, which is found at higher levels in marijuana plants⁽²⁴⁾. 

Popular forms of CBD products currently sold in the market include:

• CBD oil (tincture, ingestibles, and topical solutions)
• Ointment
• Cream
• Capsule
• Spray
• Inhalation liquid for vaping
• Gummies

According to a recent survey of Twitter messages with CBD themes, sleep disorders were among the top four reasons behind the strong consumer demand for such products⁽²⁵⁾.

Meanwhile, CBD’s reported pharmacological effects have also led to its development to address inflammatory ailments, including neuronal conditions (epilepsy, Alzheimer’s, and Parkinson’s), cancer, bowel disease, and skin diseases⁽²⁶⁾. 

In addition, there has been a growing interest in the study and manufacture of CBD for treating chronic pain⁽²⁷⁾ felt by those with medical conditions such as multiple sclerosis, fibromyalgia, and spinal cord or brachial plexus injury. 

Cannabis Indica vs. Cannabis Sativa 

There is an ongoing debate about the distinction between Cannabis indica and Cannabis sativa strains⁽²⁸⁾, with one study⁽²⁹⁾ saying that the indica strain is more effective for insomniacs.

However, board-certified neurologist and psychopharmacology researcher Ethan Russo, MD,⁽³⁰⁾ says that current interbreeding processes will make it difficult to accurately distinguish which plant is purely an indica or sativa plant.

Dr. Russo is a former senior medical adviser for the study of Epidiolex, a CBD solution for people with epilepsy. He proposed that the scientific community push for biochemical analysis of medicinal and recreational cannabis to settle the issue.

Legality of CBD

The U.S. Food and Drug Administration (FDA) has yet to approve a CBD product as prescription medicine for sleep. 

Thus, the agency does not regulate formulations sold over-the-counter for sleep improvement or treatment for other health conditions.

However, in Minnesota, doctors within the state can now recommend medical cannabis treatment for obstructive sleep apnea (OSA)⁽³¹⁾. The state government included OSA in its medical cannabis program in 2018.

At the same time, its Office of Medical Cannabis advises health care providers to educate citizens about various multiple therapies during related consultations.

Until now, Epidiolex is the only FDA-approved product with CBD as an active ingredient⁽³²⁾. 

Epidiolex is an oral solution used as a treatment for those aged two years and above and have Dravet syndrome or Lennox-Gastaut syndrome, which are severe and rare kinds of epilepsy. 

Amid mislabeling cases, authorities have warned the public to practice caution when buying products claiming to treat any condition⁽³³⁾. 

When the FDA tested the content of 102 CBD products in 2020, 45% of them contained only around 20% of the CBD stated on their labels. 

Meanwhile, the CBD content of 37% of the items was over 120% of the amount found in the products’ ingredient list.

In a separate test of undercover purchases, the highest number of CBD content inaccuracies was found on labels of vaping liquid. Meanwhile, CBD oil products appeared to have the most accurate labels.

Understanding REM Sleep

Regular sleep is composed of cycles of non-REM and REM sleep. They are also called the two phases of sleep, with non-REM (NREM) sleep divided into three stages⁽³⁴⁾. 

REM sleep follows NREM sleep and is usually when vivid dreams occur. During REM sleep, the eyes move rapidly while closed, and one’s brain activity, heart rate, and blood pressure also speed up.

Skeletal muscles also become atonic or act as if they are paralyzed during REM sleep. People can go through up to five sleep cycles lasting around 90 minutes each.

What is REM Sleep Behavior Disorder?

Those who fall asleep and make sounds or vigorous actions during their REM dream state, typically an hour to 1.5 hours after they fall asleep, suffer from REM sleep behavior disorder.

Signs of REM Sleep Behavior Disorder

The most common symptoms of this parasomnia or sleep disorder are⁽³⁵⁾: 

• Minor to aggressive body movements that can include kicking, flailing, punching, grabbing, as well as sitting up or jumping out of bed. 

These actions may be responses to dream scenes, including being chased, attacked, or playing sports.

• Vocalizing such as talking, laughing, shouting, cursing, and other emotional outcries.

Sleep centers conduct a diagnostic assessment and a polysomnography screening to verify if one has REM sleep behavior disorder⁽³⁶⁾. 

In a polysomnogram, a person undergoes overnight monitoring in a lab using sensors and video-recording to determine the movements and activities of one’s heart, brain, and lungs during REM sleep cycles.

Who Are at Risk of Having REM Sleep Behavior Disorder

The following are more likely to experience REM sleep behavior disorder:

• Male adults aged 50 and above, although there could be an early onset of the disorder⁽³⁷⁾
• People with narcolepsy⁽³⁸⁾ or overwhelming daytime drowsiness
• Individuals taking antidepressants⁽³⁹⁾
• Those with post-traumatic stress disorder⁽⁴⁰⁾ and multiple sclerosis⁽⁴¹⁾

A Minnesota Regional Sleep Disorders Center study suggests that the disorder can be hereditary⁽⁴²⁾.

Complications Linked to REM Sleep Disorder

People with REM sleep behavior disorder may experience the following:

• Injury

Those with this REM sleep behavior disorder are usually unaware of this condition until their bed partner or roommate tells them about their symptoms. There have been cases in which persons with this parasomnia⁽⁴³⁾ or their spouses⁽⁴⁴⁾ sustain injuries.

However, it is relatively easy to wake up those with such a disorder during their dream episodes. Once awake, they can coherently recall the subject of their dreams.

• Daytime sleepiness

Poor sleep or the lack of a good night’s sleep can result in drowsiness, affecting one’s alertness and focus during the day. 

• Neurodegenerative disorders⁽⁴⁵⁾

Those with REM sleep behavior disorder usually develop Parkinson’s disease, Alzheimer’s disease, dementia with Lewy bodies, or multiple system atrophy.

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