Use of Cannabidiol in the Management of Insomnia: A Systematic Review

Summary & key facts

Researchers reviewed 34 studies that looked at whether cannabidiol, or CBD, helps with insomnia. Many studies reported some people felt better, especially when CBD was given alone or together with similar amounts of THC. But most research did not focus on people who actually had insomnia, and many studies used weak ways of measuring sleep. That means CBD might help, but stronger studies are needed before we can be sure.

Key facts:

• The authors searched for all study types up to the end of 2021 and found 34 studies that tested CBD for sleep problems.
• Every study reported that at least some participants had improved sleep after using CBD or CBD with THC.
• About 19 studies used treatments that were mostly CBD, and about 21 studies used treatments that had roughly equal amounts of CBD and THC.
• When studies did formal statistical testing, 4 out of 7 CBD‑predominant groups and 12 out of 16 groups with equal CBD and THC showed significant sleep improvements.
• Only 2 of the 34 studies actually focused on people diagnosed with insomnia, and one of those was just a single case report of one person.
• Many studies used unproven or informal sleep questions and most did not include objective sleep tests like actigraphy or sleep recordings.
• Because most studies were not designed specifically for insomnia and measurement was limited, the review says we cannot draw firm conclusions yet.
• The overall takeaway is that CBD alone or with similar amounts of THC may help some people sleep better, but better research on people with real insomnia is needed before we can say it definitely works.

Abstract

Background: Cannabidiol (CBD), one of the major cannabinoids derived from the cannabis plant, is available over the counter. CBD is often used by patients for the management of insomnia, yet research supporting CBDs effectiveness as a treatment for insomnia is inadequate. Objective: The objective of this review was to critically evaluate the literature regarding the therapeutic benefits of CBD in the management of insomnia. Methods: A comprehensive search of the following databases from inception to December 29, 2021, was conducted: Ovid MEDLINE ® and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily, Ovid Embase, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus. The search included randomized controlled trials, nonrandomized experimental studies, cross-sectional studies, cohort studies, case series, and case reports. Risk of bias was assessed with the Agency for Healthcare Research and Quality design-specific recommended criteria. Results: Thirty-four studies were eligible for inclusion. All studies reported improvement in the insomnia symptoms of at least a portion of their participants. Of the 34 studies, 19 studies used CBD predominant therapy and 21 studies used nearly equal ratios of CBD to Δ 9 -tetrahydrocannabinol (THC). Of the studies that performed hypothesis testing, 4 of 7 studies with a CBD predominant arm and 12 of 16 studies with a nearly equal ratio of CBD to THC arm reported significant improvement in insomnia outcomes. However, only 2 of the 34 studies focused on patients with insomnia, of which 1 study was a case report. Additionally, several studies used nonvalidated subjective measures, and most studies failed to include objective measures for symptom assessment. Conclusions: The results of our systematic review suggest that CBD alone or with equal quantities of THC may be beneficial in alleviating the symptoms of insomnia. Nevertheless, future research assessing CBDs effectiveness in population of patients specifically with insomnia utilizing validated subjective and objective measures is necessary before definitive inferences can be made.

Topics

Cannabis and Cannabinoid Research Sleep and related disorders Sleep and Wakefulness Research

Categories

Health Sciences Medicine Pharmacology

Tags

Cannabidiol Cannabis Cochrane Library Insomnia Internal medicine Law Medicine MEDLINE Meta-analysis Political science Primary Insomnia Psychiatry Randomized controlled trial Sleep disorder Systematic review

Substances

Cannabis

Conditions & symptoms

Sleep disorder Poor sleep