cbd and insomnia

Cbd and insomnia

These results must be interpreted cautiously because this was a naturalistic study, all patients were receiving open-label treatment, and there was no comparison group. Concurrent psychiatric medications were employed as in routine clinical care. This is both a limitation and strength, as very few publications exist in this population. Other researchers have noted that the large societal notoriety about cannabis and medical marijuana probably contributes to a larger-than-normal placebo effect.20 Any study that explores efficacy in this therapy probably will struggle with a potentially inflated placebo effect that will make these determinations more difficult. Likewise, the clinical population in this case series is skewed younger than typical for our clinic, and future studies could explore the possible selection bias inherent in this treatment option. Most patients were also taking psychiatric medications and receiving other mental health services, such as counseling, which limits the ability to make any causal links to CBD treatment. Clinical attrition is evident in the dataset. The reason for this might be related to CBD ingestion or not, so the overall component remains unclear. Furthermore, patients at our clinic often express a desire to reduce or to avoid use of psychiatric medications, which may contribute to an enhanced placebo effect or additional bias. The length of clinical monitoring may help to decrease this concern. However, the clinical data in this analysis show a trend toward clinically significant relief of anxiety upon the start of CBD treatment.

Sleep and anxiety were the targets of this descriptive report. Sleep concerns were tracked at monthly visits using the Pittsburg Sleep Quality Index. Anxiety levels were monitored at monthly visits using the Hamilton Anxiety Rating Scale. Both scales are nonproprietary. The Hamilton Anxiety Rating Scale is a widely used and validated anxiety measure with 14 individual questions. It was first used in 1959 and covers a wide range of anxiety-related concerns. The score ranges from 0 to 56. A score under 17 indicates mild anxiety, and a score above 25 indicates severe anxiety. The Pittsburg Sleep Quality Index is a self-report measure that assesses the quality of sleep during a 1-month period. It consists of 19 items that have been found to be reliable and valid in the assessment of a range of sleep-related problems. Each item is rated 0 to 3 and yields a total score from 0 to 21. A higher number indicates more sleep-related concerns. A score of 5 or greater indicates a “poor sleeper.”

The doses used in this study (25 mg/d to 175 mg/d) were much lower than those reported in some of the clinical literature (300 mg/d to 600 mg/d)12–14,17 for 2 reasons. The first is that in our experience lower doses appear to elicit an adequate clinical response. Second, the current retail cost of CBD would make the use of 600 mg/d cost prohibitive.

Side effects and tolerability of CBD treatment were assessed through spontaneous patient self-reports and were documented in case records. Any other spontaneous comments or complaints of patients were also documented in case records and included in this analysis.

Legality of Cannabidiol

Nearly all patients were given CBD 25 mg/d in capsule form. If anxiety complaints predominated, the dosing was every morning, after breakfast. If sleep complaints predominated, the dosing was every evening, after dinner. A handful of patients were given CBD 50 mg/d or 75 mg/d. One patient with a trauma history and schizoaffective disorder received a CBD dosage that was gradually increased to 175 mg/d.

Cannabidiol (CBD) is one of many cannabinoid compounds found in cannabis. It does not appear to alter consciousness or trigger a “high.” A recent surge in scientific publications has found preclinical and clinical evidence documenting value for CBD in some neuropsychiatric disorders, including epilepsy, anxiety, and schizophrenia. Evidence points toward a calming effect for CBD in the central nervous system. Interest in CBD as a treatment of a wide range of disorders has exploded, yet few clinical studies of CBD exist in the psychiatric literature.

CBD was well tolerated, with few patients reporting side effects. Two patients discontinued treatment within the first week because of fatigue. Three patients noted mild sedation initially that appeared to abate in the first few weeks. One patient with a developmental disorder (aged 21 years) had to be taken off the CBD regimen because of increased sexually inappropriate behavior. The CBD was held, and the behavior disappeared. The behavior reappeared on redosing 2 weeks later, and the CBD regimen was formally discontinued. The treating psychiatrist thought this was related to disinhibition because the patient’s anxiety responded dramatically. One patient noted dry eyes. Reasons for patients not following-up at later assessment points are largely unknown but are probably because of standard attrition experienced in usual clinical practice. There was no evidence to suggest patients discontinued care because of tolerability concerns. The attrition rates were similar in nature and size to those found in routinely scheduled visits in this clinic.

Design and Procedures

CBD has demonstrated preliminary efficacy for a range of physical and mental health care problems. In the decade before 2012, there were only 9 published studies on the use of cannabinoids for medicinal treatment of pain; since then, 30 articles have been published on this topic, according to a PubMed search conducted in December 2017. Most notable was a study conducted at the University of California, San Diego’s Center for Medicinal Cannabis Research that showed cannabis cigarettes reduced pain by 34% to 40% compared with placebo (17% to 20% decrease in pain).8 In particular, CBD appears to hold benefits for a wide range of neurologic disorders, including decreasing major seizures. A recent large, well-controlled study of pediatric epilepsy documented a beneficial effect of CBD in reducing seizure frequency by more than 50%.9 In addition to endorphin release, the “runner’s high” experience after exercise has been shown to be induced in part by anandamide acting on CB1 receptors, eliciting anxiolytic effects on the body.10 The activity of CBD at 5-HT1A receptors may drive its neuroprotective, antidepressive, and anxiolytic benefits, although the mechanism of action by which CBD decreases anxiety is still unclear.11 CBD was shown to be helpful for decreasing anxiety through a simulated public speaking test at doses of 300 mg to 600 mg in single-dose studies.12–14 Other studies suggest lower doses of 10 mg/kg having a more anxiolytic effect than higher doses of 100 mg/kg in rats.15 A crossover study comparing CBD with nitrazepam found that high-dose CBD at 160 mg increased the duration of sleep.16 Another crossover study showed that plasma cortisol levels decreased more significantly when given oral CBD, 300 to 600 mg, but these patients experienced a sedative effect.17 The higher doses of CBD that studies suggest are therapeutic for anxiety, insomnia, and epilepsy may also increase mental sedation.16 Administration of CBD via different routes and long-term use of 10 mg/d to 400 mg/d did not create a toxic effect on patients. Doses up to 1500 mg/d have been well tolerated in the literature.18 Most of the research done has been in animal models and has shown potential benefit, but clinical data from randomized controlled experiments remain limited.

The treatment with CBD was in general well accepted, as judged by the clinicians’ and patients’ responses. Four patients declined CBD treatment because of religious or ethical concerns about the relation to cannabis. Nearly all patients easily provided informed consent once the nature of the treatment was explained. Most patients appreciated the opportunity to try something natural and avoid further or initial psychiatric medication use.

Cbd and insomnia

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