Formal studies on efficacy and dose finding are much needed. Some urgency exists, given the explosion of lay interest in this topic and the rush to market these compounds. Current understanding of the physiology and neurologic pathways points to a benefit with anxiety-related issues. The results of our clinical report support the existing scientific evidence. In our study, we saw no evidence of a safety issue that would limit future studies. In this evaluation, CBD appears to be better tolerated than routine psychiatric medications. Furthermore, CBD displays promise as a tool for reducing anxiety in clinical populations, but given the open-label and nonrandomized nature of this large case series, all results must be interpreted very cautiously. Randomized and controlled trials are needed to provide definitive clinical guidance.
A retrospective chart review was conducted of adult psychiatric patients treated with CBD for anxiety or sleep as an adjunct to treatment as usual at a large psychiatric outpatient clinic. Any current psychiatric patient with a diagnosis by a mental health professional (psychiatrist, psychiatric nurse practitioner, or physician assistant) of a sleep or anxiety disorder was considered. Diagnosis was made by clinical evaluation followed by baseline psychologic measures. These measures were repeated monthly. Comorbid psychiatric illnesses were not a basis for exclusion. Accordingly, other psychiatric medications were administered as per routine patient care. Selection for the case series was contingent on informed consent to be treated with CBD for 1 of these 2 disorders and at least 1 month of active treatment with CBD. Patients treated with CBD were provided with psychiatric care and medications as usual. Most patients continued to receive their psychiatric medications. The patient population mirrored the clinic population at large with the exception that it was younger.
The Cannabis plant has been cultivated and used for its medicinal and industrial benefits dating back to ancient times. Cannabis sativa and Cannabis indica are the 2 main species.1 The Cannabis plant contains more than 80 different chemicals known as cannabinoids. The most abundant cannabinoid, tetrahydrocannabinol (THC), is well known for its psychoactive properties, whereas cannabidiol (CBD) is the second-most abundant and is nonpsychoactive. Different strains of the plant are grown containing varying amounts of THC and CBD. Hemp plants are grown for their fibers and high levels of CBD that can be extracted to make oil, but marijuana plants grown for recreational use have higher concentrations of THC compared with CBD.2 Industrial hemp must contain less than 0.3% THC to be considered legal, and it is from this plant that CBD oil is extracted.3
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.
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.”
CV Sciences Inc, Las Vegas, NV, provided cannabidiol products for the study. CV Sciences was not involved in the data collection, data interpretation, preparation of the report, or decision to submit the report for publication. No other financial support was provided. The authors would like to express their deep appreciation to the staff and clinicians at Wholeness Center for their professionalism.
Finally, the most notable benefit of cannabis as a form of treatment is safety. There have been no reports of lethal overdose with either of the cannabinoids and, outside of concerns over abuse, major complications are very limited.19 Current research indicates that cannabis has a low overall risk with short-term use, but more research is needed to clarify possible long-term risks and harms.
Given the promising biochemical, physiologic, and preclinical data on CBD, a remarkable lack of randomized clinical trials and other formal clinical studies exist in the psychiatric arena. The present study describes a series of patients using CBD for treatment of anxiety or sleep disturbances in a clinical practice setting. Given the paucity of data in this area, clinical observations can be quite useful to advance the knowledge base and to offer questions for further investigation. This study aimed to determine whether CBD is helpful for improving sleep and/or anxiety in a clinical population. Given the novel nature of this treatment, our study also focused on tolerability and safety concerns. As a part of the evolving legal status of cannabis, our investigation also looked at patient acceptance.
However, smoking CBD flower comes along with the benefit of having a more rapid onset than taking a dose of CBD oil, so you can use that closer to bedtime. You’ll feel the effects five to ten minutes after smoking, says Fuimaono-Poe.
There’s also the question of what form of CBD is best for sleep. Fuimaono-Poe says two common delivery methods are taking CBD oil or smoking CBD flower. CBD oil is preferable and healthier for your throat and lungs since smoking can cause throat irritation and coughing, says Fuimaono-Poe.
Since researchers haven’t determined a rule of thumb when it comes to CBD dosage for sleep, experts can only guesstimate. If you want to give CBD a shot, Fuimaono-Poe suggests starting with 25 milligrams and increasing as needed, taken one to two hours before bed.
How should I take CBD to sleep?
And to make things even more confusing, it’s possible that smaller doses of CBD may have a stimulating effect rather than a sedating effect, says Me Fuimaono-Poe, MSN, FNP, faculty at Pacific College of Health and Science, and the medical director for the Malie Cannabis Clinic.
The lack of large-scale clinical studies makes it difficult to draw solid conclusions. “There is no firm evidence regarding whether CBD may help with sleep, and if so, what dose of CBD is most appropriate,” says Chen.
For example, a 2014 study found that a dose of 15 milligrams of CBD may have an “alerting” effect.
Risks of CBD
CBD is typically well-tolerated, however, it is possible to experience some side effects. Some documented potential side effects of CBD (discovered during human studies of using CBD for epilepsy and psychiatric disorders) include:
At the end of the day, more research is needed to determine the efficacy of CBD for sleep, as well as the best dosage and most effective ways to consume it.