Nowadays, it is not surprising that at some point in our lives, we end up seeking help with sleep issues. While for some a warm glass of milk before going to bed can do the trick, most need something stronger, often a bottle of wine and/or chemical aides. So, many of us turn to other natural ways to help us fall asleep and to have a restful night. We try some foods or drinks, like herbal teas (e.g. camomile), we try herbal extracts or root powders (e.g. valerian). Eventually, you come across stories about how taking CBD oil helps with sleep issues, and you can find CBD oil formulated with night-time use in mind.
But where is the evidence from clinical studies?
Most of the data available is from animal studies, and the limited number of existing clinical studies look at the quality of sleep as a secondary outcome to other conditions.
The “Cannabidiol in Anxiety and Sleep: A Large Case Series” article published in 2019 is, at the time of writing, the last publication of data obtained from a clinical study about the effects of CBD on anxiety and sleep. The attractiveness of this particular study comes from the fact that the group of people selected to participate in it are patients in a clinic who present anxiety or sleep as a primary concern. Additionally, the study also focuses on tolerability and safety concerns.
Researchers tracked the patients’ monthly sleep concerns using the Pittsburgh Sleep Quality Index (PSQI) and monthly anxiety levels using the Hamilton Anxiety Rating Scale (HAM-A). The higher the scores to these questionnaires, the more severe the concerns. Keeping this in mind, let’s take a look at the results that the researchers nicely summarised in Table 1.
The numbers on the table represent the average of the scores for each questionnaire during each monthly visit. The numbers in brackets tell us how much the variation was within the scores of each questionnaire. We can immediately see that the score for the anxiety levels and sleep concerns dropped in both the anxiety and sleep groups.
The results look promising. Most patients reported anxiety and sleep improvements within the first month, and they were able to maintain them for the duration of the study.
A few patients reported worsening symptoms in anxiety and sleep concerns. Still, in general, CBD was well tolerated by the majority of patients as few reported side effects. Some of the reported complaints included fatigue, dry eyes, or sedation. The sedation effect of CBD can be positive if you are also looking for pain relief.
Although I want to celebrate these encouraging results, I am aware that as it happens with many clinical studies, this one will also have several limitations. We need to take a closer look at how the researchers designed this study to understand the context of the outcomes:
The group of people testing the efficacy and tolerability of CBD consisted of 72 adult patients exhibiting primary concerns of anxiety (65.3%) or poor sleep (34.7%).
Most patients received 25 mg of CBD per day in capsule form. A few patients received more CBD, up to 175 mg per day. All patients completed the first monthly follow-up, about 57% remained for the second, and about 38% finished the third monthly follow-up.
The authors were clear about the limitations of their study: “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.“
Also, there was a significant drop out from the study; only 38% completed the three months of treatment. The authors list the cases where patients discontinued therapy due to unwanted side effects, but speculate that most did it for reasons other than tolerability issues.
Even though 72 is a significant number of people for this type of study (i.e., a case series), it is far too small to represent the general population. Which means the percentage of people that would likely benefit from taking CBD in the general population can be much different than that found in this study. That is why the researchers in this study, as with many others in the field of medical cannabis, keep claiming that more randomised and controlled trials are needed to provide definitive clinical guidance.
What does this mean for you?
Nothing prevents you from trying whether it works for yourself. If you still feel inclined to try broad spectrum CBD oil to assist you with your sleep and anxiety issues, then make sure to use the highest quality oil, and the chances are that you will fall in the group of people that will benefit from it. The likelihood of severe side effects appears to be small when taking between 25 mg to 175 mg per day for a period of 3 months.
CARINA PINTO KOZMUS
ŽELJKO PERDIJA M.D.
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