Kathleen Louden, ELS, of Louden Health Communications provided editorial assistance.
The final sample consisted of 72 adults presenting with primary concerns of anxiety (n = 47) or poor sleep (n = 25). Anxiety scores decreased within the first month in 57 patients (79.2%) and remained decreased during the study duration. Sleep scores improved within the first month in 48 patients (66.7%) but fluctuated over time. In this chart review, CBD was well tolerated in all but 3 patients.
HAM-A = Hamilton Anxiety Rating Scale; PSQI = Pittsburg Sleep Quality Index.
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.
Often CBD was employed as a method to avoid or to reduce psychiatric medications. The CBD selection and dosing reflected the individual practitioner’s clinical preference. Informed consent was obtained for each patient who was treated and considered for this study. Monthly visits included clinical evaluation and documentation of patients’ anxiety and sleep status using validated measures. CBD was added to care, dropped from care, or refused as per individual patient and practitioner preference. The Western Institutional Review Board, Puyallup, WA, approved this retrospective chart review.
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.
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.
Main Outcome Measures
A large retrospective case series at a psychiatric clinic involving clinical application of CBD for anxiety and sleep complaints as an adjunct to usual treatment. The retrospective chart review included monthly documentation of anxiety and sleep quality in 103 adult patients.
Wholeness Center is a large mental health clinic in Fort Collins, CO, that focuses on integrative medicine and psychiatry. Practitioners from a range of disciplines (psychiatry, naturopathy, acupuncture, neurofeedback, yoga, etc) work together in a collaborative and cross-disciplinary environment. CBD had been widely incorporated into clinical care at Wholeness Center a few years before this study, on the basis of existing research and patient experience.
Because the THC content in CBD oil may vary, depending on the state it’s sold, there may be restrictions. For example, in some states, CBD oil is sold legally if all of the THC is removed. If CBD oil still contains THC or other cannabinoids, it may only be sold in states that have legalized marijuana use.
The results indicated the cannabinoids in cannabis decreased symptoms of insomnia. But the study involved using the cannabis flower, which contains several cannabinoids. It’s difficult to determine if relief from insomnia was due to CBD or another cannabinoid.
The most well-known and probably most researched cannabinoids include cannabidiol (CBD) and tetrahydrocannabinol (THC). We know that THC is the cannabinoid that leads to the “buzz or high” from cannabis use.
Though there is plenty of supporting evidence that shows CBD and cannabinoids can improve sleep, the results are not conclusive and more research needs to be done.
The Endocannabinoid System and Sleep
CBD differs from THC and does not cause psychoactive effects or a “high.” Because it does not cause the psychoactive effects and it might help certain conditions, such as pain, anxiety, and insomnia, CBD is gaining traction as a possible treatment for several diseases.
The participants were treated using the cannabis flower with varied combustion methods including vape, pipe, and joint. THC potency on average was 20 percent and limited to 30 percent. CBD potency was on average 5.7 percent and limited to 30 percent. After using cannabis, participants rated symptoms on average to be 2.2, which was a decrease of 4.5.
Although more studies need to be performed, some research supports the theory that CBD and cannabinoids may improve sleep. This study published in the journal, Medicines, involved 409 people with insomnia. Data was collected from June 2016 to May 2018. Participants rated their symptoms of insomnia on a scale of 1 to 10 with 10 being the most severe. Starting symptoms were rated 6.6 on average.
Fab CBD Chews
Several smaller studies have also supported the use of CBD oil to improve sleep. For example, a case study involving a 10-year-old girl with post-traumatic stress disorder and poor sleep was treated with CBD. A trial of 25 mg of a CBD supplement was administered at bedtime. An additional 6 to 12 mg of CBD was given via a sublingual spray during the day for anxiety. Sleep quantity and quality gradually improved over five months.
Not everything is completely understood about how cannabinoids (including CBD) work. What we do know from research is that CBD and cannabinoids interact with proteins and cells in the brain. A relatively newly discovered system may also hold some answers.