The Influence of CBD on Sleep and Sleep Stages

Introduction

Cannabidiol (CBD) has been the subject of various studies for its potential to influence sleep and its stages. This guide aims to shed light on how CBD might affect sleep, comparing its effects with other over-the-counter medications, other cannabinoids, and pharmaceuticals such as benzodiazepines, Ambien, and Lunesta. The flowchart above gives the shortest version of the story: a small dose may improve sleep onset, a medium dose carries the potential for improved sleep quality, and a large dose may affect REM sleep.

Stages of Sleep

Sleep is divided into four primary stages:

1. Stage 1 (NREM1): the first phase, when you drift in and out of consciousness. It lasts around 5 to 10 minutes.
2. Stage 2 (NREM2): light sleep, with reduced body temperature and heart rate. It lasts about 20 minutes.
3. Stage 3 (NREM3): deep sleep, the stage that matters most for physical restoration. It lasts about 30 minutes.
4. Stage 4 (REM): rapid eye movement sleep, which is critical for memory consolidation and mental restoration. Its duration varies through the night.

These durations describe a typical first sleep cycle. Later cycles shift the balance, with deep sleep concentrated early in the night and REM periods lengthening toward morning.

CBD and Sleep Stages

CBD has been studied for its potential to influence these stages, although more research is required for a comprehensive understanding. In the largest controlled study of healthy adults, a single oral dose of CBD did not change the sleep-wake cycle measured by polysomnography, which is a reminder that reported effects in people with sleep complaints may differ from effects in people who sleep well (Linares 2018). An earlier crossover study in young adults found that CBD given with THC in the evening offset some of the sedative effect of THC and that CBD alone was associated with increased wakefulness (Nicholson 2004).

Comprehensive Comparison Table

Comparisons with Other Medications

1. OTC sleep aids: usually antihistamines, which may reduce REM sleep.
2. Other cannabinoids: THC may impair REM sleep and affect sleep quality. See the companion guide on the influence of THC on sleep and sleep stages.
3. Benzodiazepines: can reduce the time it takes to fall asleep but may reduce REM and deep sleep stages.
4. Ambien (zolpidem): targets GABA receptors, similar to benzodiazepines, but can disrupt sleep architecture.
5. Lunesta (eszopiclone): a non-benzodiazepine hypnotic that acts on the GABA receptor and affects the REM stage.

For context on how large the benefit of the non-benzodiazepine hypnotics actually is, a meta-analysis of trial data submitted to the FDA found that these drugs shortened the time to fall asleep by a modest amount compared with placebo (Huedo-Medina 2012). Ramelteon, a melatonin receptor agonist, also reduced latency to persistent sleep in a model of transient insomnia (Roth 2005).

Medical Conditions That Call for Caution

The source guide flags three groups of conditions where CBD for sleep deserves extra care and a conversation with a clinician:

• Liver disorders
• Cardiovascular diseases
• Sleep apnea

For guidance tailored to these conditions, patients can consult Dr. Benjamin Caplan at CED Clinic. Broader background on cannabinoids and sleep lives in the CED guide to cannabis for sleep.

What This Does and Does Not Show

The dose by stage table and the flowchart are schematic summaries drawn from the review literature, not the output of a single trial. They describe the direction and rough degree of reported effects so that a reader can see the pattern at a glance. They do not report measured minutes of REM or deep sleep at a given milligram dose, and they do not replace a sleep study or an individualized plan. Where controlled data exist, they are cited in the text above.

References

1. Babson KA, Sottile J, Morabito D. Cannabis, Cannabinoids, and Sleep: a Review of the Literature. Current Psychiatry Reports. 2017;19(4):23.
2. Linares IM, Guimaraes FS, Eckeli A, et al. No Acute Effects of Cannabidiol on the Sleep-Wake Cycle of Healthy Subjects: A Randomized, Double-Blind, Placebo-Controlled, Crossover Study. Frontiers in Pharmacology. 2018;9:315.
3. Nicholson AN, Turner C, Stone BM, Robson PJ. Effect of Delta-9-tetrahydrocannabinol and cannabidiol on nocturnal sleep and early-morning behavior in young adults. Journal of Clinical Psychopharmacology. 2004;24(3):305-313.
4. Huedo-Medina TB, Kirsch I, Middlemass J, Klonizakis M, Siriwardena AN. Effectiveness of non-benzodiazepine hypnotics in treatment of adult insomnia: meta-analysis of data submitted to the Food and Drug Administration. BMJ. 2012;345:e8343.
5. Roth T, Stubbs C, Walsh JK. Ramelteon (TAK-375), a selective MT1/MT2-receptor agonist, reduces latency to persistent sleep in a model of transient insomnia related to a novel sleep environment. Sleep. 2005;28(3):303-307.

This page is a reconstruction of the original CaplanCannabis.com guide. The book that grew out of that series, The Doctor-Approved Cannabis Handbook, is available here.

Frequently Asked Questions