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Medical Cannabis and the Treatment of Obstructive Sleep Apnea: An American Academy of Sleep Medicine Position Statement The diagnosis and effective treatment of obstructive sleep apnea (OSA) in Does sleep apnea bother you at night? Learn how you can use CBD oil to reduce the symptoms and improve the quality of your sleep. Sleep healthy. Live happy

Medical Cannabis and the Treatment of Obstructive Sleep Apnea: An American Academy of Sleep Medicine Position Statement

The diagnosis and effective treatment of obstructive sleep apnea (OSA) in adults is an urgent health priority. Positive airway pressure (PAP) therapy remains the most effective treatment for OSA, although other treatment options continue to be explored. Limited evidence citing small pilot or proof of concept studies suggest that the synthetic medical cannabis extract dronabinol may improve respiratory stability and provide benefit to treat OSA. However, side effects such as somnolence related to treatment were reported in most patients, and the long-term effects on other sleep quality measures, tolerability, and safety are still unknown. Dronabinol is not approved by the United States Food and Drug Administration (FDA) for treatment of OSA, and medical cannabis and synthetic extracts other than dronabinol have not been studied in patients with OSA. The composition of cannabinoids within medical cannabis varies significantly and is not regulated. Synthetic medical cannabis may have differential effects, with variable efficacy and side effects in the treatment of OSA. Therefore, it is the position of the American Academy of Sleep Medicine (AASM) that medical cannabis and/or its synthetic extracts should not be used for the treatment of OSA due to unreliable delivery methods and insufficient evidence of effectiveness, tolerability, and safety. OSA should be excluded from the list of chronic medical conditions for state medical cannabis programs, and patients with OSA should discuss their treatment options with a licensed medical provider at an accredited sleep facility. Further research is needed to understand the functionality of medical cannabis extracts before recommending them as a treatment for OSA.

Citation:

Ramar K, Rosen IM, Kirsch DB, Chervin RD, Carden KA, Aurora RN, Kristo DA, Malhotra RK, Martin JL, Olson EJ, Rosen CL, Rowley JA; American Academy of Sleep Medicine Board of Directors. Medical cannabis and the treatment of obstructive sleep apnea: an American Academy of Sleep Medicine position statement. J Clin Sleep Med. 2018;14(4):679–681.

INTRODUCTION

The American Academy of Sleep Medicine (AASM) is the leading professional society dedicated to promotion of sleep health. The AASM promotes sleep health and fosters high-quality, patient-centered care through advocacy, education, strategic research, and practice standards. The AASM endeavors to advance sleep health policy that improves the health and well-being of the general public.

Obstructive sleep apnea (OSA) is a sleep-related breathing disorder that is characterized by repetitive episodes of complete or partial upper airway obstruction during sleep. 1 Untreated, OSA is a potentially lethal disease that increases the risk of numerous health complications including hypertension, congestive heart failure, atrial fibrillation, coronary artery disease, stroke and type 2 diabetes. 2 Data show that untreated OSA is associated with an increased risk of all-cause and cardiovascular mortality, and that this risk can be reduced with effective treatment. 3 , 4 Therefore, the diagnosis and effective treatment of OSA in adults is an urgent health priority.

CANNABIS AND SLEEP

The flower from the cannabis plant has nearly 100 different active compounds called cannabinoids that work on the human endocannabinoid system through two main receptors, the CB1 and CB2 receptors. The two extensively researched cannabinoids are delta-9 tetrahydrocannabinol (THC) and cannabidiol (CBD). THC is the primary psychoactive component of cannabis that results in euphoria, hallucinations, anxiety, and tachycardia by acting on the CB1 receptor, while CBD counteracts the THC effects and has potential medicinal value of analgesia, neuroprotection, and anti-inflammatory action by acting on the CB2 receptor. To maximize the potential therapeutic applicability of medical cannabis, synthetic-based cannabis products have been developed such as synthetic THC (dronabinol, nabilone), CBD, and nabiximols (1:1 THC/CBD combination). Some of these synthetic cannabis products are approved by the United States Food and Drug Administration (FDA) for certain medical indications.

The effects of medical cannabis on sleep vary depending on acute versus chronic use, withdrawal after chronic use, the type of cannabinoids based on their effects on the CB1 versus CB2 receptors, and the types of synthetic extracts. Early animal studies demonstrated that cannabinoid agonists such as dronabinol improved respiratory stability through peripheral serotonergic antagonism activity, and thereby provide therapeutic benefit to treat OSA. 5 This led to human studies that assessed the effectiveness of dronabinol in pill form of different strengths from 2.5 to 10 mg to treat patients with OSA. 6 – 8 Prasad et al. reported a significant improvement in apneahypopnea index (AHI) of 32% at 3 weeks compared to baseline (−14.1 ± 17.5; P = .007). Side effects related to treatment were reported in most patients, and somnolence was reported in 29% to 50% of patients. A recent placebo-controlled randomized trial in people with moderate or severe OSA found a similar response after 6 weeks of treatment using a 10-mg dose of dronabinol that reduced AHI by 33 percent with no change in the Maintenance of Wakefulness Test (MWT) latency scores. Eight percent of patients reported sleepiness and drowsiness. 8

Importantly, the long-term use of these products on other sleep quality measures, their tolerability, and safety are still unknown. Dronabinol is not FDA approved for treatment of OSA. Medical cannabis and synthetic extracts other than dronabinol have not been studied in patients with OSA. Additionally, the safety and efficacy of other delivery methods (eg, vaping, liquid formulation, oral capsule) have not been studied. Medical cannabis and other synthetic extracts may not only have differential effects on the CB1 and CB2 receptors; their delivery methods might also create differential effects. Therefore, further research is needed to understand their functionality before recommending them as a treatment for OSA.

POSITION

It is the position of the AASM:

That medical cannabis and/or its synthetic extracts should not be used for the treatment of OSA due to unreliable delivery methods and insufficient evidence of treatment effectiveness, tolerability, and safety, and OSA should be excluded from the list of chronic medical conditions for state medical cannabis programs.

That patients with OSA should be advised to discuss their treatment options with a licensed medical provider at an accredited sleep facility.

DISCUSSION

Most states in the United States do not have laws legalizing the use of cannabis. However, certain states have laws that legalize it for medical and recreational use. At least one state has announced that OSA will be added to the list of medical indications for the use of medical cannabis. 9 This is concerning as the announcement was based on limited evidence citing pilot or proof of concept studies with small sample sizes. Additionally, the duration of these studies was only 3–6 weeks, and therefore the long-term effects of use of these medical cannabis products and the effect on OSA is unknown at this time. Also, treatment with the use of medical cannabis has shown adverse effects such as daytime sleepiness and may lead to unintended consequences such as motor vehicle accidents. Most studies only evaluated a specific synthetic cannabis extract (ie, dronabinol). The effects of other medical cannabis products for treatment of OSA are unknown currently.

PAP therapy remains the most effective treatment option for OSA. 10 Adherence with PAP therapy is optimized by a patient-centered approach that includes pretreatment education and ongoing follow-up. 11

Dronabinol is one of the many synthetic medical cannabis extracts. The composition of cannabinoids within medical cannabis varies significantly and is not regulated. Therefore, synthetic medical cannabis may have differential CB1 and CB2 receptor effects, with variable efficacy and side effects in the treatment of OSA.

There is a need for increased funding and further research on the use of synthetic medical cannabis extracts to treat OSA. We need a better understanding of the pathophysiologic mechanisms on how synthetic medical cannabis extracts work differentially on the CB1 and CB2 receptors peripherally to help patients with OSA. This may also identify other potential synthetic extracts with higher efficacy and lesser side effects to treat OSA. Because of the potential for misuse and increased costs, the lack of evidence on beneficial effects, and risk of side effects including increased daytime sleepiness, which might lead to more harm than benefit, the AASM takes the position that medical cannabis should not be used for the treatment of OSA at this time.

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CONCLUSIONS

Based on the available evidence, it is the position of the AASM that medical cannabis should not be used for the treatment of OSA. The AASM also advises state legislators, regulators and health departments that OSA should not be included as an indication for their medical cannabis programs. Further research is needed to better understand the mechanistic actions of medical cannabis and its synthetic extracts, the long-term role of these synthetic extracts on OSA treatment, and the harms and benefits.

DISCLOSURE STATEMENT

This position statement was developed by the board of directors of the AASM to help physicians and other health care providers make decisions about the appropriate treatment of patients with OSA. It is published by the AASM as an advisory that is to be used for educational and informational purposes only.

ACKNOWLEDGMENTS

The board of directors thanks AASM staff members who assisted with the development of this position statement.

REFERENCES

1. American Academy of Sleep Medicine. International Classification of Sleep Disorders. 3rd ed. Darien, IL: American Academy of Sleep Medicine; 2014. [Google Scholar]

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10. Epstein LJ, Kristo D, Strollo PJ, Jr, et al. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med. 2009; 5 (3):263–276. [PMC free article] [PubMed] [Google Scholar]

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Articles from Journal of Clinical Sleep Medicine : JCSM : Official Publication of the American Academy of Sleep Medicine are provided here courtesy of American Academy of Sleep Medicine

CBD Oil for Sleep Apnea: How Can It Help?

Sleep apnea refers to a group of breathing disorders such as problems with snoring, headaches, difficulty staying asleep, and lethargy in the daytime.

Although CBD isn’t an established treatment for sleep apnea, many people are using CBD oils and other products to improve their quality of sleep and control the symptoms of sleep apnea.

CBD is the major cannabinoid in hemp plants; it modulates the activity of the endocannabinoid system (ECS), which is the master regulatory network in the body. By interacting with the ECS, CBD can act on several essential functions, including pain, mood, memory, fertility, immune response, appetite, sleep, and more.

Today, we explain how using CBD may help you alleviate the symptoms of sleep apnea — and how to use it to get the most out of your supplementation.

But first, let’s take a closer look at sleep apnea.

What Is Sleep Apnea?

As reported by Mayo Clinic, sleep apnea is a sleeping disorder manifesting as problems with breathing that repeatedly starts and stops.

Sleep apnea can be broken down into three main types, including:

  • Central sleep apnea (CSA) – this type of sleep apnea occurs when the brain fails to communicate properly with the muscles responsible for breathing.
  • Obstructive sleep apnea (OSA) – is the most common sleep apnea disorder. It occurs upon the relaxation of the throat muscles.
  • Complex sleep apnea syndrome – this disorder can be triggered by both types of sleep apnea and is often called treatment-emergent central sleep apnea.

The two common underlying causes of sleep apnea are a person’s physical structure or comorbid conditions, such as:

  • Endocrine disorders
  • Genetic syndromes
  • Heart or kidney failure
  • Neuromuscular disorders
  • Obesity
  • Premature birth

Symptoms of Sleep Apnea

The symptom of apnea include:

  • Difficulty focusing
  • Decreased sexual drive
  • Loud and frequent snoring
  • Irritability
  • Insomnia
  • Unrefreshing sleep
  • Morning headaches
  • Gasping sounds
  • Choking
  • Silent pauses when breathing
  • Memory loss
  • Nocturia (waking up to head to the bathroom at night.

The risk factors for sleep apnea include the following:

  • Hypertensive patients
  • Males
  • Middle-age people
  • Overweight or obese individuals
  • People with large neck sizes
  • Individuals with a family history of sleep apnea

Untreated sleep apnea can cause daytime fatigue, cardiovascular problems, metabolic syndrome, type 2 diabetes, and co-deprivation of sleep on the partner’s side (due to loud snoring).

Does CBD Oil Help with Sleep Apnea?

In a study published in the journal Current Neuropharmacology, the authors found that CBD might be the modulator of the sleep-wake cycle.

The National Sleep Foundation states that the sleep-wake cycle, also known as the body clock or circadian rhythm, is the body’s internal system that controls feelings of wakefulness and sleepiness over 24 hours.

A study from the journal Sleep indicates that the circadian system plays an important role in the development of sleep apnea. The research team also suggested that this system could be the therapeutic target in the treatment of sleep apnea.

In 2016, a study was published in the journal Endocrine Reviews, stating that the circadian system influences the body’s sleep-wake cycle. The authors also added that sleep duration is affected by the circadian phase at which sleep occurs.

Research has concluded that the endocannabinoid system (ECS) helps regulate the sleep-wake cycle — suggesting that the lack of restorative sleep could lead to dysregulation within the ECS.

The authors also noted that the ECS becomes engaged in the recovery of sleep after a person suffers from abnormal sleep periods.

Why Are People Turning to CBD for Sleep Apnea

As mentioned earlier, there are no direct studies on the effects of CBD on sleep apnea. That being said, research shows that CBD might be a promising therapeutic agent for this condition — and for the management of its symptoms.

Here’s why people are using CBD for sleep apnea instead of conventional medications.

CBD for Sleep

People with sleep apnea often experience trouble sleeping (insomnia) or go through excessive daytime sleepiness as a result of the imbalance in their circadian rhythm.

In 2017, researchers published a study in the journal Current Psychiatry Reports, highlighting CBD as the potential treatment for insomnia depending on the CBD dose. High doses of CBD had a sleep-inducing effect, while low CBD doses stimulated daily awareness.

Another study found that patients with insomnia who took a high dose of 160 mg of CBD reported increased total sleep time.

The Journal of Clinical Psychopharmacology has also found that low doses of CBD were linked with increased alertness in four males and four females who received 15 mg of CBD.

In a case study published in The Permanente Journal, the researchers have shown that CBD oil administration improved the quality and quantity of the test subject’s sleep. The patient also reported reduced anxiety.

Another study from the Journal of Psychopharmacology found that rats who were given CBD exhibited increased sleep time overall.

CBD can also help with snoring. Although there are no studies that would examine CBD’s efficacy in this condition, there are studies on its potential effects on the conditions that cause snoring.

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A study published in The American Review of Respiratory Disease concluded that heavy snorers experience more intense snoring during slow-wave rapid eye movement (REM) sleep.

A research paper from the journal FEBS Letters found that CBD might reduce REM sleep. This animal-based study also found that CBD might increase daytime wakefulness.

However, the authors didn’t draw a clear line between CBD, sleep apnea, and snoring.

CBD for Blood Pressure

Sleep apnea patients are prone to developing high blood pressure also known as hypertension.

A 2017 study released in the journal JCI Insight showed that a single dose of CBD reduced blood pressure in healthy participants.

9 males took a dose of 600 mg of pure CBD. The research team suggested that CBD may affect cardiovascular disorders. They have yet to study these properties in sleep apnea patients who have hypertension.

A 2017 review of the existing studies on CBD’s effects on the dynamics of blood flow found that CBD might be useful for treating several cardiovascular disorders, including myocardial infarction, hypertension, and strokes.

CBD for Anxiety and Depression

A 2019 study reported that the frequency of anxiety and depression was higher in patients with sleep apnea than in most individuals.

The Permanente Journal published a research paper revealing that CBD had a calming and balancing effect on the central nervous system. 22 adult subjects with anxiety and sleep disorders reported that their conditions improved after taking CBD.

In a 2019 study posted in the journal Frontiers in Psychology, the authors stated that CBD might curb anxiety-like behaviors. The study tested 37 patients with social anxiety; all subjects reported that their anxiety significantly dropped after a dose of 300 mg of CBD oil.

Other studies have brought similar results, suggesting that CBD had anxiolytic and antidepressant properties.

CBD for Headaches

Sleep apnea patients regularly suffer from headaches. They are typically woken up by these headaches resulting in the person feeling unrefreshed even after a full night’s sleep.

Headaches involve mild to moderate pain, typically in the neck or at one side of the head.

A 2020 study from the journal Frontiers in Pharmacology pointed to CBD as a promising treatment for chronic pain and headaches.

In another study — conducted in 2018 — researchers tested 7 kidney transplant patients. The subjects first took 100 mg of CBD twice a day for 3 weeks. The dosage was steadily increased by 150 mg throughout the study’s duration.

Two patients reported total pain relief, while four experienced a partial response in the first two weeks. Meanwhile, one patient reported no signs of relief.

The authors of the study concluded that CBD could be a safe and well-tolerated treatment for headaches.

In 2020, the journal Current Pharmaceutical Biotechnology released a study that found a CBD topical formulation to be effective for symptomatic relief of peripheral neuropathy of the lower body parts.

The study involved 29 patients with peripheral neuropathy. They reported that the topical formulation reduced severe pain, cold, and itchiness in the problematic spots.

CBD for Diabetes

Sleep apnea was linked to type 2 diabetes in a 2016 study. Type 2 diabetes is a condition occurring when a person’s blood sugar is too high and the body can’t use it for energy — it’s the most common type of diabetes.

In a study published in the Journal of the American College of Cardiology, the researchers noted that CBD has positive effects on diabetes. The study highlighted the antioxidant, neuroprotective, and anti-inflammatory properties of CBD.

A combination of CBD and THCV (tetrahydrocannabivarin) helped reduce blood glucose levels and increase insulin production in type 2 diabetes patients in a study published in 2016 by the journal Diabetes Care.

Why Use CBD Oil for Sleep Apnea?

  • CBD has demonstrated potential benefits for the symptoms of sleep apnea in animal and human studies, as well as in clinical trials despite not being an established treatment.
  • CBD has a great safety profile. You can use it without the risk of dangerous side effects, lethal overdose, or addiction.
  • CBD is legal in all 50 states and can be purchased over the counter. You don’t need a prescription for hemp-derived CBD products.
  • CBD can influence our circadian system, which is a potential therapeutic target for sleep apnea.

The Limitations of Using CBD for Sleep Apnea

  • There are no direct studies that would investigate CBD’s efficacy for sleep apnea.
  • CBD still has a few mild side effects, such as tiredness, diarrhea, and changes in appetite.
  • The FDA hasn’t approved the use of CBD for treating medical conditions other than epilepsy. Therefore, there are no standard dosage guidelines or regulations surrounding the quality of CBD products.
  • The above situation creates room for mislabeled products. According to different studies, 26% of tested samples contained less CBD than advertised, and 21% had THC amounts that were large enough to get children high.

How to Choose the Right CBD Oil for Sleep Apnea?

People generally prefer the full-spectrum type of CBD for sleep apnea. This type uses all the ingredients occurring in the Cannabis sativa plant, such as CBD, adjunctive cannabinoids, terpenes, flavonoids, fatty acids, essential oils, and traces of THC.

All these compounds work together in synergy to boost the therapeutic effects of the plant. Scientists call this mechanism the entourage effect.

If for some reason, you don’t want to take any THC in your CBD oil, you can opt for a broad-spectrum version of CBD, which comes with the same range of phytonutrients, save for THC.

People who are allergic to certain hemp compounds turn to CBD isolates. This is the purest version of CBD; it has no odor and flavor and provides the highest dose of CBD per serving.

Unfortunately, isolate-based CBD oils don’t leverage the concept of the entourage effect, which makes them a less desired option among users.

You should also check your vendor’s reputation, the source of CBD, extraction method, and third-party testing before buying any CBD product for sleep apnea.

CBD Dosage for Sleep Apnea

Due to the lack of FDA guidelines, CBD has no standard dosage recommendations. If you want to figure out the best CBD dosage for you, then you should increase the amount of CBD oil intake gradually. Patients with sleep apnea are encouraged to start with a low amount and gradually work their way up to the dosage when they reap the most benefits without adverse reactions.

As mentioned before, high doses of CBD might act as sedatives, while low doses might promote alertness.

It’s a good idea to write down how you feel after each dose of CBD so that you can monitor the effects and adjust the dosage accordingly.

If you have sleep apnea and are considering adding CBD to your daily routine, it’s best to consult a doctor. Properly treated sleep apnea by a qualified professional is important to protect you against long-term complications.

How to Take CBD Oil for Sleep Apnea?

There are several forms of CBD you may take that are available on the market that you can use for sleep apnea. However, some CBD types may be more effective than others.

CBD oils are the most common format. They are taken under the tongue for improved absorption. Patients can place the oil using a dropper attached to the bottle and hold it beneath the tongue for about 60 seconds before swallowing.

There are also CBD vape pens available in the market today that offer higher bioavailability than oils; they also have a faster onset, but on the other hand, their effects are shorter-lived.

CBD also comes in oral formats, such as capsules and edibles. These products provide a fixed dose of CBD per serving, so there is no guesswork involved — you just eat your favorite CBD-infused gummies or take as many CBD capsules to help you sleep as recommended by your doctor, or as stated on the jar.

Finally, there are CBD topical formulations that you can use as a means of localized relief from pain, irritation, redness, swelling, and other kinds of physical discomfort.

Key Takeaways on Using CBD Oil for Sleep Apnea

CBD has demonstrated several health benefits for patients with sleep apnea. Both animal and human studies suggest that this cannabinoid can be used for symptom control and to improve sleep quality in people suffering from this condition.

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On top of that, CBD might be useful in regulating a person’s sleep-wake cycle — one of the main therapeutic targets for sleep apnea.

More research needs to be done on the link between CBD and sleep apnea, but current findings are very promising.

You can incorporate CBD oil into your daily routine to reduce anxiety, hypertension, pain, and type 2 diabetes, all of which are the side effects of untreated sleep apnea.

CBD may be used safely as adjunctive therapy to some conventional sleep apnea treatments, such as lifestyle changes, physical activity, CPAP machine use, and diet modifications.

Do you take CBD oil for sleep apnea? Does it help? Let us know by leaving a comment below:

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Nina Julia

Nina created CFAH.org following the birth of her second child. She was a science and math teacher for 6 years prior to becoming a parent — teaching in schools in White Plains, New York and later in Paterson, New Jersey.

Can CBD Treat Sleep Apnea? An Expert Weighs In

It seems like CBD is everywhere. Lotions, creams, oils, and even lattes with CBD in them are all the rage. Some people are even turning to CBD to find relief from obstructive sleep apnea. But can it really help? In this article, a sleep medicine expert discusses what CBD is, whether it might be able to treat sleep apnea, and how you can find sure relief from your sleep problems.

What Is CBD?

CBD stands for cannabidiol. It’s a compound derived from the cannabis sativa plant, which is also known as marijuana or hemp. CBD is not psychoactive, which means that it cannot get you high. A separate compound in the marijuana plant, THC, is what is responsible for the plant’s mind-altering properties.

CBD’s Uses

Research has established that CBD has a number of useful applications:

  • It can relieve pain
  • It may help relieve anxiety and depression
  • It may alleviate cancer-related symptoms
  • It could help to reduce acne
  • It might benefit heart health
  • And more

There is even some evidence to suggest that CBD can be used as a treatment for insomnia. And, as mentioned at the outset of this article, it has even been used to treat obstructive sleep apnea (OSA). However, any evidence that supports CBD as a therapy for sleep apnea is purely anecdotal. Some people may have found a degree of relief from it, but there have not been any extensive studies that delve into its use as a therapy for OSA.

Should You Try It?

If you are currently using a CPAP machine to treat your OSA, and you find the machine to be uncomfortable, CBD might seem like an attractive alternative. Giving try will probably not harm you — and it may even help. However, there are some cautions that you should keep in mind:

  • CBD may have side effects. Diarrhea, changes in appetite and weight, fatigue are all known possible side effects of CBD.
  • CBD can interact with certain medications. It may slow down the metabolism of certain drugs, particularly drugs with a “grapefruit” warning.
  • CBD could affect the liver. Some studies show a connection between CBD and liver toxicity (if the CBD is taken in extremely large doses).

Finding Real Relief from OSA

The best thing you can do to find real relief from sleep apnea is consult with a qualified doctor. You can ask them about whether you should try CBD, and you can discuss other, proven CPAP alternatives, such as oral appliance therapy or lifestyle changes. A better night’s sleep may be within your reach!

About the Author

Dr. Kenneth Mogell, a board-certified specialist in sleep medicine with over 10 years of experience treating sleep breathing disorders is the practice’s founder and primary practitioner. The practice has three South Florida locations: Melbourne, Vero Beach, and Boca Raton. To learn more about Florida Dental Sleep Disorders and Dr. Kenneth Mogell, contact our team at 844-294-7559. We accept Medicare, Tricare and most medical insurance!

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