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¿El CBD sirve para dormir?
Los expertos dicen que las investigaciones al respecto son pocas. Pero hay indicios del modo en que podría ayudarte a conciliar el sueño.
Credit. Eric Helgas for The New York Times
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- 16 de septiembre de 2022
P: ¿El CBD alivia el insomnio?
R: Si, al igual que muchos adultos en el mundo, te has encontrado dando vueltas en la cama sin poder conciliar el sueño durante la pandemia, quizá te hayas sentido tentado a probar algo que te ayude a descansar por la noche, como el CBD o cannabidiol, uno de los 113 compuestos orgánicos de la planta de cannabis. A diferencia del otro compuesto famoso —y psicoactivo—, el THC, el CBD no droga a los usuarios y es elogiado como un auxiliar para aliviar una amplia variedad de padecimientos, como el dolor, la ansiedad y, sí, la falta de sueño.
Aunque no está del todo claro cómo funciona el CBD en el cuerpo, se piensa que reduce la inflamación, lo cual podría ayudar a aliviar el dolor, y puede calmar el sistema nervioso central, lo cual a veces reduce la ansiedad, explicó Mitch Earleywine, profesor de Psicología de la Universidad Estatal de Nueva York en Albany, y miembro asesor del consejo de administración de la Organización Nacional para la Reforma de las Leyes de Marihuana, una entidad sin fines de lucro.
(También se ha demostrado que los efectos relajantes del CBD pueden tratar ciertos tipos de convulsiones; un medicamento antiepiléptico llamado Epidiolex es el primero y único fármaco con CBD de prescripción que tiene aprobación de la Administración de Alimentos y Medicamentos, o FDA, por su sigla en inglés).
¿Qué sabemos sobre el efecto del CBD en el sueño?
Sin embargo, hay poca investigación sobre el CBD como tratamiento de los trastornos del sueño. “A la fecha, no hay ningún estudio que haya usado el CBD por sí solo en algún ensayo clínico sobre el insomnio”, comentó Anastasia Suraev, candidata doctoral y becaria de investigación en la Iniciativa Lambert para Cannabinoides Terapéuticos en la Universidad de Sídney. Existen estudios que han hallado que el CBD en combinación con el THC presenta potencial como tratamiento para trastornos del sueño como el insomnio, la apnea del sueño, el síndrome de las piernas inquietas y las pesadillas relacionadas con el trastorno de estrés postraumático. Pero no hay ensayos clínicos controlados con placebo a gran escala (el estándar de oro en la investigación científica) que hayan investigado cómo el CBD por sí solo podría ayudar a resolver los problemas para dormir.
Suraev, junto con otros expertos con los que hablamos, señaló que el propio CBD no tiene efectos sedantes. Si bien algunos estudios sobre el CBD como tratamiento para las convulsiones hallaron que un efecto secundario de su uso era la somnolencia, eso tal vez se debió a que el “CBD interactuó con otros medicamentos” como los fármacos antiepilépticos, aclaró Suraev.
Aun así, el CBD podría ayudarte a dormir de manera indirecta, al paliar otros padecimientos, dijo Ryan Vandrey, profesor de psiquiatría y ciencia del comportamiento en la Escuela de Medicina de la Universidad Johns Hopkins e investigador principal del Laboratorio de Ciencias de Cannabis en la universidad. Por ejemplo, prosiguió, si un dolor te mantiene despierto por las noches y el CBD ayuda a aminorar ese malestar, quizá puedas dormir mejor. Del mismo modo, si no puedes dormir porque te sientes ansioso, añadió, “el CBD puede reducir la ansiedad” y, a su vez, ayudarte a descansar.
En una serie de casos, los investigadores analizaron los expedientes médicos de 72 personas con ansiedad y problemas para dormir que fueron atendidas en la misma clínica con dosis de 25 a 175 miligramos de CBD al día durante tres meses. Con base en lo que reportaron los pacientes en citas de seguimiento, los investigadores descubrieron que el CBD les ayudó más a calmar la ansiedad, no a dormir. Pero “a fin de cuentas, aunque no dormían mejor, estaban menos ansiosos al respecto y tal vez se sentían más descansados”, comentó Scott Shannon, el psiquiatra de Fort Collins, Colorado, que lideró el estudio.
Vandrey advirtió que los estudios disponibles, como este, son limitados y no hay suficientes datos para determinar qué dosis tomar, qué presentación elegir o qué marcas comprar para la ansiedad o cualquier otra aflicción. Epidiolex es el único producto de CBD que regula la FDA, así que hay una gran variedad (incluyendo una gama de fórmulas, niveles de pureza y prácticas de etiquetado) en productos como aceites, gomitas, cremas, parches y vaporizadores. “Hay regulación a nivel estatal, pero varía de un estado a otro”, señaló Vandrey. “Y ninguno de esos estados tiene la infraestructura, los recursos ni el nivel de aplicación de normas que tiene la FDA”.
En un estudio publicado en 2017 en JAMA, por ejemplo, Vandrey y sus colegas analizaron el contenido de 84 productos distintos de CBD que compraron en línea a 31 empresas —aceites, tinturas, líquidos para vapeo— a fin de averiguar si el etiquetado era preciso. Hallaron que solo 26 de los productos tenían un etiquetado correcto en cuanto a su contenido de CBD: 36 productos contenían más CBD de lo que anunciaban y 22 tenían menos. También encontrar que 18 de los productos tenían THC sin anunciarlo y en algunos casos en dosis suficientemente altas como para causar una intoxicación.
“Así que puedes pedir aceite de CBD, pero el aceite de CBD no es aceite de CBD”, dijo Vandrey.
Cómo tomar CBD de forma segura
Pese a la falta de claridad, los expertos que consultamos afirmaron que no es descabellado probar el CBD si te cuesta dormir por las noches. Pero toma en cuenta las siguientes recomendaciones.
Consulta a tu médico primero. “El CBD como entidad química es una molécula muy segura con toxicidad muy baja”, explicó Vandrey. Pero puede interactuar con algunos medicamentos, como la warfarina (anticoagulante), el tamoxifeno (medicamento para el cáncer de mama), algunos fármacos anticonvulsivos y ciertos antidepresivos, así que asegúrate de que tu médico conozca los medicamentos y suplementos que estás tomando.
Cerciórate de que la marca sea creíble. En Estados Unidos, la mejor manera de encontrar un producto CBD de calidad es comprarlo en un dispensario de cannabis regulado por un estado, aconsejó Vandrey. “Si no puedes hacer eso”, añadió, “busca marcas nacionales de buena reputación”. Las marcas de confianza deben tener sitios web que ofrezcan certificados de análisis para cada lote de productos. Este documento —que se puede encontrar en el sitio web de la empresa en el apartado de “Preguntas frecuentes”, “Preguntas”, “Resultados de laboratorio” o simplemente “Certificado de análisis”— muestra que su producto fue probado en un laboratorio independiente que analizó sus niveles de CBD, THC y otros compuestos de cannabis, y también verificó que no tuviera contaminantes como pesticidas o metales pesados. Si no puedes encontrar fácilmente un certificado de análisis en el sitio web, elige otra marca. Algunas empresas también indican que siguen las buenas prácticas de manufactura (BPM), lo que significa que sus productos se elaboran conforme a los lineamientos de la FDA.
Empieza con una dosis baja y auméntala poco a poco. Dado que no hay un consenso sobre cuántos miligramos de CBD puede tomar una persona, o de qué manera (a excepción del Epidiolex), los expertos que consultamos sugirieron que empieces con una dosis baja para garantizar que la toleras. Luego, sube poco a poco la cantidad hasta que comiences a sentir un efecto. Aunque muchos estudios clínicos sobre el CBD usan dosis de 200 a 800 miligramos diarios, Shannon recomendó empezar con una dosis de 15 a 20 miligramos al día, y consumir poco a poco para saber qué cantidad te va mejor.
No olvides la buena higiene del sueño. Earleywine dijo que, si duermes mejor con dosis bajas de CBD, eso podría deberse al efecto placebo, no al propio CBD. Aunque eso no es necesariamente malo, puede ser igual de útil —y menos costoso— combatir tu insomnio con modificaciones conductuales, como reducir tu consumo de cafeína y evitar las pantallas antes de dormir.
Rachel Rabkin Peachman es colaboradora habitual del Times, donde escribe con frecuencia sobre salud, ciencia y familia. @RachelPeachman
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