Get a good night's rest with CBD: Does it work against insomnia?

The phases of sleep and restful sleep

Sleep is the most frequent activity of every human being, being of fundamental importance for the health of our organism. As we learned in the article on "how to take CBD for sleep", sleep disorders are very common and can have negative consequences on many metabolic functions, as well as entailing varying degrees of personal and occupational disability.

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The phases of sleep

Sleep is made up of several cycles of approximately 1:30-2 hours' duration that are repeated 5-6 times each night: for this reason it is advisable to have 7-8 hours of sleep, as a shorter duration would mean a reduction in the number of cycles and/or the possibility of interrupting one of them, which would have a negative influence on the quality of sleep and rest.

Each sleep cycle is composed of 4 phases, of which only the last one represents REM sleep (rapid eye movement)

• Phase 1 NREM: This is the stage of superficial sleep, in which one enters a state between sleep and wakefulness. It lasts for a few minutes, during which the body relaxes by slowing down the heartbeat, breathing rate, eye movements and brain waves.
• Phase 2 NREM: This is the stage in which the sleep state begins, disconnecting from the external world and further slowing down vital functions, which is why the body temperature drops.
• Phase 3 NREM: This is the stage of deep sleep, in which the body minimises its vital functions and rests from daily activity, recharging its energy and regenerating its tissues and functions. This phase is essential for restful sleep and for maintaining good health, as it is the time when the body sets in motion the metabolic and hormonal changes necessary for the body's development.

After 70-90 minutes, sleep begins:

• Phase 4 REM: This is the stage of processing the information acquired during the day and consolidating memories, which is why this is when most dreams appear. In this phase the body and brain are active almost as in the waking state, increasing the heartbeat, breathing rate, brain waves and eye movements, although a temporary paralysis is observed to avoid muscle movements during dreams.
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How CBD can help you get better sleep

The rhythm of sleep and wakefulness is regulated by two biological mechanisms:

• Circadian rhythms: known as the biological clock, they coordinate the temporal variables of sleep (when to sleep and when to wake) with the environment and regulate metabolic functions and body temperature.
• Homeostasis mechanisms: coordinate the qualitative variables of sleep (quality and duration required), influencing the quantity and depth of sleep according to events that have occurred during the waking state.
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The endocannabinoid system is primarily responsible for maintaining the psycho-physical balance of our organism, and therefore plays a very important role in the regulation of circadian rhythms and the different phases of sleep (11).

Fluctuations in the concentration of the main endocannabinoids in the brain are related to the sleep-wake cycle, in particular 2-AG is more present during the day and promotes alertness, while Anandamide is more concentrated at night, promoting the appearance of slow brain waves.

The cannabinoid receptor most involved in brain circuits and whose expression influences the regulation of circadian rhythms and the stability of NREM sleep is the CB1 receptor, through which the Endocannabinoid System modulates the different neurotransmitters involved in the different phases of sleep.

One third of the world's population reports having problems related to the quantity or quality of sleep, which can be caused by a variety of factors, from stress or illness to eating habits and daily activities. In addition, sleep disorders can be a trigger for psychiatric problems such as anxiety and depression, as well as having a negative impact on the quality of daily life.

In any of the above-mentioned cases, an altered activity of the Endocannabinoid System can be observed, therefore a treatment with phytocannabinoids could be very promising.

In particular, CBD could represent a very effective tool due to its different properties:

• Physical relaxation: CBD has a hypotensive effect that facilitates muscle and nervous system relaxation.
• Mental relaxants: CBD has a hypnotic and anxiolytic effect, thanks to the modulation of the serotonergic system
• Modulation of the Endocannabinoid System: CBD increases the levels of Anandamide, which influences the state of sleep and also helps to regulate the hormonal system and the regulation of psycho-physical stress.
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References and Studies on CBD and insomnia

Studies show that among the vast majority of therapeutic users of Cannabis, one of the main reasons for its use is to alleviate sleep problems or improve sleep quality (4-6).

Some studies have shown beneficial effects of CBD on the quantity and quality of sleep (14), increasing its duration and reducing night-time awakenings, as well as being able to alleviate behavioural disorders during REM sleep (3-13).

Other studies have observed an improvement in sleep problems related to phase 3 NREM sleep, due to an inhibitory effect on FAAH enzymes (Anandamide degrading enzymes), which is one of the effects of CBD on the endocannabinoid system (6).

In clinical trials of Sativex, it has been observed that a balanced combination of THC and CBD provides significant improvements in sleep quality (5), and some researchers hypothesise that CBD can improve sleep problems when accompanied by a small proportion of THC, thanks to the synergistic effect between the two compounds. In general, while sporadic use of higher amounts of THC may facilitate a state of relaxation and drowsiness, continued use may negatively influence sleep quality (7-12).

Clinical trials are showing very promising results using CBD products alone or in combination with other cannabinoids such as THC and CBN. (6)

How to take CBD to facilitate restful sleep

To alleviate sleep problems and to improve its restorative effect, it is essential to take CBD internally, especially through sublingual use (not regulated in Spain).

In general, it is advisable to start with a low to medium concentration of cbd oil (5%-10%), initially using minimal doses and gradually increasing the amount of drops until the effect appears. If you want to go down this route, it is advisable to seek advice and follow-up with a specialised health professional.

Other tips to help you get a good night's sleep

The quality of sleep can be influenced both positively and negatively by some daily habits, so there are some good practices that help to facilitate a restful sleep, for example:

• Eating habits: factors that have a negative influence can be late dinners, eating a lot of food and/or eating heavy or high-calorie foods. It is advisable to eat a light meal such as vegetables, allowing at least 2 hours before going to bed.
• The intake of stimulating substances such as coffee, alcohol or tobacco can make it difficult to sleep, so try to avoid their use during the night.
• Night-time activities involving mental and physical stimulation can make relaxation and sleep difficult, so it is advisable to stop any stimulating activity one hour before bedtime.
  electronic screens during the night can alter levels of melatonin, the hormone that induces natural sleep, so stop using electronic devices in the last 1-2 hours before bedtime.
• It is advisable to go to bed and get up at regular times, keeping a routine.
• The environment: it is advisable to sleep in a dark and quiet environment, as bright or noisy places can have a negative effect on the restorative effect of sleep.

Final conclusions on CBD and insomnia

Thanks to its relaxing and modulating effect on the Endocannabinoid System, CBD can represent a valuable therapeutic tool both for dealing with sleep-related problems and for optimising and facilitating its regenerative and restorative effect.

Is CBD safe? Precautions

CBD is a very safe substance even if used in large quantities, but care should be taken when taking medication or if you suffer from heart or blood pressure problems. For this reason in these cases it is always advisable to contact a health professional.
Possible adverse effects
Adverse effects are usually mild to moderate in severity and may include tiredness, drowsiness, dry mouth, dizziness and decreased appetite.

Bibliography:

1. https://espanol.nichd.nih.gov/salud/temas/sleep/informacion/sucede
2. https://www.ninds.nih.gov/health-information/patient-caregiver-education/brain-basics-understanding-sleep
3. https://www.projectcbd.org/medicine/cannabis-sleep-disturbances
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5. Russo, E. B., Guy, G. W., & Robson, P. J. (2007). Cannabis, pain, and sleep: lessons from therapeutic clinical trials of Sativex, a cannabis-based medicine. Chemistry & biodiversity, 4(8), 1729–1743.
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9. Méndez-Díaz, M., Ruiz-Contreras, A. E., Cortés-Morelos, J., & Prospéro-García, O. (2021). Cannabinoids and Sleep/Wake Control. Advances in experimental medicine and biology, 1297, 83–95
10. Hanlon E. C. (2020). Impact of circadian rhythmicity and sleep restriction on circulating endocannabinoid (eCB) N-arachidonoylethanolamine (anandamide). Psychoneuroendocrinology, 111, 104471
11. Prospéro-García, O., Amancio-Belmont, O., Becerril Meléndez, A. L., Ruiz-Contreras, A. E., & Méndez-Díaz, M. (2016). Endocannabinoids and sleep. Neuroscience and biobehavioral reviews, 71, 671–679.
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