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How to use CBD for different sleep disorders

Learn how CBD can become an ally to regulate our Endocannabinoid System and help us achieve repairative sleep.

How to use CBD for different sleep disorders
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Cannabinoids are substances that are increasingly present in clinical practice. Cannabidiol (CBD), along with THC, are two of the main phytocannabinoids present in the Cannabis Sativa L plant (there are more than 120). In the 2017 report of the Expert Committee on Drug Dependence, the World Health Organisation, (WHO) described CBD as lacking significant adverse effects or potential for dependence as well as presenting great therapeutic possibilities. (1)

In this article we will focus on sleep, a pivotal element for our health and well-being given its functions involved in metabolic and mood regulation as well as cognitive performance. Today, sleep disorders are the number one reported complaint in the United States and is a serious public health issue. (2) Sleep disorders are a motive for consultation in general practice and psychiatry. More than 50% of patients in general practice mention insomnia when asked about their sleep patterns. (3) Sleeping well is no longer only important because of daily mental and physical fatigue but because it can have great long-term consequences. Sleep deprivation can be related to alterations in:

  • The immune system(4)
  • Infectious diseases (4)
  • The cardiovascular system (5)
    • Arterial hypertension (6)
    • Type 2 diabetes (6)
    • Cerebrovascular diseases (7)
    • Arrhythmia (7)
    • Obesity: According to studies directed by NIH, this is due to a hypothalamic alteration which affects the regulation of our appetite and energy. (6)(8)
    • Neurodegenerative diseases: currently being investigated as a diagnostic marker for Parkinson’s (9)
    • Psychiatric disorders: Depression, anxiety, manic and psychotic episodes. (10)

Furthermore, certain pathologies are at higher risk (75-95%) of suffering sleep disorders. Some of these include:

  • Respiratory problems
  • Acid reflux
  • Chronic pain
  • Neurodegenerative diseases

Multiple sleep disorders exist which affect people in different ways. The most well known are:

  • Insomnia
  • RBD (REM Sleep Behavior Disorder)
  • Restless leg syndrome
  • Hypersomnolence
  • Narcolepsia
  • Sleep disorders related to breathing issues

In all of these disorders our Endocannabinoid System is altered, due to its role in regulating our sleep-wake cycle.(2)

What should I do if I have sleep issues?

As a general rule, it is recommended to sleep between 7 and 8 hours, knowing that according to each stage of development, those hours ??may vary. It’s important to pay attention and modify, if necessary, all those behaviors that harm us when it comes to sleeping well. This can be achieved by avoiding a number of patterns such as (11):

  • Naps exceeding 2 hours
  • Irregular hours when going to bed and waking up
  • Tobacco, alcohol, caffeine 4 hours before going to sleep
  • Stimulating activity (e.g: exercise, tv, phone use) before going to sleep
  • Using our bed to do things that aren’t sleeping (ie. working in bed, eating in bed)
  • Waking periods in bed exceeding 30 minutes

If our problems continue after correcting these behaviors, it would be time to think about taking something extra. Typically, the drugs recommended for sleep disorders are called hypnotics, among which are: benzodiazepines and non-benzodiazepine sleep inducers. Additionally, antidepressants may be recommended based on the individual’s sleep profile. It is well known that hypnotics are not recommended for long periods of time due to their potential side effects, which considerably complicate the use of this treatment, which is often prescribed for chronic issues.

It is for this reason that CBD can be an interesting option to complement our treatment, improve our sleep quality and in turn our quality of life.

CBD’s effect on sleep

In recent years, CBD has opened a door to a new alternative to treat sleep disorders. Several studies seem to indicate good results for relaxation and improving sleep quality. 

Project CBD, conducted several surveys (Cultivating Wellness) to understand typical uses of CBD. Their findings uncovered that most people use CBD to relieve pain, anxiety and improve sleep quality. (12) In the study, it was reflected that CBD helped users fall asleep and stay asleep, as well as helping reduce fatigue when waking up. Sleep is regulated by the endocannabinoid system (ECS) due to its homeostatic action on the circadian rhythm. This process includes:

  • hormonal production
  • heart rate
  • body metabolism
  • the sleep-wake cycle

It is also influenced by multiple factors (see: diet, stress, working hours, travel, medication, etc).

Each night, endocannabinoids activate the CB1 receptor of the ECS of the Central Nervous System (CNS), including zones dedicated to sleep regulation. This controls the release of neurotransmitters and reduces excess neuronal activity, helping to manage pain, anxiety and sleep quality. CBD increases the activity of endocannabinoids at CB1 receptor, and may play a fundamental role in regulating the sleep-wake cycle like many other processes previously mentioned. (13)

H3 Clinical cases

The effect of CBD on sleep is currently being investigated at various levels. An example is the US National Library of Medicine, which revealed that the use of CBD during the first month of the study improved sleep parameters (66%) and reduced anxiety (79%). Anxiety levels, closely related to the quality of sleep, remained low in the long term as well.(14)

Scientific Studies discussing CBD use for Sleep disorders

A systematic review of various data sources such as PubMed, Scopus, Web of Science, Embase, CINAHL and PsycInfo databases indicate that, despite insufficient evidence on the benefits of CBD in the treatment of sleep disorders, it appears to be promising preliminary evidence on the subject in question. The most characteristic examples that have been studied are: circadian rhythm alteration (hypersomnolence), insomnia related to anxiety and post-traumatic stress disorder, restless leg syndrome, REM sleep behavior disorders and daytime sleepiness/drowsiness. (14)(15)(16)

Sleep disorders that can be treated with CBD

CBD & Circadian Rhythm Alteration

CBD helps to regulate the wake-sleep cycle, which frequently affects night time workers or travelers experiencing jet lag … Circadian rhythm alterations can manifest as both insomnia and hypersomnolence depending on the type of time alteration they present. In both cases, there is promising evidence that CBD may be beneficial to regulate these imbalances. (15)

Anxiety

CBD has also been studied to reduce anxiety that can end up manifesting insomnia, either making it hard to sleep or hard to stay asleep. CBD has been studied to help people suffering from anxiety fall asleep quicker and avoid waking up too early, especially in cases of anxiety induced depression. According to Project CBD, in a survey of 1,521 individuals, the time elapsed until achieving sleep was reduced from 1 hour to 20 minutes and nighttime awakenings were reduced by a third while using CBD. Its possible benefits are even being studied in cases of sleep disturbance due to post-traumatic stress.(12)(14)

REM-phase alteration

In addition, CBD seems to act in the rapid eye movements (REM) phase of sleep, and can help normalize the latency of REM sleep, that is, the time it takes a patient between falling asleep and entering REM phase, normally about 90-120 minutes. Regulating the REM phase could help in cases of nightmares, restless legs syndrome or even in REM sleep behavior disorder.(14)(16)

Excessive Daytime Sleepiness (EDS)

As if that wasn’t enough, research also points out that CBD may be beneficial for daytime sleepiness. Patients suffer episodes of intense sleepiness during the day and a need to sleep, as well as having great difficulty waking up. In this field, studies are starting to investigate what kind of effects CBD produces in sleep disorders related to breathing.(14)(16)

How to use cannabis-derived oils to sleep

As we mentioned before, there are no clear validated indications when consuming CBD, that is until studies continue to progress. To start, we recommend that each person adapt their consumption on an individual level, starting with small doses.

In general, experts agree to adopt a daily and regular use to maximize the effects of CBD. All this, under medical consultation if you are taking any pharmaceuticals so as to ensure that there is no risk of interaction.

Different formats

The most common and effective way to use CBD, especially for sleep, is sublingually. In Canada, where medical cannabis is legal for ingested consumption, they have the motto “Start low and go slow,” meaning start small and increase the dose little by little. Why? Well, because each body is unique and our ECS is also unique. So the dosage is not standard like typical drugs.

Finding your dose

Experts recommend a split dose (that is, 3 times a day; morning, noon and night) and regular daily use to achieve the effects. In the case of solely treating sleep disorders, certain studies opt for the option of taking a CBD capsule in the evening after dinner. (14)

In general, certain studies, such as one published by the US National Library of Medicine, begin by administering doses of 25 mg / day. As we have said, it would be a matter of evaluating the effect day by day and listening to our body and in case of modification, we should go little by little, raising the dose 5-10 mg after testing for a week. Something important to bear in mind is that our body suffers when we generate big changes, so changing the dose significantly and abruptly will never be beneficial. In any case, there is a pretty large margin of action, as there are even studies, such as one published in the British Journal of Clinical Pharmacology, that have indicated that the therapeutic range to use CBD is between <1 and 50 mg / kg / day, a dose could be considered extremely high for first-time users.

A sublingual and/or ingested dose can vary for a variety of reason:

  • Past/current cannabis use
  • The medications we take
  • Our metabolism
  • Our age and weight
  • Our mental health
  • Our mental disposition
  • The format (sublingual, topical, edible/ingested, vaporized ect.)

Several scientific sources have validated CBD’s beneficial interactions with other hypnotic herbs and supplements such as melatonin, causing a greater degree of sedation and hypnosis. Despite little evidence and conclusive results on the clear effects of the synergy of both substances, the interaction between both seems to give us some clue to propose new research in the future. (18)(19)

It is true that although research is accelerating and advancing in this regard, the sources of journals and scientific articles do not have enough evidence to give any certainty and give clear indications on how to use CBD. For this reason, we must promote research and critical analysis to continue investigation and continue to understand this promising plant!

Precautions

If you are taking other medications, consult your doctor to ensure there are no interactions with CBD. Above all, it is important to rule out interactions with other drugs metabolized at the hepatic level, a process that would result in an increase of the drug at the plasma (blood) level. Even though the exact dose of CBD for the appearance of interactions is not clear, it is assumed that these are cases with high doses of CBD and in no case life-threatening. However, always check with your doctor.

Side Effects

CBD’s action at the level of the endocannabinoid system and other neurochemical systems allows its use to treat sleep with a favorable safety and tolerability profile. To date, no fatal cases of cannabis intoxication have been recorded.

In any case, there are a number of possible doses and possible side effects. These are usually of mild-moderate intensity and include: tiredness, drowsiness, dry mouth, headaches, dizziness, and decreased appetite.

As stated by Fundación Canna, based on current data, CBD is unlikely to create tolerance. This means that long-term most doses won’t have to be increased to achieve the same effects. (20)

Bibliography

  1. CANNABIDIOL (CBD) Pre-Review Report. Expert Committee on Drug Dependence. Thirty-ninth Meeting. Geneva, 6-10 November. 2017
  2. Nishi Whiteley. Cannabis and Sleep Disturbances. Project CBD. 2017
  3. F. Sarrais, P. de Castro Manglano. Insomnia. Anales Sis San Navarra vol.30  supl.1 Pamplona  2007
  4. MJ Jurado Luque. Revista Neurología. Vol. 63, Supl. 2, Octubre 2016. ISSN 0210-0010
  5. Taheri, S., Lin, L., Austin, D., Young, T., & Mignot, E. (2004). Short sleep duration is associated with reduced leptin, elevated ghrelin, and increased body mass index PLoS Medicine, 1 (3), 210-217
  6. Grandner MA, Patel NP, Perlis ML, et al. Obesity, diabetes, and exercise associated with sleep-related complaints in the American population. Z Gesundh Wiss. 2011;19(5):463-474. doi:10.1007/s10389-011-0398-2
  7. American Heart Association. Sleep apnea and heart disease, stroke. Retrieved June 12, 2017.
  8. Wu, Y., Zhai, L., & Zhang, D. (2014). Sleep duration and obesity among adults: A meta-analysis of prospective studies. Sleep Medicine, 15(12), 1456–1462. Retrieved March 19, 2019.
  9. Marcelo Miranda, C. Rodrigo O. Kuljis. Sleep disorders in neurodegenerative diseases. 2013.
  10. Breslau N, Roth T, Rosenthal L, Andreski P. Sleep disturbance and psychiatric disorders: a longitudinal epidemiological study of young adults. Biol Psychiatry. 1996 Mar 15;39(6):411-8. doi: 10.1016/0006-3223(95)00188-3. PMID: 8679786.
  11. National Heart, Lung and Blood Institute. Healthy Sleep at a glance.
  12. Cultivating Wellness. Survey dirigido por Project CBD. 2019
  13. De Petrocellis L, Ligresti A, Moriello AS, Allarà M, Bisogno T, Petrosino S, Stott CG, Di Marzo V. Effects of cannabinoids and cannabinoid-enriched Cannabis extracts on TRP channels and endocannabinoid metabolic enzymes. Br J Pharmacol. 2011 Aug;163(7):1479-94. doi: 10.1111/j.1476-5381.2010.01166.x. PMID: 21175579; PMCID: PMC3165957.
  14.  Shannon S, Lewis N, Lee H, Hughes S. Cannabidiol in Anxiety and Sleep: A Large Case Series. Perm J. 2019
  15. Chagas MHN, Crippa JAS, Zuardi AW, et al. Effects of acute systemic administration of cannabidiol on sleep-wake cycle in rats. Journal of Psychopharmacology. 2013.
  16. Suraev A S, Marshall N S, Vandrey R, McCartney D, Benson M J, McGregor I S,  Cannabinoid therapies in the management of sleep disorders: A systematic review of preclinical and clinical studiesGrunstein R R, Hoyos C M.. Sleep Medicine Reviews.
  17. Millar S A,  Stone N L, Bellman Z D, Yates A S, England T J, O’Sullivan S E. A systematic review of cannabidiol dosing in clinical populations. British Journal of Clinical pharmacology. 2019.
  18. M. Treese, Natalie. Pharmacist guide to CBD. 2020
  19. Cannabidiol. Medline Plus.
  20. García Palau, Mariano. Principales efectos secundarios del consumo de cannabis

 

Ines Gasset (Author)

Estudiante de Medicina en la USPC Madrid y la Universidade Nova de Lisboa. Formación en neurociencia, teatro y otros elementos interdisciplinares. Actualmente investiga sobre neurocinemática y efectos del cannabis a nivel neurológico.

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Viola Brugnatelli (Reviewer)

Viola Brugnatelli (Padua, Italia), neurocientífica y endocannabinóloga. Forma parte del departamento Neurociencia de la Universidad de Padua donde es investigadora y docente. Es la cofundadora de Cannabiscienza, colaboradora en una serie de editoriales en el campo cannábico como Project CBD y Fundación Canna. Además, Viola es la vicepresidenta de una organización sin ánimo de lucro que tiene como objetivo empoderar a las mujeres que trabajan con la medicina vegetal, LERN Herstory.

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