Although sleep is essential for our health, its biological purpose is not fully understood. Oddly, the seemingly inactive state of sleep is actually a dynamic and critical process that helps us store memories, build immunity, repair tissue, regulate metabolism and blood pressure, control appetite and blood sugar, and process learning, along with a myriad of other physiological processes — all of which are regulated by the endocannabinoid system (ECS).
Sleep is essential for maintaining our mental and physical health, yet it eludes many adults.
According to the American Sleep Association, 50 to 70 million U.S. adults experience symptoms of a sleep disorder. Around 40 million Americans experience insomnia every year and about 10 to 15 percent of adults will deal with chronic insomnia.
Over 60% of American adults report having problems sleeping several nights per week. Over 40 million Americans suffer from more than 70 different sleep disorders. The most common sleep-related ailments include:
- Insomnia – when one cannot fall asleep or stay asleep.
- Sleep apnea – which involves impaired breathing while sleeping.
- Restless leg syndrome – characterized by tingling, discomfort, and even pain in the legs that increases at night and is relieved by movement.
- Circadian rhythm disorders – when one’s internal clock is off and one’s sleep patterns are disturbed.
- Parasomnias – which entails abnormal movements and activities while sleeping, including sleepwalking and nightmares.
- Excessive daytime sleepiness – when an individual experiences persistent drowsiness during daylight hours from narcolepsy or another medical condition.
Poor sleep is a risk factor for serious illness. Compared to people who get enough sleep, adults who are short-sleepers (less than 7 hours per 24-hour period) are more likely to experience one or more of 10 chronic health conditions, including obesity, heart disease, diabetes, arthritis, stroke, and depression.
Those with chronic illnesses are at greater risk for insomnia, which exacerbates their discomfort. Comorbid medical disorders — including conditions that cause hypoxemia (abnormally low blood oxygen levels) and dyspnea (difficult or labored breathing), gastroesophageal reflux disease, pain, and neurodegenerative diseases — have a 75-95% increased risk of insomnia.
THE ENDOCANNABINOID SYSTEM AND SLEEP
Given the problems with conventional soporifics, medical scientists have been exploring other ways to improve sleep by targeting the endocannabinoid system (ECS). As the primary homeostatic regulator of human physiology, the ECS plays a major role in the sleep-wake cycle and other circadian processes.
The Sleep Wake Cycle
How we fall asleep, stay asleep, wake up, and remain awake is part of an internal biological process regulated by our circadian rhythms and our endocannabinoid system. Circadian rhythms govern a diverse array of actions in the body, including hormone production, heart rate, metabolism, and when to go to sleep and wake up.
It’s as if we have an internal biochemical timer or clock that keeps track of our need for sleep, guides the body to sleep, and then influences the intensity of sleep. This biological mechanism is affected by external forces such as travel, medication, food, drink, environment, stress, and more.
Does the endocannabinoid system regulate our experience of circadian rhythms or vice versa?
Evidence of a strong relationship between the two is observed in the sleep-wake cycle fluctuations of anandamide and 2-AG (the brain’s own marijuana-like molecules), along with the metabolic enzymes that create and break down these endogenous cannabinoid compounds.
Anandamide is present in the brain at higher levels at night and it works with the endogenous neurotransmitters oleamide and adenosine to generate sleep. Conversely, 2-AG is higher during the day, suggesting that it is involved in promoting wakefulness.
The highly complex sleep-wake cycle is driven by a variety of neurochemicals and molecular pathways.
Both anandamide and 2-AG activate CB1 cannabinoid receptors that are concentrated in the central nervous system, including parts of the brain associated with regulating sleep.
CB1 receptors modulate neurotransmitter release in a manner that dials back excessive neuronal activity, thereby reducing anxiety, pain, and inflammation. CB1 receptor expression is thus a key factor in modulating sleep homeostasis.
This is not the case, however.
With respect to the CB2, the cannabinoid receptor is located primarily in immune cells, the peripheral nervous system, and metabolic tissue. Whereas CB1 receptor expression reflects cyclical circadian rhythms, no such fluctuations have been described for the CB2 receptor.
The challenge of studying and treating sleep disturbances is complicated by the fact that sleep disorders are symptomatic of many chronic illnesses. In many cases, poor sleep results in chronic illness, and chronic illness always involves an underlying imbalance or dysregulation of the endocannabinoid system. Although we still have much to learn about the relationship between the ECS and circadian rhythms, it’s clear that adequate quality sleep is a critical component of restoring and maintaining one’s health.
Cannabinoids have been used for centuries to promote sleepiness and to help people stay asleep.
Sleep-related problems continue to drive a large percentage of people to seek relief with cannabis. Poor sleep and lack of sleep cause physiological changes in the body after just one night, resulting in slower reaction times, decreased cognitive performance, less energy, aggravated pain and inflammation, and in many cases overeating or cravings for high-fat, high-carbohydrate “comfort” foods.
A 2014 study by Babson et al notes that approximately 50% of long-term cannabis consumers (over 10 years) report using cannabis as a sleep aid. Among medical marijuana patients, 48% report using cannabis to help with insomnia.
Another study revealed that 40% of insomniacs also suffer from anxiety and depression or another psychiatric disorder. Would it surprise you to learn that people with mood disorders who use cannabis have the highest rates of sleep benefit at 93%?
CBD, THC, CBN
What about specific plant cannabinoids for sleep?
Cannabidiol (CBD) is alerting or mildly stimulating in moderate doses, while its psychoactive counterpart delta (8) 9-tetrahydrocannabinol (THC) tends to be sedating. However, the science is somewhat paradoxical.
Research data and anecdotal accounts indicate that CBD and THC have differential effects on sleep – both can be alerting or sedating depending on the dosage.
Curiously, CBD can help people fall asleep as well as stay awake.
An insomnia study indicated that the administration of 160mg of CBD decreased nighttime sleep interruptions and increased total sleep time, suggesting that high-dose CBD therapy can improve the quality and duration of sleep.
In addition to showing promise as a safe and effective alternative to conventional psychiatric treatments for insomnia, cannabidiol can reduce symptoms of REM behavior disorder (RBD), which is characterized by the acting out of vivid, intense, and sometimes violent dreams. A preliminary study examined the efficacy of CBD in patients with both Parkinson’s disease and RBD and the results were encouraging.
Additionally, cannabinol (CBN), most commonly associated with aged cannabis, is said to potentiate the sedative properties of THC when these two cannabinoids are used together, although this notion may be more modern-day marijuana folklore than scientific fact.
CANNABIS COMPARED TO OTHER SLEEP AIDS
Because marijuana is still considered a controlled substance, there is limited research on the safety and efficacy of cannabis sleep aids compared to other sleep aids. Only a few synthetic drugs made to mimic THC, as well as one naturally derived CBD product, have been approved by the FDA. These are prescribed for nausea, epilepsy, and other conditions, but not sleep.
As with other natural sleep aids, it is possible that some people may turn to medical cannabis in an effort to avoid more potent drugs, such as opioids. Although they can be very effective in the short term, many prescription and over-the-counter sleep medications are associated with a risk of abuse, tolerance, or dependence. Some natural sleep aids, like oral melatonin, appear to reduce insomnia without strong side effects, while other homeopathic options, like valerian, still need more research.
HOW TO CONSUME CANNABIS FOR A GOOD NIGHT’S SLEEP
Most people consume cannabis by smoking it as a joint or with a pipe.
Then comes the question of how much to dose. It might take some experimentation to get the dosage that’s right for you — so don’t try this during a work week! If smoking or vaping, you’ll want to start with just a few puffs. A little bit goes a long way and overdoing it can lead to grogginess the next morning.
Take note of how you feel after you smoke. Feeling “high” can vary from feeling slight euphoria to a slowed sense of time, to enhanced sensations such as cottonmouth.
TIMING BEFORE BED
Timing is important when it comes to using cannabis, especially for sleep. Edibles can also affect us for longer than intended and cause grogginess in the morning. Because of the way cannabis is processed from our gut to our liver, the duration of action can be much longer, like 8 to 12 hours.
While everyone’s physiology is different, it’s usually better to ingest the marijuana at least an hour before bedtime. This is ideal because the cannabis will work for about three to four hours, helping you to fall asleep. That way, you won’t feel the effects right as you are going to sleep, which can cause excitability and prevent sleep.
DECIDING IF CANNABIS IS RIGHT FOR YOU
Whether or not to use cannabis for sleep is a highly personal decision. Synthetic forms of cannabis appear to relieve nightmares and insomnia, but some researchers warn about the limitations of these studies and the potential risks of using marijuana until dosing is more standardized.
Many people use cannabis to successfully manage their pain and insomnia. However, some people find it makes them feel more paranoid or anxious. If you do not like the feeling of being high, a strain with a higher amount of CBD may be a better option for you.
Another important consideration is whether marijuana is legal where you live. If not, talk to your doctor about other ways to improve your sleep, such as better sleep hygiene or alternative sleep aids.
PRACTICAL TIPS FOR IMPROVING SLEEP
Here are a few simple lifestyle modifications and holistic healing options that may improve your sleep quality.
- Create an inviting sleep environment. Having a comfortable bed in a relaxing environment is key to quality sleep. Reduce outside or harsh overhead lighting and maintain a comfortable temperature for sleeping. And, reduce noise. If you are a light sleeper consider using a white noise machine to drown out unwanted sound. Salt lamps may help clean the air by reducing positive ions (and provide enough light to get to the bathroom without intruding on sleep).
- Have a sleep routine. Going to bed and waking at the same time seven days a week is optimal. Additionally, it is helpful for some people to have a relaxing bedtime routine that lets the mind know it is time to get sleepy. This may include a small warm cup of milk or green tea 45 minutes to an hour before bed, or a few simple yoga stretches to relax, or an Epsom salt bath.
- Avoid overstimulation. It is best not to have a television in the bedroom and not to watch violent shows before bedtime, especially for those with adrenal fatigue. Avoid reading or using your phone, laptop or tablet in bed.
- Exercise daily. Regardless if your preference is jogging, weightlifting, gardening, walking, or tai chi, do some form of exercise every day. But avoid exercising within two hours of bedtime.
- Avoid stimulants after 1PM. Caffeine, alcohol, tobacco, certain herbal supplements, and drugs may leave you feeling “hyper” and overstimulated, which can impede the brain’s ability to transition into sleep.
- Aromatherapy. Many of the sedating essential oil components present in cannabis can also be found in other plants at your local grocery or natural products store, along with misters that billow the oil into the air. Aromatherapy can be relaxing and very helpful to induce sleep. Lavender essential oil, for example, can help to manage certain sleep disorders.
- Use sleep supporting herbs. It is best to work with a healer or someone knowledgeable about herbs and supplements instead of buying whatever sleep cure is touted on the internet. Herbs that have sleep-promoting properties include Valerian, Kava, German Chamomile, Roman Chamomile, Passion Flower, California Poppy, Hops, Lemon Balm, Linden, Skullcap, and Oats. Visit the American Herbalist Guild to find a qualified practitioner.
- Nutritional supplements. Consult your physician about products made with Kava, calming minerals, and taking the right kind of magnesium at night.
- Other therapies. In addition to cannabis, safe holistic healing alternatives include cognitive-behavioral therapy for insomnia and bright light therapy for circadian rhythm disorders.