About 20% of Americans and 50% worldwide suffer from insomnia, a sleep disorder characterized by difficulty falling or staying asleep at least 3 nights per week for 3 months or more. Acute insomnia occurs even more frequently and is the type of sleeplessness that comes before an exam or a big meeting. Insomnia is not an isolated condition. Over 83% of those with insomnia also suffer from depression.
What causes poor sleep?
How many nights have we all counted sheep to get to sleep? What causes this restlessness, sometimes even when dead tired we still can’t fall into a deep slumber that is so restful and nurturing. Sometimes it’s just the stress of the day or we have too much on our minds or maybe we just had too much caffeine. But often it’s one of the following 3 conditions – a mood disturbances such as anxiety, depression or PTSD (post-traumatic stress disorder); alterations in the sleep/wake cycle or daytime grogginess.
About 34% of people with anxiety suffer from insomnia and insomnia with poor sleep is a hallmark of PTSD. In a given year about 8 million people suffer from PTSD.
Alteration in sleep/wake cycle
The sleep wake cycle is the interplay between the homeostatic mechanism that regulates how much sleep we get and the circadian rhythm that determines when we get that needed rest. The homeostatic and circadian system work against each other with the circadian process winning out during the day and the homeostatic processes taking over at night. The circadian process is governed by light and melatonin, a hormone secreted by the pineal gland in the brain. The two opposing processes determine our sleep-wake cycle.
Excessive sleepiness during the day can be a symptom of something else but is common with many illnesses including insomnia itself making it a vicious cycle. The less sleep you get, the more tired you are and the sleepier during the day you get. If you are frequently tired, make a lot of mistakes, can’t focus and have daytime grogginess, it is time to take a trip to the doctor for a check-up.
Often daytime grogginess is caused by a problem with sleep apnea where the body stops breathing for a period and the brain doesn’t get enough oxygen. Take care of the daytime grogginess and often the insomnia goes away. Other times daytime grogginess is caused by schedule overload when you push yourself too hard and your body does not get rest from sleep and/or meditation. You may, in fact, be getting sleep but it is not restful.
Does CBD work to promote sleep?
Both animal and human studies support indications for the use of CBD in promoting restful sleep and tackling insomnia. For example, a large case series revealed that a dosage of 25 mg of CBD once per evening alleviated the insomnia in 66% of a study group of 72 people where 25 complained of poor sleep.
CBD regulates learned fear by dampening its expression, enhancing its extinction and disrupting its reconsolidation. In this manner it is particularly effective in sleep disorders associated with PTSD where nightmares and reliving of traumatic events interfere with restful sleep.
Cannabinoid strains high in THC might be the most reliable source of sedating effects in treatment of insomnia. If THC causes you anxiety which in turn disturbs your sleep, stick with a lower dose of THC with a CBD dominant cannabis profile.
CBD controls causes of sleep disorders
Using CBD to promote sleep in PTSD patients has been of great interest because the antipsychotics and benzodiazepines being currently used for insomnia treatment are ineffective or are associated with significant harm. Expert opinion has been expressed in favor of trialing the use of CBD in insomnia treatment of PTSD patients.
CBD may help people sleep by calming the nervous system. Taken orally, it does not interfere with REM (rapid eye movement) sleep, the sleep where our brains are more active, and dreams occur. CBD may be effective in alleviating REM sleep disorders and in improving daytime grogginess.
Because CBD indirectly influences the CB1 receptors where THC has its greatest influence, CBD tones down any anxiety that THC might cause by binding to this receptor.In a study of 409 people where use of CBD and relief of insomnia was looked at, it was found that the level of CBD was directly related to insomnia symptom relief. Since the study was done on CBD naturally occurring in the flower of the cannabis plant high doses were not used such as could be obtained through CBD oil.
CBD works through the signaling mechanism of the endocannabinoid system and has a direct effect on the serotonergic system, thought to be the main mechanisms in insomnia reduction.
CBD could work well with sleep hygiene
For those individuals who are starting to have sleep issues, are having short-term sleep issues or are headed for insomnia, implementing a sleep hygiene program along with CBD would seem to be a prudent way to go. To implement such a program, one would do the following:
- Start with a low dose CBD product and go slow
- Limit naps to 30 minutes or exchange for meditation
- Exercise at least 10 minutes per day
- Avoid caffeine and nicotine, especially before bed
- Try to go to bed at a consistent time each night
- Turn off all lights including night lights and computer screens
- Surround yourself with a relaxing environment (comfortable bed,etc.)
- Do not eat before bed
Use of CBD with synergistic sleep elements
Some practitioners choose to use a combination of therapies in the individualized care plan. They may implement sleep hygiene, a CBD product and a third, synergistic product, one that compliments CBD but acts via a different mechanism thus creating a more effective effect on the sleep disorder or insomnia being treated.
Other compounds frequently combined with CBD include lemon balm (noted for its sedating qualities), melatonin (known to help regulate the sleep/wake cycle), Bacopa, Ashwagandha and chamomile. It must be remembered, however, that with each herb or medication addition the chances of a drug/drug interaction or side-effect increase and should not be done without a physician’s supervision.
Terpenes are part of the cannabinoid profile and each terpene has an individual action and effect on the body. Combining CBD with terpenes that cause sedation or sleepiness may enhance the effect of CBD. Myrcene is a terpene excellent for this type of synergistic combination since Myrcene is very sedating and relaxing. Another common practice is to combine the terpenes found in hops with CBD for additive sedative effects. The common terpenes in hops are myrcene, beta-pinene and alpha-humulene.
Terpenes are not known to be addictive, habit forming or to cause any drug/nutrient interactions and are on the Generally Recognized as Safe List (GRAS).
Dangers of combining CBD with other substances
For example, the combination of CBD and Benadryl or diphenhydramine (an over the counter sleep aid) may cause eventual worsening of dementia or cognitive function due to the cumulative build up of acetylcholine in the bloodstream from the Benadryl. A combination of CBD and valerian herb may cause residual daytime drowsiness and difficulty concentrating. When choosing combination therapy side-effects of such combinations need to be considered.
How to Use CBD for Insomnia
Insomnia happens after mild sleep problems have already developed and weren’t properly dealt with. So, the first place to start with in treating insomnia is a good sleep hygiene program and consistency with that program.
How much CBD should I take for insomnia?
The next consideration is choosing a good CBD product for your problem and starting a dose regimen. Use a low dose of 25 mg/day in the evening to start. Studies have shown that it takes some time for CBD to help people with insomnia. A small case study of a 10 year old PTSD child showed that it took 8 months for symptoms of insomnia and PTSD to resolve when treated with CBD at 12-25 mg/day as a sole source of therapy.
When should I take CBD?
If you are treating daytime grogginess as your source of insomnia then you take your CBD in the am to promote a state of wakefulness and again, start at a low dose and monitor effects. If you are treating insomnia take about one hour before bedtime. This is especially important if taking with melatonin (a common sleep hormone) since melatonin needs to be taken just before bedtime.
How long does it take CBD to work?
As mentioned previously, be patient. If you want something to work immediately taking a CBD product at a low dose with melatonin and sleep hygiene would be a way to start. Monitor your dose and effects and increase the CBD as needed. Melatonin works on the sleep wake cycle fairly quickly and should not have to be taken longer than one month to stabilize sleep cycles.
Larger doses may have a quicker effect, but studies are limited.
Another consideration in the length of time it takes for CBD to work is whether it is taken as an isolate or full spectrum since the entourage effect may not only lower effective dosages it may affect how long it takes CBD to calm the storm of insomnia or produce restful sleep.
Does CBD affect the dream state?
Evidence to date state that CBD treats REM related disorders which is where your dreams happen. Strangely, anecdotal testimonies state that when CBD is applied topically to the forehead as for headaches the user experiences vivid dreams, sometimes good and sometimes not. It may be that topical applications and location of that application may affect the brain differently than when taken internally, yet this remains an interesting area of study.
CBD as a safe alternative for sleep
Remember, CBD is safer than prescription drugs, is non-addictive and won’t get you high. Right now, it is the most promising alternative on the market with pretrial investigations of novel therapeutic CBD pharmaceuticals to treat insomnia happening at this very moment.