Do you lie awake in bed waiting, no hoping, to fall asleep? Is sleep an “issue” for you? Do you “struggle” with sleep?
If so then this article and podcast episode is for you.
We discuss sleep hygiene techniques, prescription sleep medications and medical cannabis’ role in helping you sleep.
Below is our podcast episode for this article.
You can listen right here on the website, or search for us in your favorite podcast app.
Nationwide sleep issues
Quoting a report from Statistics Canada
“Insomnia is predominantly characterized by dissatisfaction with sleep and difficulties initiating or maintaining sleep, along with substantial distress and impairments of daytime functioning.”
And the impact of the “impairment of daytime functioning” can have a huge economic impact on a person. The same Stats Canada report goes on to say: “In Canada, the individual economic burden of insomnia is estimated at $5,010 per person per year, with nearly 90% of this amount attributed to indirect costs such as work absenteeism and reduced productivity.”
Are people learning to sleep better?
It appears the opposite is occurring. Based on information collected in a large study the “Canadian Health Measures Survey (CHMS)” the report concluded.
“Nighttime insomnia symptoms have also become more prevalent in recent years. For example, nighttime insomnia symptoms increased by 42% over the eight-year period from 2007 to 2015 among Canadians aged 18 or older”
- from 16.8% in 2007-2009
- up to 23.8% in the 2014-2015 period
So almost a quarter of Canadians report having insomnia symptoms. And I bet you’ll find similar data in other industrialized countries.
And looking at the data it appears that women report insomnia more frequently than males. The “working age” (18 years old to 64 years old) and people with lower education and lower household income also generally report higher incidences of insomnia.
I don’t know if its been shown to be a cause, or just an association, but perhaps this group of people are concerned about their financial situations and this affects their sleep.
Sleep is an opportunity for your body to repair, regenerate and refresh.
Anybody who has experienced sleep deprivation (so pretty much any new parent) will understand the profound impact this has on every part of your life.
But imagine this sleep deprivation never went away. Imagine you suffered from chronic insomnia. In the morning you never feel refreshed.
Do you think that will affect your mood? Do you think that will affect your relationships? Undoubtedly.
In order to sleep you need to be able to relax and slip into a deep restful sleep.
How easy is it to relax when you are worrying about something?
Even worse, is how easy is to relax when you know view sleep as an adversary? Just look at the terminology we use. We “struggle” to fall asleep. We are “fighting” or “battling” with sleep issues.
We have built up an opponent, and that opponent’s name is sleep. This is not a good mindset to promote relaxation.
If you are planning to fight with something, does that put your body at ease and make you nice and relaxed?
No. You have set your bed up to be a battleground.
Time it takes to fall asleep
And some people get stressed out that they don’t fall asleep right away when their head hits the pillow. In fact, the May 2019 issue of “Psychology Today” points out that if you fall asleep right away like that, you’re probably sleep deprived.
The article states it should take 10 – 20 minutes to fall asleep. A direct quote from the article, “But whether it takes 20 or 45, “you simply have to think it’s too long for it to be too long,” says Michael Perlis, director of the Behavioral Sleep Medicine Program at the University of Pennsylvania School of Medicine.”
Meaning if you feel its taking too long to fall asleep then you’re probably stressing over it and therefore it is taking too long.
Can be many reasons WHY you don’t sleep
I attended a sleep talk put on by a naturopathic doctor.
She brought up some very interesting points.
She said the reason people don’t sleep can be extremely varied…there is no single reason why all people don’t sleep…every individual can have sleep deficiencies for different reasons.
- You may not be able to sleep because of pain. It is hard to relax when the pain is throbbing or burning inside you
- You may not be able to sleep because of anxiety. When your bed hits the pillow your mind suddenly turns on and your thoughts start racing like a NASCAR event. It is hard to relax and drift off to sleep when you stress yourself out over something you said (or didn’t say) to someone standing behind you in the coffee shop lineup.
- Your partner’s snoring may not only keep you up but the neighbors too.
- And snoring (either your own or your partners) can tie in with sleep apnea. (A serious medical condition in which your breathing stops…and then restarts…sometimes several times per minute. When you don’t breath properly your body gets starved of oxygen. Sleep apnea is a risk factor for several health conditions including developing high blood pressure and diabetes. Not all sleep apnea patients snore though, so if you sleep yet feel unrefreshed and groggy during the day you should speak to your doctor.)
I love the points the naturopath had brought up. There can be many reasons why YOU don’t sleep well.
As an individual you need to address YOUR reasons for not sleeping well.
Prescriptions Sleeping Pills
There are prescription sleeping medications available from your doctor.
I can’t speak for other pharmacies in Canada, nor USA or elsewhere, but the community pharmacy I worked at regularly had Zopiclone in the top 3 drugs dispensed year after year.
Zopiclone is a prescription sleep aide, called a hypnotic, that is intended to help a person fall asleep.
If you’ve ever received a prescription sleep medication you’ll see on the patient information brochure that comes with it that you are only supposed to take it short term. Generally 2 weeks or less.
What can happen with many of these medications is that your body builds up a tolerance to it…so ½ tablet doesn’t work anymore, so you start taking one tablet, but after awhile you need to increase to 1 and ½ tablets and so on.
And you may develop a dependence. A dependence is when your body is used to receiving that medication night after night. And if you stop the medication suddenly you may experience “withdrawal” reactions. And though it seems like a terrible joke, one of the withdrawal symptoms patients may experience is insomnia.
Some prescription sleep medications can be deadly when combined with other medications that depress the central nervous system.
The ones that come to mind here are a group of drugs called the Benzodiazepines. The benzodiazepines were brought to market several decades ago and they were an improvement over the sleeping pills available at the time…primarily the barbiturates which had a low therapeutic window. Meaning the dose required to have an effect was quite close to the dose required to have very bad effects.
I heard a psychologist’s presentation a few years back and he said that the Benzodiazepines work in a very similar way to alcohol. They affect the GABA receptors in the brain.
And so to remember the possible Benzodiazepine adverse events then just think of alcohol intoxication. Drowsiness, muscle relaxation, staggering around, lowered inhibition, dulled thinking skills, decreased judgement, etc…
In the same presentation the doctor went on to say that many patients don’t even know it, but their consistent use of the Benzodiazepines basically makes them a little less smart. They are functioning at less than their full mental capacity, and they don’t even know it.
Prescription sleep medications have their place
We’re not saying that prescription sleeping pills don’t have their place. They do.
As the American Academy of Sleep Medicine points out: “Hypnotic sleeping pills also are an effective treatment option for chronic insomnia when used as prescribed by a physician.”
Then they do go on to say that, “Efforts should be made to use the lowest effective dose of an insomnia medication and to taper the medication when conditions allow.”
That is the key point: short term use…just when needed.
This can be tough when someone says they need it all the time, but the ideal situation is that when you start to address the other issues that are affecting your sleep, you use the prescription sleep medication just for a few days in order to get your sleep cycle healthy. (I used to say “get your sleep cycle back to ‘normal’” but normal for you may not be “healthy”).
If you’re reading this, you may have already tried many other sleep medications over the years, and may be on some prescription sleep pills now.
If you have taken these pills regularly for longer than a couple weeks then talk to your doctor before suddenly stopping them. Your doctor may advise a tapering program.
What is Sleep Hygiene?
Though it conjures up images of you washing yourself before bed, the National Sleep Foundation defines it as, “Sleep hygiene is a variety of different practices and habits that are necessary to have good nighttime sleep quality and full daytime alertness.”
When I counsel pharmacy patients on sleep hygiene I use the analogy of putting a baby to sleep.
When you have a baby you develop a bedtime routine.
It can be different for every child but might include dinner, a short playtime, then bath time, then quiet time, then story time then bedtime.
You don’t jostle with them or stimulate them with TV right up to the minute before bed then put them in their crib.
Yet many adults do this to themselves every night!
They watch TV or use their phones and get worked up over the nightly news, and generally get bombarded by the stimulating blue light.
Then expect to hit the pillow and go to sleep.
In the Psychology Today issue on sleep…the May 2019 issue…they state, “Our screens’ melatonin-inhibiting blue light delays sleep latency by an average of 10 minute.”
We wouldn’t do that to a baby yet we do it to ourselves ALL THE TIME.
So forgetting about all the bad things we do, lets go over some of these good practices and habits that someone should develop.
Sleep Hygiene Techniques Summarized
The following sleep hygiene suggestions are what we collected from the National Sleep Foundation.
- If you need a nap keep it short (20-30 minutes only)
- Avoid stimulants such as nicotine and caffeine close to bedtime.
- Alcohol only in moderation (may help you fall asleep but the quality of your sleep will suffer as your body tries to process what it views as a toxin)
- Get exercise and stay active. (But not too close to bedtime because some people find it too stimulating and they can’t sleep
- Avoid foods that trigger heartburn or indigestion
- Get exposure to sunlight during the day and darkness at night
- Develop a nice relaxing bedtime routine. Get yourself mentally and physically “prepared” for bedtime
- Maintain a good environment for sleeping (have your room dark, turn any clocks away from sight, and use a white noise machine or similar sound-emitting device if needed)
For a complete list and further explanation of these points check out the article on the Sleep Foundations website. Link: https://www.sleepfoundation.org/articles/sleep-hygiene
My personal sleep technique
Most of the time I sleep well, but if I’m having difficulty falling asleep here is the technique I use.
I keep my eyes open and stare up at the ceiling of my pitch-black room. If my eyelids want to close I try to keep them open just a little while longer.
The key is to have the room very dark.
What time of day does sleep hygiene pertain to?
These sleep hygiene techniques play a role in developing healthy sleep patterns. And did you note the times of day these sleep hygiene techniques pertain to?
All times of the day.
People are mistaken in thinking that they should only be concerned about sleep at night.
That is when they may actually go to sleep, but preparing your body for a restful sleep is an all-day affair.
Many people just want the proverbial “hammer over the head”…the thing that will knock them out and put them to sleep.
But learning this different mindset – that healthy sleep doesn’t only involve the time right before bed – can be life-changing.
Address the other issues that affect sleep
We still need to address the other issues why people don’t sleep. Earlier I mentioned the naturopath’s talk I attended where she brought up several reasons people don’t sleep including pain, anxiety, and other issues.
Well we still need to address those.
Quoting the Psychology Today May 2019 issue again it states,” “It’s my estimate that good sleep hygiene strategies will solve roughly a quarter of sleep issues,” Dr. Winter says. “The best environment won’t address intrinsic issues like sleep apnea and restless leg syndrome,” conditions that affect 22 million and 12 million Americans, respectively. If two weeks devoted to improved sleep hygiene doesn’t make a difference, he suggests contacting a sleep specialist.”
Can Cannabis and CBD oil help sleep?
We have gone over the different reasons people don’t sleep, we’ve addressed how prescription sleeping pills can work well in some folks when used appropriately and short term, we have gone over sleep hygiene techniques to promote a healthier routine, now lets look at medical cannabis itself.
In the book, “CBD: A Patient’s Guide to Medicinal Cannabis” the authors Leonard Leinow and Juliana Birnbaum summarized cannabis and sleep very well.
Quoting the book, “Cannabis and sleep have a complex relationship that is only beginning to be understood by science.”
And that is a very good way to put it “complex.”
The book goes on to point out some studies that seem to have different results.
(The link above to Amazon is an affiliate link…meaning I get small commission if you buy. I like and use the book, that is why I feel comfortable recommending it to you.)
In a video presentation Dr Ethan Russo said that Cannabidiol (or CBD for short) itself does not cause drowsiness at low to moderate doses. (Around the 11 minute mark he discusses this aspect of CBD.)
And this is echoed in the “CBD A Patient’s Guide to Medicinal Cannabis” book where the authors highlight a study that concluded – “…study found CBD to be wake-inducing for most subjects, though some reported better sleep a few hours after taking it.”
In the Epidiolex® drug monograph (the prescription CBD product licensed in the USA) it cautions that CBD ‘CAN’ cause drowsiness. A portion of the drowsiness experienced by patients in the Epidiolex® study may have been due to drug-drug interactions, or the high doses they used.
In Dr. Russo’s presentation he did go on to say that if your CBD is a whole plant extract then it’s likely the terpene called Myrcene from the Cannabis plant that causes the drowsiness. (In the video around the 14:20 minute mark.)
We discussed terpenes in Episode 5 of the Medical Cannabis podcast, but a quick recap.
Terpenes are the essential oils of plants, including the cannabis plant, that give it its variety of smells.
Interestingly these terpenes can have their own medicinal properties and when the terpenes are believed to actually affect how the cannabinoids (like THC and CBD) will quote “make us feel” unquote.
The particular terpene that Dr. Russo is referring to is called Myrcene (sometimes labelled as Beta-myrcene).
This terpene is also found in some other plants including hops.
It is known to have sedative effects. In his famous paper entitled “Taming THC” published in the British Journal of Pharmacology
He wrote, “…data would support the hypothesis that myrcene is a prominent sedative terpenoid in cannabis, and combined with THC may produce the ‘couch-lock’ phenomenon of certain chemotypes that is alternatively decried or appreciated by recreational cannabis consumers.”
You’ll often hear or read that to help with sleep you need an “Indica strain” of cannabis.
This cannabis folk knowledge has been passed down, but it is more likely the higher myrcene content in some Indica strains that provides the hypnotic effect, not simply because it is an Indica strain.
In the same British Journal of Pharmacology article it says,
“The effects of cannabis on sleep have been reviewed (Russo et al., 2007), and highlight the benefits that can accrue in this regard, particularly with respect to symptom reduction permitting better sleep, as opposed to a mere hypnotic effect. Certainly, terpenoids with pain-relieving, anti-anxiety or sedative effects may supplement such activity, notably, caryophyllene, linalool and myrcene.”
And this ties in with what we discussed above, about the other symptoms or issues we may have that interfere with our ability to have a good night’s rest.
Linalool as we just heard from that quote is another terpene that may have medicinal properties. It is also found in lavender and may provide Lavender’s famous anti-anxiety and calming aromatherapy benefits.
So if you have some anxiety, some racing thoughts, some worry that are keeping you from sleeping well, then you may want to look toward a cannabis chemovar (also known as a strain) that contains both linalool to help reduce anxiety, and myrcene to help make you drowsy.
CBD Improves Sleep Quality
What many people claim about CBD is that even though it doesn’t make them drowsy or “knock them out” like a sleeping pill would, they still notice an improvement in sleep quality. And I’ve heard this from patients I’ve spoken to.
And if pain or anxiety is why they can’t sleep, then CBD may help reduce these symptoms thereby making them more relaxed and able to get a good night’s rest.
THC causing drowsiness
THC is known to cause drowsiness…that is why we say don’t combine it with alcohol. And according to Dr. Russo, Myrcene will intensify this effect. So make you even drowsier.
The different terpene content in cannabis may explain why some people find a particular strain to make them awake or alert, and another strain will make them drowsy and sleepy..
When to take it
Different routes of administration have different onsets of action. We talked about some of these routes of administration in Episode 3, but we’ll quickly recap.
Oral (swallowing) takes longer to start to work (could be 30 minutes to 2 hours), but lasts longer than other routes of administration. It may last in the system 6-12 hours. This could be a benefit for patients that have frequent nighttime awakening. Perhaps they will be able to stay asleep longer.
Vaporizing works quicker – usually works within minutes, but doesn’t last as long. So may be more appropriate for patients that have trouble initially falling asleep.
Sublingual – so putting cannabis oils under the tongue – seems to be a bit of happy medium… it doesn’t take as long to start to work as swallowing the medicine (might start to work in about 15-30 minutes), but it seems to last almost as long as oral administration.
It seems that more studies are longer-term studies are required to better understand Cannabis’ role in sleep.
Quick summary of whether Cannabis and CBD oil helps sleep.
Sleep hygiene techniques are very important. Remember my baby analogy. You calm them, you soothe them, then you put them to bed. Do that with/to yourself.
If you are wondering if CBD oil can help with sleep the answer is it might. It might if the reason you aren’t sleeping is pain or anxiety-related.
As Dr. Russo said in ‘Taming THC’ paper, cannabis can help “symptom reduction promoting better sleep.”
And CBD is known to help relieve pain, act as an anti-inflammatory and relieve anxiety.
CBD may not be the “knockout drug” that people are programmed to think they need, but instead it may help calm you from within – ease the pain and anxiety that is rousing you – so you can get a better natural sleep.
If you are wanting to try a CBD oil you should look for a full spectrum CBD oil. This means the other synergistic molecules from the cannabis plant, such as the terpenes, are in the oil too. It isn’t just CBD by itself.
But keep in mind that even when it is extracted from hemp (a variety of cannabis with naturally very low amounts of THC) there is still some THC present. Talk to your employer about this if you’re concerned with THC showing up on a blood test. If this is something you’re concerned with then you’ll want to look closer at a CBD isolate (just the CBD molecule by itself, zero THC).
If you have tried CBD and it didn’t improve the quality of your sleep, or you still cannot fall alseep then you may want to talk to your doctor about THC.
Choose a cannabis chemovar (aka strain) that is high in myrcene: a terpene with known sedative effects. This should help you fall asleep.
Remember to start low and go slow. THC at doses higher than you’re used to can cause some undesired effects…so “take it easy.”
I hope this answered some of your questions concerning cannabis and if CBD oil can help sleep.