Sleep is essential for our daily routine. We sleep about one third of a day. Sleeping quality and length are as important for survival, as food and water. Sleep is crucial for building new and maintaining old connections in the brain, which enable new memories generation. With a lack of sleep, it is harder to focus, and response time is slower as well. Sleep is important for many brain functions, including neuron communication. Furthermore, our brain and body remain surprisingly active while we are asleep. Sleep has an effect an almost all types of tissue and body systems, from the brain, hearth, lungs, metabolism, to immune function, our mood, and disease resistance function.
Sleep is a complex and dynamic process, which has a strong effect on how we function. Scientists are just beginning to understand this complex process. We all require sleep, although its biological purpose remains a mystery. However, there is no doubt sleep is essential for our performance, health, and life quality improvement.
SLEEPING AND BRAIN ANATOMY
There are multiple brain parts included in the sleeping process. Hypothalamus acts as a control center for sleep and stimulus, which is also controlled by our light exposure response (it receives information directly from our eyes). People with damaged hypothalamus sleep very unregularly as they cannot harmonize their circadian rhythm. Most blind people retain the ability to sense the light, which effects our sleep/wake cycle. The second part is the brainstem, which communicates with hypothalamus and controls the transition between wokeness and sleep. It also plays a part in REM sleep, where it sends the signal for muscle relaxation (important for our posture and limb movement), that we do not act out our dreams. The next part is thalamus, which acts as an information switch. During most of the sleep phases it remains quiet and lets us isolate the surroundings. On contrary, it is very active during REM sleeping and sends images, sound and other feelings we experience during dreaming to our cerebral cortex.
Pineal gland is located deep in the brain, where the two halves join. When it gets darker, it increases the release of hormone melatonin, which helps us sleep. Scientists believe that melatonin minimums and maximums during time are important in harmonizing our circadian rhythm with the outside day/night cycle. The next part is our forebrain, which control our sleep and wokeness and act as a stimulus system. The release of adenosine from the cells of forebrain and most probably other parts as well, supports our sleep aspiration. And finally, there is amygdala, which is involved in emotion processing and becomes more active during REM sleep.
SLEEP TYPES AND PHASES
There are two general types of sleep. REM (Rapid Eye Movement) sleep and non-REM sleep (which has 3 different phases). Each of them is linked to specific brain waves and neuron activity. During a typical night we repeat the entire REM and non-REM cycle multiple times. Longer and deeper REM sleep occurs towards the morning.
PHASE 1 of non-REM sleep is a change that occurs in transition from waking state to falling asleep. In this short period (a few minutes) of relatively light sleep, our heart rate, breathing, and eye movement slow down, and our muscles relax with occasional twitching. Brain waves start to slow down opposite to daytime patterns when we are awake.
PHASE 2 of non-REM sleep is a period of light sleep before we transition to deep sleep. Heart rate and breathing slow down, and muscles relax even more. Body temperature decreases and eye movement stops. Brain wave activity slows down, however short electrical bursts are present. In the repeating cycles we spend most of the time sleeping in this phase.
PHASE 3 of non-REM sleep is a period of deep sleep that we require to wake up fresh and well rested. It starts in the first part of the night. Our heart rate and breathing drop to the slowest possible level during the entire sleep. Muscles are completely relaxed, and it is usually hard to wake a person up in this phase. Brain waves slow down even more.
REM sleep appears at first approximately 90 minutes after we fall asleep. Our eyes quickly move from one side to the other behind closed eyelids. Mixed brain wave frequency is closer to the one in our waking state. Our breathing becomes faster, irregular, and heart rate, as well as blood pressure increase almost to the level as in our waking state. Most of our dreams occur during REM sleep, however some can also occur during non-REM sleep. Our leg and arm muscles become temporarily paralyzed, which prevents us to act out our dreams. While we age, we spend less time in the REM phase during sleep. Memory consolidation most probably requires REM as much as non-REM sleep.
Circadian rhythm and homeostasis are the internal biological mechanisms, which work together to regulate our waking and sleep state.
It controls a wide range of functions, from daily waking variations to body temperature, metabolism, and hormone release. It also controls our sleeping time, and because of it we are sleepy in the nighttime and start to wake up closer to morning without an alarm. Our bodies biological clock, which is set to approximately 24-hour day, controls most of the circadian rhythm. Circadian rhythm synchronizes with the environmental signals (light, temperature) depending on the real time of the day; however, it continues in absence of these signals as well.
It follows our need for sleep. Homeostatic sleep aspiration warns the body to sleep after a certain period and regulates the sleep intensity. This sleep aspiration is stronger every waking hour and causes a longer, deeper sleep after a lack of sleep period. Sleep is essential to maintain the homeostasis of our body.
SLEEP QUALITY AND SLEEP DISORDERS
There are more than 80 different sleep disorders. Inability to fall asleep and to sleep are only the most common among many others. Chronicle lack of sleep or low-quality sleep can have a great risk increase in high blood pressure, cardiovascular disease, diabetes, depression, and body weight. Sleep is essential for our health.
Our sleep/wake needs are affected by factors such as various medical conditions, medication, stress, sleeping environment, food, and beverages. Though the greatest effect might come from light exposure. Specialized cells in our eye retina process the light and inform the brain on whether it is day or night. In this way it can slow down or faster our sleep/wake cycle. Due to light exposure, it can be harder for us to fall asleep, or fall back asleep if we wake up. It is common for people who work at night to have problems falling asleep and staying awake during their work period. This occurs because their natural circadian rhythm and sleep/wake cycle are heavily disturbed. In case of longer air travel across the globe circadian rhythm is no longer in sync with the local time, due to crossing of different time zones. That is why imbalance is created between our internal and local time.
We all dream. Every night we dream for approximately 2 hours, but most probably we do not remember most of our dreams. The exact purpose of our dreams is unknown; however, dreams can help us process our emotions. Events that happen to us during the day, often emerge in our thoughts while we are sleeping and people that have stress or anxiety problems, tend to have higher probability to experience awful dreams. We can dream in all phases of sleep; however, the most intense dreams usually occur in the REM phase. Some people dream in color, while others only in black and white.
ENDOCANNABINOID SYSTEM AND SLEEP
As a primary homeostatic regulator of human physiology, the endocannabinoid system (ECS) plays a major part in sleep/wake cycle and other circadian processes. Italian scientist Vicenzo DiMarzo summed up the broad regulating function of the endocannabinoid system in this phrase: “Eat, drink, relax, protect and forget”. How we fall asleep, sleep, and wake up is also a part of the endocannabinoid system. The main question is if the ECS regulates our circadian rhythm experience or is it the other way around?
Strong evidence for connection of both emerged while observing the sleep/wake cycle and variations of anandamide and 2-AG (brains own molecule similar to the ones in cannabis) together with metabolic enzymes, which create and dissolve these endogenic cannabinoid elements.
Sleep/Wake Cycle and the Endocannabinoid System
There is no doubt that sleep and endocannabinoid system are closely connected. Larger amount of anandamide is present in our brain during nighttime, and it works with endogenic neurotransmitters oleamide and adenosine to generate sleep. On the contrary, we can find larger amounts of 2-AG during the day, which points to the fact it encourages wokeness. Very complex sleep/wake cycle is affected by a group of neurochemicals and molecular paths. Both anandamide and 2-AG activate CB1 cannabinoid receptors, which are concentrated in the central nervous system including part of the brain, that relate to regulation of sleep.
CB1 receptors modulate the release of neurotransmitters in a way, that it limits excessive neuron activity and decreases anxiety, pain, and inflammation. CB1 expression is the main factor in modulating sleep homeostasis. In case of CB2 cannabinoid receptors located primarily in immune cells, peripheral nervous system, and digestion tissue this is not the case. While CB1 receptor expresses cyclical circadian rhythm, fluctuations such as these were not observed with CB2 receptor.
The challenge of researching and treating sleeping disorders is very complex, as sleep disorder they are symptoms of many chronicle disease. Often, chronicle disease is a result of lack or low-quality sleep, which always includes imbalance or poor regulation of endocannabinoid system. Although, we have to learn much more on the relationship between ECS and circadian rhythm it is clear, that optimal, high quality sleep is an important component to regain or retain our health.
CANNABIS FOR SLEEP QUALITY
Cannabinoids have been used to improve sleep quality for centuries. In medical journal “Materia Medica” published in the 18th century, cannabis was proclaimed as the “narcotica” or “anodyna” (pain reliever). Sir William B. O’Shaughnessy re-included cannabis back to western medicine in 1843, which lead to studies once again confirming the positive effects of cannabis and cannabinoids on sleep (you can read more about cannabis history here). German researcher Bernard Fronmueller shared his observation in 1860:
“From all suggested anesthetics, cannabis showed a sleeping effect closest to natural sleep, without unnecessary system disturbance, without dangerous reactions or paralysis.”
One of the studies claims that 40% of people that have trouble sleeping, suffer from anxiety, depression, or other psychological disease as well (Roth, 2007). It is interesting as well that 93% of people with sleep disorders benefit from cannabis use (Babson & Bonn-Miller, 2014). Research data show that CBD and THC have different effects on sleeping. They can both calm and stimulate the body, depending on the dosage. For CBD it concluded that it helps with sleep in higher dosage (also depends on an individual, that is why it is best for a person to slowly try different dosages, starting with the lowest possible).
Additionally, cannabidiol can mitigate the symptoms of REM behavior disorders (RBD), which are characterized with acting out strong, intense, and sometimes violent dreams. In preliminary study, that researched the efficiency of CBD in patients with Parkinson’s and RBD, the results looked very promising.
PAIN AND SLEEP
Pain mitigation is another reason why many people decide to use cannabis. Chronicle pain and sleep are also very closely connected. Often it is hard to tell whether the pain is causing sleep problems, or if sleep problems are causing pain.
People who are trying to mitigate pain and improve their sleep quality, can achieve positive results with cannabinoids and other cannabis components. One of the research sums up 13 studies researching different cannabis combinations for pain mitigation and sleep quality improvement. The authors concluded that combination of CBD and THC improves our sleep most efficiently (full spectrum and entourage effect).
CANNABIS PRODUCT DOSING
Cannabis use is a very personalized therapy – especially if used to improve the quality of sleep. Efficiency of cannabis use as a mean to improve sleep is highly variable. It depends on a specific user, how the product is consumed, ratio between CBD and other cannabinoids, cannabis terpene profile, time of consumption, and consumed dosage. Combination of all these factors determines the result. That is why we advise to start with lower doses and continuously increase them until the optimal dosage and ratio is reached.
WHAT CAN WE DO TO IMPROVE OUR SLEEP?
Sleeping is essential for our health and life quality. Below you can find a few tips on how to improve the quality of your sleep:
- SCHEDULE – go to sleep and wake up at the same time each day.
- EXERCISE – exercise for at least 20-30 minutes per day, but not later than a few hours before sleep.
- Avoid caffeine and nicotine later in the day, and alcohol in the evenings.
- RELAXATION – relax before going to bed. Maybe treat yourselves with a bath, reading or any other relaxation routine you might have.
- Create a sleeping room – avoid strong lights and sound, adjust the room temperature, and remove any displays from the room.
- Do not look at any displays such as TV, computer, phone or other mobile devices before going to bed.
- Do not lay in the bed awake – if you cannot fall asleep do something else such as reading or listening to music until you feel sleepy.
- Aromatherapy and the use of various herbs that are relaxing, calming and prepare you for sleeping. You can also treat yourself with a cup of relaxing calming tea.
- Use of cannabis products such as CBD oil, cannabis tea, and other natural food supplements with full spectrum of cannabinoids.
- STRESS – excessive stress can cause many disorders as well as health problems. Try to minimize it to an optimal level. You can read more about stress and CBD here.
Scientists are constantly learning and researching the functions and regulation of sleep. The main goal of these research is to understand the risks involved with chronicle lack of sleep and connection between sleep and diseases. People with chronicle lack of sleep have a higher probability of being overweight, to have a stroke, cardiovascular disease, infections, and can develop certain types of cancer. Sleep disorders are commonly connected to people with aging medical states, such as Alzheimer’s or Parkinson’s disease. Many correlations between sleep and these conditions remain a mystery. Does lack of sleep lead to certain health conditions, or do certain health conditions cause the lack of sleep? This and many other questions present the frontiers of sleep research. However, there is no doubt that sleep is crucial to improve our performance, health, and quality of life.
Below you can find some useful sources used in Sleep is essential article and for further reading and research.
Sleep is Essential 1 – 10:
- Americal Sleep Association. (2017, July 7). Sleep Statistics. Retrieved from American Sleep Associaton: https://www.sleepassociation.org/sleep/sleep-statistics/
- Babson, K.A., Bonn-Miller, M.O. Sleep Disturbances: Implications for Cannabis Use, Cannabis Use Cessation, and Cannabis Use Treatment. Curr Addict Rep 1, 109–114 (2014). https://doi.org/10.1007/s40429-014-0016-9.
- Babson, K.A., Sottile, J. & Morabito, D. Cannabis, Cannabinoids, and Sleep: a Review of the Literature. Curr Psychiatry Rep 19, 23 (2017). https://doi.org/10.1007/s11920-017-0775-9.
- Centers for Disease Control and Prevention. (2017, May 2). Sleep & Sleep Disorders. Retrieved from Centers for Disease Control and Prevention: https://www.cdc.gov/sleep/data_statistics.html
- Ferguson, G. and Ware, M.A. (2015). Review Article: Sleep, Pain and Cananbis. Journal of Sleep Disorders & Therapy, https://www.omicsgroup.org/journals/review-article-sleep-pain-and-cannab….
- Gates, Peter J and Lucy Albertella, Jan Copeland (2014). The effects of cannabinoid administration on sleep: a systemc review of human studies. Sleep Medicine Reviews, https://www.researchgate.net/profile/Peter_Gates/publication/260604558_T….
- Gyllenhaal, Charlotte, et al. Efficacy and safety of herbal stimulants and sedatives in sleep disorders. Sleep Medicine, Vol. 4, No. 3, pp 229-251, 2000.
- Kripke, D. (2016). Hypnotic drug risks of mortality, infection, depression, and cancer: but lack of benefit [version 1;. F1000 Research, https://mechanism.ucsd.edu/teaching/f16/cogs200/Kripke%202016%20F1000Res….
- Lee, Martin A. Smoke Signals: A Social History of Marijuana – Medical, Recreational and Scientific. New York: Scribner, 2013.
- Mechoulam, R. (2015). Cannabis – The Israeli perspective. Basic Clinical Physiology Pharmacology, https://www.researchgate.net/profile/Raphael_Mechoulam2/publication/2823….
Sleep is Essential 11 – 20:
- Mechoulam, Raphael and L.A. Parker (2013). The Endocannaboind System and the Brain. The Annual Review of Psychology, 21-47.
- Murillo-Rodriquez, Eric and Jose Carlos Pastrana-Trejo, Mireille Salas-Crisostomo, and Miriel de-la-Cruz (2016). The Endocannabinoids System Modulating Levels of Consciousness, Emotions and Likely Dream Contents. CNS & Neurological Disorders – Drug Targets, 370-379.
- Murillo-Rodriguez, E. (2008). The role of the CB1 receptor in the regulation of sleep. Progress in Neuro-Psychopharmacology & Biological Psychiatry, 1420-1427.
- National Institute of Health. (2017). Brain Basics: Understanding Sleep. Retrieved from National Institute of Health: National Institute of Neurological Disorders and Stroke: https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Understa…
- National Institute of Neurological Disorders & Stroke. (2017, July 23). Brain Basics; Understanding Sleep. Retrieved from National Institute of Neurological Disorders and Stroke: https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Understa…
- Nicholson, A. N., Turner, C., Stone, B. M., & Robson, P. J. (2004). Effect of Delta-9-tetrahydrocannabinol and cannabidiol on nocturnal sleep and early-morning behavior in young adults. Journal of Clinical Pharmacology, 305-313.
- Pava, Matthew J., Alexandros Makriyannis, David M. Lovinger (2016). Endocannabinoids Signaling Regulates Sleep Stability. PLoSOne, http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0152473.
- Pava, Matthew J. et al (2014). Endocannabinoid Modulation of Cortical Up-States and NREM Sleep. PLoSONE, http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0088672.
- Prospero-Garcia, Oscar et al (2016). Endocannabinoids and sleep. Neuroscience and Beobehavioral Reviews, 671-679.
- Russo, Ethan B. (2007). Cannabis, Pain and Sleep: Lessons from Therapeutic Clinical Trials of Sativex, a Cannabis-Based Medicine. Chemistry & Biodiversity, 1729-1743.
Sleep is Essential 21 – 26:
- Russo, E. B. (2001). Handbook of Psychotropic Herbs. Bringhamptom: The Hawthorne Press, Inc.
- Russo, E. B. (2011). Taming THC: potential cannabis synergy and phytocannabinoid-terpenoid entourage effect. British Journal of Pharmacology, 1344-1364.
- Roth, T. (2007). Insomnia: Definition, Prevalence, Etiology, and Consequences. Journal of Clinical Sleep Medicine, S7–S10.
- Shannon, Scott and Janet Opila-Lehman. (2016) Effectiveness of Cannabidiol Oil for Pediatric Anxiety and Insomnia as Part of Posttraumatic Stress Disorder: A Case Report. Permanente Journal. Fall 2016.
- Scheet, F. A. (2016). Hungry for Sleep: A Role for Endocannabinoids. Sleep, 495-496.