Paraskevas Arseniou, Doctor, Special Pathologist
Although sleep quality is a determining factor in human, emotional, mental and physical health, many are deprived of it.
Physiology of Sleep
The brain oscillates in situations
- REM Sleep (dream sleep with rapid movements of eyes)
- NREM Sleep (non-dream sleep without rapid eye movement)
o Stage 1
o Stage 2
o Stage 3
o Stage 4
As soon as we fall asleep, the brain goes through all of the above stages. It quickly descends to deep stages 3 and 4, where it stays for a while, rising after about 80-90 minutes to REM sleep for a few minutes and then goes back to NREM, again in REM etc. The cycle remains the same, but what changes is the ratio of NREM / REM sleep. Thus, in the first half of the night, the majority of the cycle is 3 and 4 NREM sleep stages, and as we go into the second half of the night, the percentage changes so that the brain has more REM and lighter NREM (Stage 2).
Frequent Sleep Disorders
- Insomnia – when we can’t sleep or stay asleep.
- Sleep apnea – includes faint breathing while sleeping.
- Restless legs syndrome – characterized by tingling, discomfort and leg pain that increases at night and eases with movement.
- Daily Rhythm Disorders – when the person’s internal clock does not work properly and sleep patterns are disturbed.
- Parasomnias – ie unusual movements and sleeping activities, including sleepwalking and nightmares.
- Excessive drowsiness during the day – when a person feels persistent daytime sleepiness from narcolepsy or other medical conditions.
It has been shown that sleep quality is more important than just quantity. It is like calories where the same amount of sugars or a balanced diet doesn’t have the same effect. At different times the brain needs different things from the sleep menu.
The table below shows the body’s needs of hours under normal conditions
|Age Group||Healthy Sleep Hours|
|Infants (0 to 3 months)||14 to 17 hours|
|Babies(4 to 11 months)||12 to 15 hours|
|Toddlers (1 to 2 years )||11 to 14 hours|
|Preschool age (3 to 5)||10 to 13 hours|
|School age (6 to 13)||9 to 11 hours|
|Teens (14 to 17)||8 to 10 hours|
|Adults (18 to 64)||7 to 9 hours|
|Elderly (65 and above)||7 to 8 hours|
It is impossible to sleep more than what is needed. Excessive sleep is mainly a sign of depression, but it is more likely just staying in bed than getting more sleep.
When we return to satisfactory sleep, many of the brain and body conditions return to normal. Events of the disordered immune system may take longer to return to normal, than others, but you can never make up for what you missed. Sleep does not work like a bank where you can sum up debts and then you can pay off at once. If you miss one night’s sleep, you can’t recover all that you missed no matter how long you sleep. It’s not like the fatty tissue, where you can make a deposit and then use it in the long-term, when you get hungry. The solution is the fat cells, but there is no equivalent in the brain. The reason is that man is the only being that submits himself to sleep deprivation without obvious reason. Maybe that’s why nature never faced the challenge, throughout evolution, to create a safety net in case of insufficient sleep. So there is no security mechanism. There is no credit system.
What can we do for good sleep?
- If we were awake for more than 30 minutes, we should go to another low-light area and maybe read a magazine until we get sleepy.
- We avoid alcohol and caffeine.
- We remove any electronic devices. We don’t check the time at the alarm clock.
- We keep the room cool, around 18Co. The body and the brain need to reduce their temperature to a certain extent to start sleeping. This is why sleeping in a very cold or very hot room is difficult.
- We go to bed at the same time and wake up at the same time. We don’t prolong sleep because the regularity changes.
- We use low light at night and bright in the morning.
The Endocannabinoid System and Sleep
Given the sleeping pills problems, doctors and scientists are investigating other ways to improve sleep, targeting the Endocannabinoid system (ECS). As the main homeostatic regulator of human physiology, the ECS plays an important role in the sleep-wake cycle and other circadian processes.
Italian scientist Vicenzo DiMarzo sums up the broad regulatory function of the Endocannabinoid system in the phrase “Eat, sleep, relax, protect and forget.”
How we fall asleep, remain asleep, awaken, and remain awake is part of an internal biological process that is regulated by our cyclical rhythms and our Endocannabinoid system. Cyclical rhythms regulate a variety of actions in the body, including hormone production, heart rate, metabolism, and when to sleep and wake up.
It’s like having an internal biochemical timer or clock, that monitors our need for sleep, guides the body to sleep and then affects the intensity of sleep. This biological mechanism is influenced by external forces such as travel, medicine, food, drink, environment, stress and more.
There is the basic question: Is the Endocannabinoid system regulating our experience with the circular rhythms or vice versa?
Evidence of a strong relationship between the two, is observed in the fluctuations of the anadamide and the 2-AG (endocannabinoid molecules of the brain itself), during the sleep-wake cycle, along with the metabolic enzymes that create and break down these endogenous cannabinoid compounds.
Anadamide is present in the brain, at higher levels, at night and works with the endogenous neurotransmitters oleamide and adenosine to create sleep. In contrast, 2AG is higher during the day, suggesting that it is involved in promoting alertness.
The extremely complex sleep-wake cycle is driven by a variety of neurochemical and molecular pathways. Both anadamide and 2AG, activate cannabinoid CB1 receptors, located in the central nervous system, including sleep-related brain parts.
CB1 receptors regulate the release of the neurotransmitter, in order to inform backwards for excessive neuronal activity, thereby reducing anxiety, pain and inflammation. Expression of the CB1 receptor is therefore a key factor in regulating sleep homeostasis.
This is not the case however with CB2, the cannabinoid receptor found primarily in immune cells, peripheral nervous system and metabolic tissue. While expression of the CB1 receptor reflects circular circadian rhythms, no such fluctuations have been described for the CB2 receptor.
The challenge of studying and treating sleep disorders is complicated by the fact that sleep disturbances are a symptom of many chronic illnesses. In many cases, poor sleep leads to chronic diseases and chronic illness always entails an underlying imbalance or dysfunction of the Endocannabinoid system. Although we still have a lot to learn about the relationship between ECS and circadian rhythms, it is clear that adequate quality sleep is a crucial component of restoring and maintaining a person’s health.
CBD improves sleep in people who have anxiety.
At higher doses, it soothes and ensures deep and rejuvenating sleep.
Unlike tetrahydrocannabinol (THC) – which is responsible for the euphoric use of cannabis – CBD doesn’t cause any intoxicating or psychotropic effects. Most commonly it is used to help with anxiety, depression, crisis, arthritis, chronic pain and other conditions. Its popularity has recently grown.
CBD seems to be a highly promising sleep aid for people suffering from persistent restlessness. It doesn’t cause drowsiness but, by reducing stress, it makes it easier to fall asleep and stay asleep.
Anxious thoughts are one of the main causes of insomnia and other sleeping problems. CBD has been shown to reduce anxiety with multiple mechanisms:
- by interacting with the serotonin 5-HT1A receptor which, as it is known, regulates mood, stress and emotion, and
- by stimulating the development of new nerve cells in the adult brain.
In addition, CBD acts as a sedative when taken at higher doses (100+ mg). This makes it easier to fall and stay asleep, ensuring a deep and refreshing sleep. Because of its analgesic properties, it helps people, suffering from chronic pain, eg arthritis and other inflammatory diseases, to sleep.
The dose for sleeping:
Research studies used doses from 15mg to 600mg CBD (3 drops of 10% CBD oil solution to 50 drops of 24% CBD solution).
Doses of 20-50mg seem to work better for sleep problems due to anxiety, while doses over 100mg have tranquilizing effects.
Dose of CBD 15mg or more for sleep