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CBD and Melatonin

CBD and Melatonin

Mar 22, 2022

Aimee Prasek, PhD

 

CBD and melatonin products have been popping up all over the place. There's some good evidence that these products can support sleep, but it's important to learn more about these products, when they may be most supportive, how they can be used, and possible side effects and contraindications. 

Melatonin benefits 

Melatonin is a brain chemical that everyone makes themselves, though the amount that we produce does diminish with age. It plays an essential role in regulating the body’s daily and annual biological rhythms, including the sleep/wake cycle. Newborns have tons of melatonin, which explains why they sleep so much. It stays high for most people through their teens, even into the college years. But there’s a wide range of natural melatonin production, with some people having much more than others. There is a genetic component to this, which likely explains why you may see insomnia run rampant within some families.

Most people think of melatonin as the sleep hormone, which it is. It's also a naturally occurring indolamine, which is a family of neurotransmitters that includes serotonin. This can be helpful to know as melatonin and serotonin are intimately related and a serotonin deficiency may also result in decreased levels of melatonin. 

Human studies suggest that melatonin supports the quality of healthy sleep as it relates to falling asleep, sleep efficiency (percent of time asleep to total time in bed), and awakening. In one study, melatonin appeared to positively support normal sleep onset, maintenance, efficiency, and activity within one week of supplementation compared to a placebo [13]. Another randomized, double-blind, placebo-controlled study of 33 individuals over a 16- day period suggested that the onset, quality, depth, and duration of sleep can be supported by melatonin supplementation without the occurrence of daytime drowsiness or adverse effects* [2]. In addition to supporting sleep, research suggests that melatonin supports antioxidant activity, cardiovascular health, and immune function* [11, 17, 22].

Melatonin and sleep 

Melatonin has more to do with the timing of when we fall asleep, rather than the thing that keeps us asleep for the whole night. In other words, melatonin is part of the vitally important time-keeping function in the body, the circadian rhythm. And although melatonin can be released in bone marrow, platelets, gastrointestinal tract, eyes, skin, and lymphocytes, it is primarily regulated by the pineal gland (just behind your forehead). When all is functioning well, a big dose of it is released shortly before bedtime, hopefully putting us to sleep [33]. However, there are a number of things that can go wrong with that system due to our modern lifestyle.

One of these obstacles is light exposure. We evolved to respond to sunrise and sunset, with the big burst of melatonin coming on roughly 2-3 hours after sunset, making us feel sleepy. For example, if the sun sets at 7:00 PM, then our bodies would want us to go to bed by 10:00 PM. Living far north of the equator, however, the sun may set before 5 PM in winter and after 9 PM in summer. That's usually not a problem in the summer. However, in winter, that early sunset may encourage sleep at around 7 or 8 PM. Most people don’t go to bed that early and since melatonin’s effect wears off after 2-3 hours, it's common to get a second wind right at bedtime.

Artificial light presents an even bigger problem Even a brief exposure to light at around 9 or 10 PM may push back our natural melatonin release by a couple of hours, meaning that we might miss nature’s cue to go to sleep.

CBD and sleep 

Most research on cannabidiol (CBD) has looked at its possible benefits for anxiety disorders, perceived stress, and more general feelings of anxiousness. This research is helpful for sleep concerns, considering stress and anxiety-related sleep disruption is quite common. Past research reporting CBD applications for sleep have lacked quality, likely a factor in why some results seem to be mixed [5]. However, more recent and sound research for the use of CBD for specific sleep concerns looks very promising [1, 5, 18, 24, 32, 35].

At this point, research most solidly points to CBD as a support for stress and anxiety-related sleep concerns. This application is also supported by current evidence indicating CBD's us for anxiety-related concerns [1, 3, 7, 8, 10, 12, 31, 32].

CBD and melatonin together

CBD may support sleep disruption through the night, whereas melatonin can support sleep onset. This combination may work to support overall sleep (head to this article for more on sleep and CBD). Interestingly, some individuals may find CBD makes them more alert, but without increased anxiousness [25]. In these individuals, using CBD at night may negatively impact sleep, whereas use earlier in the day may support sleep. This phenomena is why melatonin in combination with CBD used at night and over a short-term period may address more substantial sleep concerns as melatonin may offset the wake-inducing effects of CBD. 

Melatonin is Likely Not a Long-Term Solution

Melatonin should generally only be used for short term sleep “resets” over a few nights or a few weeks. After that, it can be used more sporadically, as needed, or again after a period of time to reestablish a sleep schedule. That's the case when it's combined with CBD as well. Occasionally, melatonin can be used more consistently for longer periods of time when under the guidance of a qualified healthcare practitioner (of course, it's important to check with your doctor/pediatrician before starting any supplement, including short-term use of melatonin).

Why can't it be used long-term? For most of us and most of the time, melatonin is produced by the body and doesn't need our assistance. However, screwy schedules, late-night device use, time changes, and other scenarios may cause melatonin disruption. Melatonin supplementation can then serve as a cue for the body to recalibrate. However, extended use lets the body off the hook for production and melatonin production can be disrupted. This can result in a rebound of wakefulness as the effects of the melatonin supplement wear off and the body's natural production drops. That’s why melatonin supplements should really only be used occasionally, and while working on the other reasons for being unable to fall asleep (e.g., handling stress in more healthy ways).

Folks who may feel it necessary to take melatonin more frequently are genuine night owls or those who work rotating or night shifts that don't allow them to sleep until their natural waking time. 

So, once a more normal sleep schedule is established, then it's likely wise to reduce the melatonin amount over a period of a week until the melatonin/CBD product is completely removed. A CBD product could then be moved earlier in the day and as needed to address stress and general anxiousness, in effect likely supporting sleep as well.

CBD Dosage and Use

It's important to not there is no established dosage for CBD and individuals may respond quite differently to different dosages. However, a common dose range for CBD in adults is 15-30 mg daily. With some conditions, such as those involving pain or inflammation, the recommended dose is often higher, but it seems to be best-tolerated and most effective for anxiety, sleep, and mood in this moderate range. 

After discussing with a doctor, look for a high quality, broad-spectrum, all natural, non-GMO hemp product that is THC-free (i.e. measures less than 0.3% THC). Avoiding THC is particularly important for some individuals looking to support anxiousness or for sleep concerns as THC may increase anxiety for some individuals and long-term THC use is associated with sleep disruption [31]. CBD is commonly take in doses of 10-15 mg twice times daily, with or without meals, or in a single dose of 20-30 mg daily. 

Melatonin Dosage and Use

As noted, melatonin is primarily used to help reset the onset of sleep for those who've gotten off schedule, or if the normal sleep cues are not working for some reason. Studies, including meta-analyses, suggest that melatonin supplementation supports desirable sleep patterns in certain individuals, including the elderly and those who have unusual work hours, such as night shift workers or people traveling across time zones [13, 15, 19, 27, 28, 34] A review of 10 trials suggests that melatonin supplementation helped support sleep patterns in individuals crossing time zones; subjects included airline passengers, airline staff, and military personnel. Daily doses between 0.5 mg to 5 mg taken at bedtime were used and found to be similarly supportive; however, the effects were greater at the higher dose. According to this review, doses higher than 5 mg do not appear to demonstrate any increased benefit* [14]. 

Melatonin is usually recommended in a sublingual form, which are forms meant to dissolve under the tongue rather than swallow it (e.g., Lights Out Quick, which is a 2.5 mg dose). Those forms works much faster and are better absorbed because they don't have to be digested and make their way through the liver—it goes directly into the bloodstream. These forms are ideal as well because they can be used shortly before bed and only when it's evident that falling asleep may be a struggle.

Combination melatonin/cbd products are generally in gummy form, and are often taken 30-60 minutes before desired bedtime.

CBD Side Effects 

As noted, CBD is generally considered well-tolerated. However, CBD can cause side effects. These side effects can be more confusing given the unreliability of the purity and dosage of CBD in products (which is why purchasing a high-quality product is essential). 

Side effects of CBD may inlude:

  • Drowsiness
  • Dizziness and lightheadedness
  • Dry Mouth
  • Diarrhea
  • Increased Appetite 
  • Lowered blood pressure

The most common side effect is very mild sedation, though that is usually not a problem for those with high anxiety, and may be a welcome effect for those with sleep troubles. Like most things that are calming, adding CBD to other sedating medications, or combining CBD with alcohol, may cause excess sedation. 

There is too little information about the safety of CBD during pregnancy or while breastfeeding, so it is not recommended. 

CBD Interactions

Research suggests many side effects that occur with CBD use are likely the result of drug-to-drug interactions between CBD and other medications an individual may be taking. That's why it's so important to speak with your doctor before starting any supplement, and this is particularly true with CBD.

Here's how these interactions occur: CBD is broken down by the body via the same pathway as many prescription drugs. If multiple compounds are competing in this pathway (e.g., CBD and a prescription drug), then something called "altered concentration" can occur. This means that too little or too much of the drug is left in the body. When too little remains, a drug may no longer work as intended. When too much remains, side effects may increase. Penn State College of Medicine has a really handy list of medications that may be impacted by altered concentration due to a combination with cannabinoids. Unfortunately, this list does not make any distinctions between CBD or THC, but it provides some guidance. Bring this list to your doctor before starting any CBD product.  

Penn State also found potentially serious interactions between prescription CBD and THC products and the following products:

  • Warfarin and other blood thinners
  • Amiodarone (heart medication)
  • Levothyroxine (thyroid medication)
  • Seizure medications (clobazam, lamotrigine, valproate)

Melatonin Side Effects

Melatonin is generally considered very safe, even at high doses (e.g., 10 mg, though as noted earlier, anything over 5 mg seems to be unhelpful). Melatonin is also non-habit forming. However, anything that is routinely taken for sleep can become a habit that is hard to break, even if it is technically not addicting.

 Some folks who take melatonin frequently may find that they begin to wake up after 3-4 hours. This might be a rebound of wakefulness as the effects of melatonin wear off. As noted above, that’s why melatonin supplements should really only be used occasionally, and while working on the other reasons for being unable to fall asleep (e.g, handling stress in more healthy ways).

As with any supplement, melatonin supplements can interact with various medications, including: Anticoagulants and anti-platelet drugs, anticonvulsants, contraceptive, diabetes medications, and immunosuppressants. As we always say around here, be sure to check with your doctor before adding any supplement.

CBD Supplements at Natural Mental Health

  • CBD Sleep is a blend of broad-spectrum CBD (30 mg per serving) combined with 5 mg of CBN (cannabinol) and 3 mg of melatonin. CBN is a form of phytocannabinoid shown to be more specifically helpful for sleep, and melatonin is nature’s internal timekeeper, helping set a more consistent bedtime. CBD Sleep may improve a variety of challenging sleep issues, and is especially helpful for those who have trouble falling asleep. 

  •  CBD Calm combines 30 mg of broad-spectrum CBD with 200 mg of l-theanine, an amino acid that can also help reduce anxiety and stabilize mood. Together, they may improve stress resilience and calm anxiety without sedation. Taken at bedtime, CBD Calm may also be helpful for those who tend to wake in the middle of the night. 

 

*These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease. Note: Some of the supplements discussed in this article can cause side effects, but many people tolerate them much better than prescription medications. They are generally considered safe, however, they should not be started without your doctor’s knowledge and supervision. If you are taking medication already, be sure to talk with your doctor before adding any of these items. If you are considering going off medication, remember never to stop your medication suddenly—always consult with your doctor about how to safely taper off any psychiatric medication. See termsThese statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.

 

 


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