Tips for restful sleep: CBD, melatonin, red light or the Sleepy Girl Mocktail?

Cannabidiol (CBD) is the second most important cannabinoid derived from Indian hemp (cannabis sativa), after tetrahydrocannabinol (THC). Unlike THC, well known for its psychotropic effects and the famous high sought by some people, CBD does not produce a euphoric effect. On the contrary, it is said to have a calming effect in many people, reducing anxiety and stress – effects that are a priori desirable for helping them fall asleep and stay asleep longer. CBD concentrations vary widely in cannabis sold on the black market. However, purified preparations with a concentration displayed on the label can be obtained with a medical prescription. For example, Epidiolex is prescribed to treat certain forms of refractory epilepsy. For recreational use, products containing CBD, such as oils with variable concentrations, are available from places such as the Société québécoise du cannabis (SQDC).

Despite hundreds of studies on the subject, science has yet to establish with certainty whether CBD is beneficial for sleep. In an interview in 2021,[1] Dr. Didier Jutras-Aswad of the CHUM correctly pointed out that the formulations available to aid sleep are far less concentrated (20 to 50 times less) than those used to treat refractory epilepsy. As a result, it is quite possible that consumers do not feel any beneficial effect on their sleep.

This is even truer for cannabis itself: Not only do THC and CBD levels vary considerably from one source to another, but according to some studies, users run the risk of developing a sleep disorder or reducing the quality of their sleep when they try to stop using it.[2]

Melatonin, also known as the “sleep hormone,” is secreted by the pineal gland, a small gland found in the brain. It is mainly produced during periods of darkness and plays a crucial role in the functioning of our internal clock, which regulates our sleep and wake cycles over 24 hours (circadian rhythm). In addition to its effects on sleep, melatonin influences the secretion of female hormones and helps regulate menstrual cycles.[3] It is thought to have anti-aging properties and play a protective role against neurodegeneration associated with diseases such as Alzheimer’s and Parkinson’s.

Melatonin, especially when taken as a supplement, is recognized for its beneficial effects in adapting to time changes and jet lag. Its effects are also well documented in treating syndromes of delayed or advanced sleep phase, such as delayed falling asleep and waking up, or early evening sleepiness and very early morning awakening.[4,5] Although melatonin is effective in reducing the time required to fall asleep, its effect on the total duration and quality of sleep is limited.

Melatonin is available in Canada in hundreds of pharmaceutical preparations, with DIN numbers, as well as in natural products. The doses available are generally much higher than the daily requirement, which can make it difficult to decide on the best time to take melatonin. Recently, sustained-release or timed-release melatonin formulations have also become available, which helps improve sleep.

Melatonin production is highest in the absence of daylight. This means that external light can disrupt the secretion of melatonin late into the evening. Light (or the absence of it) is detected by our retina, even when our eyes are closed, and this information is sent directly to the brain (pineal gland) to stimulate or stop melatonin production. For this reason, some sleep hygiene guidelines recommend avoiding interaction with screens and keeping your bedroom dark.

Daylight can be broken down into the various colours visible in a rainbow. Natural blue light, or the light emitted by screens or cool-white LED devices, interferes most with melatonin production. Red light, on the other hand, interferes least with the sleep cycle. In the absence of total darkness, exposure to red light, such as when the sun goes down, could have beneficial effects. This is the principle behind devices that give off red light to help you sleep.

Despite certain claims by some manufacturers and distributors of these devices, no respectable scientific study has been able to prove the efficacy of red light on the quality of sleep.[6] However, some patients report a significant improvement in their sleep after using these devices. A variety of models are available on the internet, ranging in price from tens of dollars to more than $300.

Magnesium, which is involved in building bones and many cellular reactions, is an essential mineral for the body to function properly. According to Health Canada, more than 40% of Canadians are magnesium deficient, often due to medications such as diuretics and antacids, or a diet low in magnesium-rich foods such as leafy green vegetables, legumes, nuts, whole grains and fermented foods.[7] Magnesium deficiency can lead to irritability, muscle weakness and an irregular heartbeat.

Since the 1990s, multiple researchers have established a two-way link between magnesium levels and stress, resulting in a vicious circle. Magnesium is said to have an inhibiting effect on the natural stress response, while stress, in turn, causes the body to lose magnesium.[8]

With stress being one of the causes of sleep problems, it is not surprising that magnesium supplements are regularly recommended as a sleep aid.

In addition to food sources, magnesium is available in numerous natural products sold by pharmacies and other retailers.[9]

For ages, calming herbal teas have been used to help people relax and get a good night’s sleep. Lime blossom, chamomile, orange blossom, vervain, passionflower and lemon balm are all plants renowned for their relaxing and calming properties that promote sleep. However, the complexity of the molecules and the diversity of the products available make it virtually impossible to conduct a respectable scientific study on the virtues of phytotherapy. The helpfulness of herbal teas is broadly confirmed by the long history of their use, especially since they are usually harmless in the recommended dose.

Recently, a new recipe for a sleep-inducing, alcohol-free cocktail was posted on TikTok and quickly went viral on social networks.[10] The Sleepy Girl Mocktail is based on tart cherry juice (made from Morello cherries) and powdered magnesium salt mixed with sparkling water or lemon-lime sparkling water. This drink therefore combines a little extra melatonin and magnesium, without alcohol, which is important because alcohol is contraindicated for sleep. Apart from those who worry about drinking a substantial amount of liquid just before bedtime, this alcohol-free cocktail is unlikely to interfere with sleep, although it is not guaranteed to promote sleep for all users.

More than half of all people have few or no problems with their sleep. For the other half, any solution that could help them would be welcome.

The first group of solutions on offer involves good sleep hygiene.[11]

• Avoid stimulants such as alcohol, caffeine, nicotine or intense exercise near bedtime.
• Relax as your bedtime approaches by reading, listening to music, or taking a bath that is not too hot, and stop interacting with your electronic devices (smartphones, computers, TVs).
• Learn to recognize the signs of sleepiness, such as mid-evening chills or heavy eyelids.
• Keep your bedroom quiet, dark and comfortable.
• If it takes long to fall asleep (more than 20 minutes), get up and do a monotonous or repetitive activity that requires no physical effort, but rather mental effort (e.g. reading, crossword puzzles, sudoku). Return to bed when you feel sleepy.
• Go to bed and wake up at the same time every day.

Everyone is of course free to complete this sleep hygiene with one of the many techniques proposed. It is important to remember, however, that in almost all cases, scientific studies have not confirmed their efficacy. That being said, many people still find these techniques beneficial for themselves, if only because of a placebo effect. However, some of these substances can have serious side-effects if recommended doses are exceeded:

• CBD: Drowsiness the next day, which can be dangerous for driving or using tools; weight loss, digestive problems, etc.[12]
• Melatonin: Risk of headaches or temporary depression[13]

CBD and melatonin may interact with other prescription drugs. Consequently, it is advisable to consult a healthcare professional, especially a pharmacist, for the right advice. It is also important to note that, according to some studies, stopping cannabis use can lead to sleep disorders or impair sleep quality.

As for other products such as red light, herbal teas or the Sleepy Girl Mocktail, the risks are minimal, with the possible exception of their impact on your budget.