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13/Aug/2022

Cannabinoid therapy for sleep

I have noticed consistently good results using cannabinoids for sleep disorders. I am often asked what are the top indications for cannabis therapy in my practice and insomnia would always be in the top three.

I first started to gain an interest in cannabis and cannabinoids back in 2015. One of the most common reasons that my patients were using cannabis was for various types of insomnia. Most of these patients were having very good results. That really peaked my interest because I too suffered from insomnia for a large part of my life.

I had used various natural sleep aids but needed a change as my current medication was producing some inconvenient side effects. After receiving my medical cannabis prescription I started using a balanced THC:CBD oil which improved my sleep latency and nighttime wakeup’s within a few days. Cannabinoid therapy is now one of my most recommended treatments for various types of insomnia as it is safe, inexpensive, fast acting and effective.

Cannabis can have calming or stimulating effects depending on the preparation, dose and mode of administration. I really wanted to find out what made cannabis effective for sleep and what would be the optimal way to use it for sleep. My research pointed towards a few mechanisms through which cannabinoids likely have sleep promoting effects: GABA, Serotonin and Endocannabinoid modulation.

GABA

GABA is an inhibitory neurotransmitter that generally promotes a relaxation response in the central and peripheral nervous system. It is well established that activation of GABA receptors favours sleep and many pharmaceutical drug classes, including benzodiazepines, act on GABA receptors.

Both animal and human studies have demonstrated that cannabidiol (CBD) has a modulatory effect on GABA activity. CBD can both increase and decrease GABA activity depending on neurotransmitter activity levels (if there’s too little it increases, if there is too much it decreases). This makes CBD useful for sleep disorders resulting from too little GABA activity (think of the overactive brain) without the addictive potential of GABA stimulating pharmaceutical preparations.

Serotonin

Serotonin is a neurotransmitter that is involved in mood and sleep/wake responses. Many antidepressant medications specifically target serotonin activity. Research from the early 2000’s by Bambico et al demonstrated that cannabinoid receptor agonists (things that stimulate cannabinoid receptors) have the ability to modulate serotonin activity. Low doses seemingly to raise serotonin activity while high doses have little effect.

Both endogenous cannabinoids (cannabinoids we make ourselves) and phytocannabinoids (THC, CBD etc..) seem to have the ability to modulate serotonin activity via stimulation of our cannabinoid receptors. This may explain some of the physiology involved in the sleep promotion and anti-anxiety effects of cannabis preparations. CBD seems to be particularly useful through its interplay with our endocannabinoid system.

The Endocannabinoid System

All species, with the exception of insects, have an endocannabinoid system. The endocannabinoid system is our bodies harm reduction system, keeping chemical and electrical singling in balance. Overall, stimulation of the endocannabinoid system has a calming effect and a known modulator of our sleep/wake cycle.

Many chronic diseases that have been linked to disruption in the endocannabinoid system (Fibromyalgia, Migraine, Inflammatory Bowel Disorder) have a sleep disruption comorbidity. This sleep disruption can usually be helped with a prescription of cannabinoids such as CBD. It is certainly plausible and empirical evidence supports the theory that patients with sleep disorders have endocannabinoid disruption. Therefore, phystocannabinoids like CBD can be helpful to restore endocannabinoid tone and subsequently better sleep.

Dosing Considerations

Cannabis is a unique medicine as it cannot be prescribed based on age and weight. Everyone has an individual response to cannabinoids due to the fact that everyone has unique  endocannabinoid tone and metabolism.

Cannabinoids like CBD and THC can interact with particular medications and preexisting conditions. Some preparations of cannabis are very different in their effect and duration. Smoked cannabis has a very fast acting effect but a short duration. Edible cannabis can have a slow onset of effect but last for a long time.

Therefore it is highly recommended to have a healthcare professional knowledgeable in cannabinoid therapy work with you for the initial stages of treatment. This will ensure a safe and effective dosing strategy with minimal chance for adverse effects. With that being said cannabis is a very safe medication and when prescribed correctly can make a significant difference in those suffering from sleep disorders. Check out the Cannabis Therapy page for more information.

References

Pretzsch CM, Freyberg J, Voinescu B, Lythgoe D, Horder J, Mendez MA, Wichers R, Ajram L, Ivin G, Heasman M, Edden RAE, Williams S, Murphy DGM, Daly E, McAlonan GM. Effects of cannabidiol on brain excitation and inhibition systems; a randomised placebo-controlled single dose trial during magnetic resonance spectroscopy in adults with and without autism spectrum disorder. Neuropsychopharmacology. 2019 Jul;44(8):1398-1405. doi: 10.1038/s41386-019-0333-8. Epub 2019 Feb 6. PMID: 30758329; PMCID: PMC6784992.

Gottesmann C. GABA mechanisms and sleep. Neuroscience. 2002;111(2):231-9. doi: 10.1016/s0306-4522(02)00034-9. PMID: 11983310.

Moreira FA. Serotonin, the prefrontal cortex, and the antidepressant-like effect of cannabinoids. J Neurosci. 2007 Dec 5;27(49):13369-70. doi: 10.1523/JNEUROSCI.4867-07.2007. PMID: 18057193; PMCID: PMC6673093.

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09/Oct/2019

Intro to Afghan Kush

I chose to review Pure Farms Afghan Kush because it is a best seller on the Ontario Cannabis Store and because it’s a genetically pure strain. Kush originated in Hindu Kush mountain region sandwiched between Afghanistan and Pakistan. Geographically, Afghan Kush is therefore pretty much as authentic as you can get. In fact, Pure Farms notes that this strain is the building block for many modern Kush varieties. 

Pure Farms Afghan Kush is a medium to high potency Indica. The Farm is located in British Columbia. They have been cultivating for 25 years. The cannabis is grown in a modern green house facility with natural light and modern app-based quality assurance systems. 

Cannabis Buds

Appearance

The batch that I sampled was around 18% THC (mid-high potency) but it can land anywhere between 16-22%.  When I took out my first bud I could see that it was heavily frosted with trichomes. I was also struck by the vibrant green color of the bud, which is an indication of its freshness and lack of oxidation. The texture was a bit drier than I prefer but the smoke was not harsh and very flavorful. 

Smell Test

Immediately after opening the package I took a good whiff of the buds. The aroma was pleasant with definite floral and earthy notes. I knew right away that Myrcene and Linalool would be two prominent terpenes in this strain. I was able to confirm that Linalool and Myrcene were indeed part of this varieties profile, along with Nerolidol, Caryophyllene and Limonene (OCS.ca). Linalool and Myrcene are typically associated with relaxation, so I knew, even before smoking, that this would probably be a very relaxing strain. 

Naturopathic Treatment for Multiple Sclerosis

The experience

I took 3 draws of the Afghan Kush from a joint. The effects started within 5-10 minutes and peaked around 45 minutes after smoking. The primary sensation was a nice enjoyable relaxation throughout the body and head. I would say that the body effect was not as potent as some other Indica’s that I have tried (see my review of MK Ultra). The high felt very clean and authentic, like I was transported back in time to when the first Indica strains were being cultivated. Despite the relatively high THC content there was no paranoia. I did develop a slight headache, and dizziness toward the end of the high (might have just taken a bit too much).  Initially the experience wasn’t very sedating; however, towards the end I did feel quite sleepy. Therefore I would recommend this as an evening/night strain, not ideal for daytime use. 

Final Thoughts

I recommend this strain to the cannabis connoisseur and those interested in trying something with a great deal of authenticity. I could also see this strain being helpful for tight sore muscles and issues with sleep and stress. Even if it was primarily a placebo effect, I enjoyed feeling connected to the roots of cannabis cultivation through this very authentic Indica.

https://youtu.be/zXiljCm2yoU

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23/Aug/2017

Relax an let go

We need to learn how to relax. Many great spiritual teachings and teachers have at some point arrived at a similar insight. At its essence it’s the importance of relaxation and letting go. A Chinese proverb states “Tension is who you think you should be, relaxation is who you are”.  We spend an awful lot of time in a state of tension and many believe this to be a productive state, describing it as “good stress”. In reality, tension of the body and mind is a great inhibitor of creative thought and positive emotions.

 

Recently I underwent a quest of sorts with a good friend of mine in the wilderness of northern Ontario. We were both very lucky to have walked away from that experience with several insights. The most important lesson was that ones true self and ones ability to act with creativity, love and insight is most possible when the mind is able to let go and the body is able to relax.

 

Health

It is a fact that stress can negatively impact health if left unchecked. Stress affects the body, mood and behavior; it can cause headache, fatigue, insomnia, anxiety, depression and overeating. A Japanese study from 2002 examined 73,000 Japanese men and women, age 40-79, for two years. Men and women who reported a high level of perceived mental stress had between a 1.5 and 2 fold increase in the risk of stroke and congestive heart disease. [1]

 

In Kompier and Coopers 1999 publication, “Preventing Stress, increasing productivity: European case studies in the workplace”, the impact of stress related illness in the UK is estimated at an economic cost of 2.5-10 percent of the gross national product, with an estimated 30 million days lost due to stress related illness every year.[2] One can easily see that stress is an impeder rather than a supporter of productivity. Kompier and Coopers publication outlines a very technical analysis of strategies for preventing stress in the workplace; however, as a healthcare practitioner I see and understand the need for a simplified strategy that one can implement anywhere and at anytime.

Training

Thus I return to the idea expressed at the beginning of this article, namely to relax and let go. I can predict that many of you reading this are probably muttering to yourself “easier said than done” or something along that line, and you would be absolutely correct; it is! Experience has taught me that in order for the mantra “relax and let go” to stick it helps to have experienced a prolonged state of mental and physical stillness, awareness,  or expanded consciousness. By sampling an elevated state of being one is able to better understand the benefit of a stilled mind and better equipped to return to awareness. Unfortunately it is one of those things that as Morpheus told Neo “you must see… for yourself”.

 

Many of you that have practiced meditation, living in the moment or even a transcendental occurrence through a near death experience or psychedelics may have a sense of what I am talking about. For the rest, step one is to capture a moment of stillness in order to sew the seed of relaxed awareness. For this I can suggest a few things:

  1. Go into nature (nature emits a certain vibration that facilitates meditation, or at least filters out the hustle and bustle of modern mechanistic living).
  2. Practice meditation (for centuries this has been the primary tool used to quiet and focus the mind and body)
  3. Practice a paradigm shift (try to gain a new perspective on yourself and life by pondering a night sky, life itself and trying to live within the moment).
  4. Respectfully and responsibly participate in a traditional healing ceremony (A sweat lodge or a ceremony incorporating herbal medicine, often psychedelics, is a centuries old practice traditionally lead through ritual. Psychedelics are traditionally used to promote expansion of consciousness and are gaining favor in modern medicine as possible treatment for PTSD and depression.)  http://www.mwikwedong.com/?page_id=131 http://www.rollingstone.com/culture/features/how-doctors-treat-mental-illness-with-psychedelic-drugs-w470673

In order to train a muscle to act in a certain way you must implement repetition, a process known as muscle memory. It is the same with the mind, in order to train the mind to relax and let go you must repeatedly remind yourself to do this. I want to clarify that it is possible to practice this without prior experience in achieving states of expanded consciousness, it is just more difficult to maintain because you may lack the frame of reference as to what to return to and why to return to it. The persistent reminding of yourself to relax and let go may be facilitated with a strategy such as setting an alert on a phone, calendar or clock every 30 or 60 minutes. Ultimately you will find a method that works best for you.

 

The take away message from this discussion is that we can all be more productive, better listeners, more creative, more loving and more aware when we relax and let go. The “relax and let go method” is simple and can be practiced anywhere, you just simply have to remind yourself to relax and let go. It helps when you have a frame of reference as to what a truly relaxed state of mind and body is; however, it’s not necessary and with enough practice you will get there. There is no trying with this method, it is in essence the complete opposite of trying, one just has to remember, over and over, to relax and let go, relax and let go. https://www.doctorshawn.ca/about-me/

[1] https://doi.org/10.1161/01.CIR.0000028145.58654.41

Circulation. 2002;106:1229-1236

Originally published August 12, 2002

 

[2] https://books.google.ca/books?id=OFsSz45OxewC&lpg=PR11&ots=S64R_GVnY2&dq=stress%20and%20productivity%20in%20the%20workplace&lr&pg=PP1#v=onepage&q=stress%20and%20productivity%20in%20the%20workplace&f=false


dr_shawn

Patient focused integrative health care. Utilizing effective natural approaches designed to be used alone or to compliment conventional medical care.


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