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Rest & Sleep

Sleep & Rest

Sleep issues have been more prevalent than ever since the start of the pandemic. The natural products industry offers supplements that can help patients get the sleep they need.

“Go to bed, you’ll feel better tomorrow” is the human version of “Did you try turning it off and on again?” Although it is unknown who stated this quote, there is an element of truth in it. Sleep can be a form of reset in itself. Getting enough sleep is one of the most important things we can do to maintain our health. When our sleep suffers, our overall wellbeing, both mentally and physically, suffers as well.

The COVID-19 pandemic in particular has had a detrimental impact on quality of sleep for many people. According to an article published on the National Library of Medicine (NIH) website, titled “Sleep problems during the COVID-19 pandemic by population: a systematic review and meta-analysis,” “The prevalence of sleep problems during the COVID-19 pandemic is high and affects approximately 40 [percent] of people from the general and health care populations. Patients with active COVID-19 appeared to have a higher prevalence rate of sleep problems.” The stress caused by the unknown surrounding the virus, along with having to socially isolate and stay at home more, has impacted sleep for many.

Laura Fuentes, RPh, CEO and co-founder of Green Roads located in Deerfield Beach, FL, offered additional insight into the impact of COVID-19 on sleep. “Certain studies indicate that Americans are struggling with sleep more prevalently now in connection with the pandemic and quarantine,” she said. “Even though we might be past the worst of it, there are stressors now that weren’t present five or 10 years ago. People sacrificed so many opportunities to earn and learn, front line workers worked exhaustively to keep the country going, we all gave up things like holiday celebrations and family gatherings that give life its richness, and some of us lost people we care about. The stress caused by the last year will linger for a while.” With stress being such a significant contributor to lack of sleep, it comes as no surprise that the pandemic has had such a significant impact.

Even before the population was stricken with the COVID-19 crisis, sleep issues have been a significant plight faced by millions. Andrew Simon, ND, BCB, naturopathic physician and clinical supervisor at Bastyr Center for Natural Health (BCNH) in Seattle, WA, noted that “Nearly 50 to 70 million U.S. adults have a sleep disorder according to sleepassociation.org, with 25 million U.S. adults having sleep apnea.” He listed some of the main causes of sleep issues as: “Restless leg syndrome or irresistible urge to move the legs; hormonal changes and related symptoms (i.e., hot flashes, night sweats); reduced ability to handle stress (i.e., depression, anxiety); sleep disordered breathing (i.e., snoring, sleep apnea); weight gain; reduced physical activity; chronic pain (i.e., arthritis, fibromyalgia, muscle spasms); medical conditions (i.e., low ferritin, hypothyroid, hyperthyroid); and medication induced sleep disorders.”

There are countless reasons why a person may not be getting the quality sleep that they need, or the number of hours they need—and there is hardly a difference in the prevalence of this issue among age populations, Dr. Simon noted. “37 [percent] of 20-39 year-olds report short sleep duration, while 40 [percent] of 40-59 year-olds report short sleep duration. When paired with many individuals working more than one job, going to school and increased use of technology, the need for focus on sleep health is strong.”

Jen Palmer, ND, director of education at Charlotte’s Web (Boulder, CO), pointed out that often, we create our own problems when it comes to sleep, “by drinking caffeinated drinks too late in the day, using certain medications or consuming alcohol, which disrupts REM sleep.” However, in concurrence with Dr. Simon, Dr. Palmer also noted that “It’s important to identify the root cause of sleep disturbance in patients, but health care practitioners find that stress and anxiety tend to be the most common sources.” In the modern era, many people’s lives have become increasingly more fast-paced and busy, with many individuals working long hours or multiple jobs, taking care of children and taking care of the household all at once. Coupled with the stress caused by the pandemic, it’s no wonder why sleep issues are as prevalent as ever.

Trends/State of the Market

Due to the steady increase of sleep issues across the U.S. and the world, the need for solutions is continuously growing. Traditionally, pharmaceutical medications have often been used. Dr. Simon stated that “Classically, sleep medications like Ambien, Trazadone, antidepressants or even anti-anxiety medications like benzodiazepines are commonly used. While these are helpful medications for some patients, they can be habit forming or cause other unwanted side effects if used habitually or have major interactions that people are tired of.” Thus, many have turned to more natural solutions for treating their sleep problems.

According to Richard Barnes, founder of Slumber Sleep Aid (Denver, CO), “The need for natural sleep aids is growing rapidly. Sleep issues are not going away, and wellness and self-care are priorities. Hemp-based sleep aids offer the safest sleep supplement options as it relates to effectiveness and no side effects. Our sales have been growing at about 15 percent per month.” He also noted that, besides COVID-19, geo-political unrest and elections have also contributed to sleep problems. “We are bombarded by too much information and the smart phone and tablet addiction will reinforce an already growing issue,” he said. As far as age discrepancies, Barnes stated that the younger generation is plagued by sensitivity to stress and inability to cope, while Baby Boomers often suffer from chronic illness and pain, all of which make sleeping difficult.

Chase Twerwilliger, CEO of Balanced Health Botanicals (parent company to CBDistillery and BOTA) located in Denver, CO, stated that “According to data from a 2020 CRN (Council for Responsible Nutrition) Consumer Survey on Dietary Supplements, 13 percent of overall users take supplements to support their mental health and 14 percent of users take supplements to support sleep. These findings show an increased need for safe and natural supplements to help consumers get to sleep and stay asleep.” In addition, he noted that “In a 2020 survey conducted by OnePoll on behalf of CBDistillery, 54 percent of respondents noted their top influencer to try CBD amidst this pandemic was due to trouble sleeping. This shows that the pandemic severely impacted sleep schedules, and people are looking for solutions.” With the aftereffects of the pandemic likely to be ongoing for quite a while, there will be no shortage of need for natural supplements to aid consumers with sleep.

Natural Products to Improve Sleep

There are a number of effective products on the market that practitioners can recommend to their patients to improve their sleep. According to Dr. Simon, “Some herbs can assist in calming the nervous system such as passionflower, lavender, valerian and California poppy.” He continued, “When combined with mind body medicine, sleep hygiene, turning off lights, and removing electronic devices from the bedroom, these can be great places to start before considering medications.” Medications, he said, often include diphenhydramine, an antihistamine that can cause sleepiness, as well as magnesium, glycine, GABA or L-theanine, which can have stronger effects and should be closely monitored for interactions.

As far as supplements, Dr. Simon noted that “Most supplements work on calming nervous system activity, slowing down receptor activation in the brain such as the GABA receptors. Some nutrients assist in decreasing muscle tension or pain such as magnesium. When paired with the right sleep hygiene environment, that may be all it takes to assist with sleep.” He also said that, when used appropriately, herbs and nutrients for sleep can be used safely and effectively, so long as the patient practices a strong routine to support their sleep. However, he also warned that “as with any supplement, good safety data and research is needed to refine the value of these products in more population groups so they can be used without interaction.” Certain ingredient interactions can occur and cause safety concerns for users, so it is important to conduct studies to ensure the efficacy and safety of every product on the market.

Sara LeBrun-Blashka, MS, director of clinical nutrition and education at Standard Process (Palmyra, WI), shared a list of common nutrients that offer positive sleep outcomes: Magnesium, vitamin C, B vitamins, kava kava, turmeric, ashwagandha, lavender and passionflower. With this in mind, Standard Process created supplements that utilize the impact of these nutrients for sleep issues. The company offers four products to aid patients with sleep. “E-Z Mg is a plant-based, multiform organic magnesium supplement developed to support patients with inadequate dietary magnesium intake. Min Tran is a vegetarian product that contains mineral complexes to support emotional balance and a healthy nervous system …[it is] a mild calmative that helps maintain emotional balance [and] helps ease the effects of temporary stress. Kava Forte contains kava root extracted with 100 percent water to promote relaxation and calm the nerves. Valerian Complex contains valerian, passionflower and jujube seed to promote relaxation and sleep.” Standard Process is a vertically integrated company, which allows it to manage the quality, safety, consistency, potency and purity of its products from raw materials handling to packaging and shipping to ensure quality and safety for consumers.

Terwilliger shared a few of CBDistillery’s cannabidiol (CBD) and cannabinol (CBN) products that can aid patients with their sleep. Research, he said, has found that CBN can help to improve sleep. “Animal studies suggest that CBN’s interaction with CB2 receptors helps improve sleep and sleep duration,” he said. With this in mind, the company offers 30 mg Broad Spectrum CBD Sleep Gummies + Melatonin, which “are specifically formulated for nighttime use. Each 30 mg supplement is paired with just enough melatonin (2 mg) to help [patients] fall asleep easily and naturally, so [they] wake up feeling refreshed.” The company also offers Extra Strength CBN + CBD Sleep Tincture 1:3, “which is considerably more potent than our other CBN tincture. Each 30 ml bottle contains 300 mg of CBN and 900 mg of CBD. Each 1 ml serving gives you 10 mg of CBN and 30 mg of CBD.”

Also speaking about CBD, Dr. Palmer explained that “CBD from a full spectrum hemp extract can help support normal consistent sleep cycles, but not because it’s a sedative on its own. It doesn’t cause drowsiness when used during the day, in contrast to the effects of sedating pills like valerian or prescription sleep medications. But it can help reduce occasional anxiety and help a stressed patient relax, thereby minimizing the two most common complaints causing sleep disturbance.” She referenced a number of studies, including one published in Frontiers in Psychology in 2019, which showed that “CBD works so well for occasional anxiety that it was demonstrated to reduce anxiety in teenagers with social anxiety tendencies.” In addition, “Another study published in Neuropsychopharmacology, 2011, showed that taking CBD prior to a public speaking event helped support a sense of calm for the speakers, and supported normal heart rate and blood pressure during the activity as compared to the participants who took a placebo.” As a result, Charlotte’s Web offers Sleep Gummies, which “offer 10 mg hemp-derived CBD per two gummies, plus 3 mg melatonin, to support a sense of calm and restful night of sleep.”

Fuentes shared a few products that Green Roads offers, which also contain CBD for sleep. The company offers sleep support in the form of combinations of melatonin, CBD and CBN. She noted that “Melatonin is a part of your sleep cycle, while CBD and CBN help you manage daily stressors, which is an important part of calming down so you can actually get to sleep.” The company offers “Sleep Sweet Oil, a blueberry flavored oil with melatonin, CBD and CBN, offered in a 30 ml bottle or in single-serving ‘Nightly Dose’ sachets; Sleep Capsules, [which are] simple vegan capsules with melatonin and CBD; and Sleepy Zs Gummies, [which are] blackberry gummies with melatonin and CBD.” Like Dr. Simon, she warned that not all lab testing or “pharmacist formulated” products are created equal. She suggests that practitioners “Look for the laboratory’s certification and dig into the company’s background. Some gummies are made in cGMP (current good manufacturing practice)-registered facilities, and others are made in backyard tool sheds. We stand by our CBD products as manufactured from premium, vetted ingredients and double-tested for quality by a third party, certified laboratory.”

Slumber Sleep Aid also uses CBD, CBN and melatonin for their sleep products, according to Barnes. “The CBN molecule interacts with the CB1 and CB2 endocannabinoid receptors. They are an agonist to this receptor and make the body respond by doing several things chemically, including affecting the ATP cycle and balancing ion channels. CBN and THC work similarly, except CBN has no psychoactivity and there is no sense of ‘high,’ just a sense of relaxation,” he explained. “We use a CBN oil formula as a product and it is taken under the tongue. This has the best uptake as it enters the bloodstream directly. Our soft gels and gummies (pectin based) work by ingesting them and being processed through the digestive tract. [Although] it takes a little more time to make it into the bloodstream, [it still] has the same effectiveness.” Slumber Sleep Aid offers its CBN oil tincture and soft gels at 10 mg per dose, while the company’s CBN gummies contain 13 mg per dose. The company also offers a Slumber Pain Relief Stick, as well as a CBN/Delta 8 Relaxation Gummy.

With the need for healthy sleep aid solutions more crucial than ever, companies are responding with high quality processes and ingredients to create the best products possible that patients can trust.

Additional Sleep Solutions

Aside from supplements, there are also products being manufactured to help consumers sleep better. For instance, Pluggerz is a company that has created affordable ear plugs to cancel out disrupting sounds. “Sleep earplugs provide filtered noise without blocking out the sounds you want and need to hear … Pluggerz offers customized hearing protection for the perfect fit, made of hypoallergenic silicone material; These special filters attenuate ambient noise without blocking out important sounds with 3-lamina design for optimal fit; and [they] have unique filters to manage noise to the desired level, while effective communication remains possible.” The ear plugs retail for an affordable price of $9.99 and are suitable for anyone who is impacted by excessive noise when they try to sleep.

In addition, there is The Sleep Shirt, founded by Alexandra Suhner Isenberg. The shirts, which are specifically made for sleeping, are made with Oeko-tex or BCI (Better Cotton Initiative)-certified fabrics from Italy, Japan, Portugal, Switzerland and China. The company also makes “tops, bottoms and pajama sets, most of which can be worn as loungewear, ready-to-wear, as a beach coverup, or even for maternity nursing.” The comfortable, lightweight material of their sleepwear keeps consumers cool, making sleep easier.

Lifestyle Solutions for Better Sleep

Although supplements can help patients sleep on their own, they are even more effective when taken with lifestyle changes. Dr. Simon noted that “One of the coolest and most efficient ways to improve your awareness about the relaxation and sleep response can be biofeedback training paired with mind-body medicine exercises such as breathing, mindfulness, autogenics (self-hypnosis) or progressive muscle relaxation exercises. Improving one’s awareness around the stress response, the effect of cortisol and mental health conditions such as anxiety and PTSD (post-traumatic stress disorder) can have very profound impact on sleep quality and nervous system regulation.” Mindfulness promotes relaxation and stress relief, and can also allow patients to find their balance between personal behavioral success and side effects of treatment, according to Dr. Simon.

According to Fuentes, “Ending time in front of your TV, laptop, smartphone or any glowing screen one hour before sleep can help. Relaxing yoga poses can also help.” LeBrun Blashka concurred, adding that exercising regularly, practicing meditation and taking a warm bath can also help. However, she noted that exercise before bedtime should be avoided, naps should be limited to 30 minutes and the intake of stimulants should be limited. In addition, she stated that “sleep experts advise eating whole foods because of the nutrients, vitamins and minerals they contain.”

Lastly, Barnes suggested that light, noise, temperature and pain must be addressed before restful sleep is to be achieved. He listed sleep obstacles for the unhealthy as poor diet, alcohol, caffeine and mental health. “Natural approaches take planning, patience and time,” he stated. “Meditation really works and very few access the immense amount of source material for this. It is a mental health issue, and learning to address stress, first through the mind, is the best course of action.” He listed the best natural remedies, in addition to meditation, as exercise, diet, no caffeine and a good sleep plan. With the implementation of all of these lifestyle changes, along with a safe and effective supplement, patients are more likely to achieve quality sleep.

Advice for Practitioners

It is likely that many patients have been approaching their health care practitioners with complaints of sleep issues, especially since the start of the pandemic. Dr. Simon suggested that “identifying the root cause of the sleep disorder is the most ideal way to approach treatment of sleep issues…[by providing] safe mind-body medicine exercises or meditations prior to sleep to support calming the nervous system and aiding natural sleep hormone production such as melatonin and lowering cortisol.” In addition, he shared that in his practice, he has “encouraged more and more use of the home sleep assessment tools that help identify sleep apnea episodes. Identifying how important sleep drives overall wellness and health through the use of sleep trackers has brought more individual behavioral change that I think benefits patients in a big way, and having more doctors trained in interpretation of this data, and the use of meditative practices could really impact sleep medicine.”

Dr. Simon went on to say that “As a naturopath prescribing these treatments, we are licensed as full primary care physicians in many states, which provides an increased scope of practice for evaluation of major medical sleep disorders, referrals to other providers, and the ability to integrate both medications, herbs, nutrition and behavioral techniques all in the same visit. Recognition of scope of practice and licensing is important when working with a practitioner, including a traditional medical doctor, which may not recognize the interaction potential as easily with some medications and herbal remedies.”

He suggested that practitioners “Evaluate and stay up to date on interactions with medications and supplements, embrace new technology such as in home sleep studies, or patient awareness of their sleep through biometric wearables. Help patients create opportunities for mental health care awareness and explore how responses to stress often cause patients to use too much caffeine or rely heavily on alcohol or marijuana to support their sleep. Many patients rely on other substances, and it is important to not judge someone’s coping mechanisms and find a safer alternative for them to transition to as they work on creating a more regulated sleep hygiene practice, naturally.”

Fuentes stated that she believes that “in many cases, the only thing holding practitioners back [from CBD products] is lack of information and official declarations from regulatory agencies. Practitioners can be honest about the benefits and drawbacks of various approaches … They can be more willing to recommend healthy sleep habits or newer options rather than immediately opting for heavy-duty pharmaceuticals.”

Lastly, Barnes noted that “Since practitioners and their patients are on the leading edge of wellness and self-care, we find it easy to integrate our products into the practices. Naturopaths should be the leaders in providing sleep solutions as they integrate body balance perfectly.” In addition, he suggested that “Practitioners should be on the forefront of using products like Slumber. Its growth should be limitless as more attention is given to hemp and cannabinoids; Practitioners should not be fearful of integrating into their practices.”

All in all, there is an extraordinary number of people worldwide who are experiencing sleep issues, often due to stress. This is evident by the increase in complaints of sleep issues since the start of the COVID-19 pandemic, which impacted the entire planet’s population. Naturopathic practitioners can recommend several natural products that can help patients sleep better, along with lifestyle and habit changes. This combination can make a significant impact on the quality of patients’ sleep, and practitioners should keep this in mind when helping their patients to resolve their sleep-related issues.

Healthy Take Aways

• Nearly 50-70 million U.S. adults have a sleep disorder according to sleepassociation.org, with 25 million U.S. adults having sleep apnea.
• 37 [percent] of 20-39 year-olds report short sleep duration, while 40 [percent] of 40-59 year-olds report short sleep duration.
• According to data from a 2020 CRN Consumer Survey on Dietary Supplements, 13 percent of overall users take supplements to support their mental health and 14 percent of users take supplements to support sleep.

For More Information:

Bastyr University, www.bastyr.edu
CBDistillery, www.thecbdistillery.com
Charlotte’s Web, www.charlottesweb.com
Green Roads, www.greenroads.com
Pluggerz, www.pluggerz.com
Slumber Sleep Aid, www.slumbercbn.com
Standard Process, www.standardprocess.com
The Sleep Shirt, www.thesleepshirt.com