More than one-third of Americans do not sleep enough.(1) This lack of rest carries tremendous costs, as reduced sleep is linked to 7 of the 15 leading causes of death in the US.(2) In fact, insufficient sleep may increase the risk of premature mortality up to 10 times.(3) The sleep crisis also has huge economic impacts, as insufficient sleep is expected to detract somewhere between $299 billion and $433 billion from the US economy in 2020 alone.(4) Clearly, there is a dire need for better sleep solutions.
As people have experienced the adverse effects of under-sleeping, the sleep market has experienced significant growth. According to a recent report by Profshare Market Research, the global sleep aid market is projected to reach $112 billion by 2026.(5)
In this post, we’ll examine some of the causes and effects of the sleep epidemic in America. After that, we’ll look at some of the benefits and drawbacks of current treatment options. Finally, we will consider how cannabinoid-based supplements may be a formidable solution to our sleep problems.
Understanding the Sleep Epidemic
There are many different reasons that people do not get enough sleep. Several lifestyle choices contribute to insufficient sleep. For example, excessive soda, salt, and tobacco consumption have all been linked to insufficient sleep.(6)(7) Different environmental factors can also cause sleeping problems: Uncertainty about basic needs, such as food and housing, can make it harder to get sleep.(8) Acute stress and raising children have also been linked to poor sleep.(9) Genetic factors may also account for up to one-third of the cases of insufficient sleep.(10)
Sleep deprivation is a modern problem.
In 1910, most people got 9 hours of sleep per night.(11) However, by 1985, this figure plummeted to just 7.4 hours a night. Since then, the amount of sleep the average American gets has further declined, down to just 7.1 hours by 2012.(12)
A wide range of health problems can occur when you don’t get enough sleep.
Insufficient sleep has been associated with negative mental effects, including negative moods, higher risk of depression, daytime drowsiness, impaired memory, slower reaction time, less effective decision making, and impaired moral reasoning.(13)(14)(15)(16)(17)(18) Insufficient sleep may also manifest a number of physiological problems, like hypertension, diabetes, heart attacks, obesity, and cancer.(19)(20)(21)(22)
Insufficient sleep impacts all brackets of Americans.
According to the CDC, men and women are equally likely to suffer from insufficient sleep. And while middle-aged people are slightly more likely to suffer from inadequate sleep (39% of 45-54 year-olds sleep under 7 hours a night), all age groups are largely under-rested (32% of 18-24 years-olds also sleep under 7 hours nightly). Some races/ethnicities have been disproportionately impacted by the sleep epidemic, as Black Americans are now 37% more likely to suffer from sleep deprivation than White Americans.(23)
The Sleep Aids Market
Insufficient sleep can have disastrous personal and societal impacts. Given that a huge percentage of the American population does not sleep enough and that insufficient sleep is a relatively modern phenomenon, we would expect to see a thriving sleep aids market. Effective, safe, and accessible sleep aids would not just be good business, they would also be something of a public health service. Yet, as we see with the decreasing sleep health in America, the current sleep aids market has room to improve.
The sleep aids market is comprised of many smaller sectors. For example, special mattresses, premium pillows, CPAP devices, sleep aid software, and sleep labs all factor into the market. Sleeping medications and supplements are also one of the market’s most popular and accessible items.
According to a recent Marketdata survey, prescription sleep medications are on the decline. Insomnia drugs like Belsomra, Ambien, and Lunesta still lead the market. Yet, expiring patents, cheap generics, and readily available over-the-counter (OTC) medications are quickly changing the landscape. In particular, OTC options like diphenhydramine or doxylamine (more recognizable as Nyquil or Unisom) are enjoying more frequent use.(24)
More natural options, including melatonin, L-theanine, and tryptophan have also entered the market. Like the OTC options listed above, these supplements seem to offer reliable sleep support at an affordable price point. These may be a serious step in the right direction, as drugs like diphenhydramine and doxylamine are frequently used by older adults, even though they are classified as potentially inappropriate for that group because of health concerns.(25)
Despite all of the great new additions to the sleep aids market, one disruptor looms large over the industry. Cannabis.
In the early 2010s, the Colorado sleep aids market enjoyed the same kind of growth that sleep markets all over the country were experiencing. Things were trending well for OTC sleep medications, as the drugs were being sold at higher and higher frequencies. But when recreational cannabis entered the market, this trend reversed suddenly and severely.
As cannabis dispensaries opened up, OTC sleep meds suffered a staggering 236% decrease in market share growth.(26)
The authors of the study concluded, “These findings support survey evidence that many individuals use cannabis to treat insomnia. . . Investigations designed to measure the relative effectiveness and side effect profiles of conventional OTC sleep aids and cannabis-based products are urgently needed to improve treatment of sleep disturbances.” In other words, cannabinoids may be an extremely valuable addition to the sleep market, but this cannot be confirmed until they have been thoroughly studied.
Cannabinoid Based Sleep Support
While there is still limited research regarding cannabinoids’ role in sleep, the early studies have been promising.(27)
CBD for sleep?
Research published just last year revealed that CBD may be able to relieve anxiety and promote sleep. The study followed 103 adults with sleep and anxiety disorders who consumed daily doses of 25mg of CBD for three months. During the first month, the group reported less anxiety and higher quality sleep. As the study continued for two more months, anxiety continued to decrease significantly, while sleep quality maintained its improved state.(28)
This was a very exciting study because it suggested that CBD could offer quick and sustained relief from sleep and anxiety disorders at relatively low doses. Previous studies on CBD have used up to 600mg of CBD. And while these doses are plenty effective, they are prohibitively expensive for consumers. But, if 25mg of CBD or less is effective, cannabinoid sleep aids could soon be more affordable and just as accessible as other OTC options.
How does CBN help with sleep?
Beyond CBD, minor cannabinoids like CBN isolate appear to offer promising therapeutic benefits. As Dr. Andrew Salzman MD has explained, “CBN may mimic natural cannabinoid-like molecules within the body (endocannabinoids) which have been shown to promote rapid-eye-movement sleep by interacting with melanin-concentrating hormone neurons in the lateral hypothalamus.” Considering that a study this month linked less REM sleep to higher all-cause-mortality, continued research into more natural sleep aids like CBN seems more than worthy.(29)
Synthetic cannabinoids may also offer new and exciting treatment options. For example, the synthetic cannabinoid nabilone may offer short term benefits for sleep apnea, reduce nightmares associated with PTSD, and improve sleep among patients with chronic pain.(30)
There are plenty of other non-cannabinoid components of cannabis plants that could be used to support sleep. Different terpenes and flavonoids, for example, may provide a wide range of benefits. In an earlier post, we reviewed how terpenes like limonene and linalool have valuable sedative and relaxation properties.
Finally, it is important to consider how cannabinoids may help block certain barriers to sleep. For example, exercise has been shown to enhance sleep, while tobacco use has been shown to impair it.(31) Cannabinoids don’t solve either of these problems directly, but they can still help. In one study, CBD supplementation helped smokers cut back on cigarettes by 40%. Another study found that CBD could help reduce pain and inflammation in athletes to help facilitate exercise.(32) So, even if cannabinoids are not used to put you to bed, they may indirectly help you sleep.
While combating the sleep epidemic is a daunting challenge, there is a lot to be encouraged about when it comes to cannabinoids + sleep. The sleep aid market plays an important role in this fight, but so do deeply ingrained cultural and lifestyle factors like long work hours, poor diet, poor exercise habits, and an increasing addiction to screens. While cannabinoids are unlikely to fix those problems, they may be able to substantially improve what the current sleep aid market offers consumers.
References
1) Chattu VK, Manzar MD, Kumary S, Burman D, Spence DW, Pandi-Perumal SR. The Global Problem of Insufficient Sleep and Its Serious Public Health Implications. Healthcare (Basel). 2018;7(1):1. Published 2018 Dec 20. doi:10.3390/healthcare7010001
2) Ibid
3) Hafner M., Stepanek M., Taylor J., Troxel W.M., van Stolk C. Why Sleep Matters—The Economic Costs of Insufficient Sleep: A Comparative Cross-Country Analysis. RAND Corporation; Santa Monica, CA, USA: 2016.
4) Ibid
5) Profshare. Sleeping Aids Market by Product Type ( Medication, Mattresses and Pillows, Sleep Laboratories, Sleep Apnea Devices) by Application ( Insomnia, Restless Legs Syndrome, Sleep Apnea, Narcolepsy, Sleep Walking) by Industry Analysis, Volume, Share, Growth, Challenges, Trends and Forecast 2018. Profshare Market Research. 2018.
6) Franckle R.L., Falbe J., Gortmaker S., Ganter C., Taveras E.M., Land T., Davison K.K. Insufficient sleep among elementary and middle school students is linked with elevated soda consumption and other unhealthy dietary behaviors. Prev. Med. 2015;74:36–41.
7) Sabanayagam C., Shankar A. The association between active smoking, smokeless tobacco, second-hand smoke exposure and insufficient sleep. Sleep Med. 2011;12:7–11.
8) Liu Y., Njai R.S., Greenlund K.J., Chapman D.P., Croft J.B. Relationships between housing and food insecurity, frequent mental distress, and insufficient sleep among adults in 12 US States, 2009. Prev. Chronic Dis. 2014;11:E37.
9) Chapman D.P., Wheaton A.G., Perry G.S., Sturgis S.L., Strine T.W., Croft J.B. Household demographics and perceived insufficient sleep among US adults. J. Community Health. 2012;37:344–349.
10) Hublin C., Kaprio J., Partinen M., Koskenvuo M. Insufficient sleep—A population-based study in adults. Sleep. 2001;24:392–400.
11) US Department of Health and Human Services. Your Guide to Healthy Sleep. National Institute of Health. 2005. https://www.nhlbi.nih.gov/files/docs/public/sleep/healthy_sleep.pdf
12) Ford ES, Cunningham TJ, Croft JB. Trends in Self-Reported Sleep Duration among US Adults from 1985 to 2012. Sleep. 2015;38(5):829-832. Published 2015 May 1. doi:10.5665/sleep.4684
13) Olsen O.K., Pallesen S., Eid J. The impact of partial sleep deprivation on moral reasoning in military officers. Sleep. 2010;33:1086–1090.
14) Killgore W.D., Kahn-Greene E.T., Lipizzi E.L., Newman R.A., Kamimori G.H., Balkin T.J. Sleep deprivation reduces perceived emotional intelligence and constructive thinking skills. Sleep Med. 2008;9:517–526.
15) Saadat H., Bissonnette B., Tumin D., Raman V., Rice J., Barry N., Tobias J. Effects of partial sleep deprivation on reaction time in anesthesiologists. Paediatr. Anaesth. 2017;27:358–362.
16) Dinges D.F., Pack F., Williams K., Gillen K.A., Powell J.W., Ott G.E., Aptowicz C., Pack A.I. Cumulative sleepiness, mood disturbance, and psychomotor vigilance performance decrements during a week of sleep restricted to 4–5 hours per night. Sleep. 1997;20:267–277.
17) McCarthy M.E., Waters W.F. Decreased attentional responsivity during sleep deprivation: Orienting response latency, amplitude, and habituation. Sleep. 1997;20:115–123.
18) Beebe D.W. Cognitive, behavioral, and functional consequences of inadequate sleep in children and adolescents. Pediatr. Clin. N. Am. 2011;58:649–665.
19) Schlafer O., Wenzel V., Högl B. Sleep disorders among physicians on shift work. Anaesthetist. 2014;63:844–851.
20) Janszky I., Ljung R. Shifts to and from daylight saving time and incidence of myocardial infarction. N. Engl. J. Med. 2008;359:1966–1968.
21) Taheri S., Lin L., Austin D., Young T., Mignot E. Short sleep duration is associated with reduced leptin, elevated ghrelin, and increased body mass index. PLoS Med. 2004;1:210–217.
22) Markt S.C., Grotta A., Nyren O., Adami H.O., Mucci L.A., Valdimarsdottir U.A., Stattin P., Bellocco R., Lagerros Y.T. Insufficient sleep and risk of prostate cancer in a large Swedish cohort. Sleep. 2015;38:1405–1410.
23) Center for Disease Control. Sleep and Sleep Disorders. CDC.gov. 2017. https://www.cdc.gov/sleep/data_statistics.html
24) MarketData LLC. The U.S. Sleep Market. Market Research. 2018. https://www.marketresearch.com/Marketdata-Enterprises-Inc-v416/Sleep-11905635/
25) Abraham, O., Schleiden, L. & Albert, S.M. Over-the-counter medications containing diphenhydramine and doxylamine used by older adults to improve sleep. Int J Clin Pharm 39. 2017. 808–817.
26) Doremus JM, Stith SS, Vigil JM. Using recreational cannabis to treat insomnia: Evidence from over-the-counter sleep aid sales in Colorado. Complement Ther Med. 2019;47:102207.
27) Shannon S, Lewis N, Lee H, Hughes S. Cannabidiol in Anxiety and Sleep: A Large Case Series. Perm J. 2019;23:18-041. doi:10.7812/TPP/18-041
28) ^Ibid
29) Leary EB, Watson KT, Ancoli-Israel S, et al. Association of Rapid Eye Movement Sleep With Mortality in Middle-aged and Older Adults. JAMA Neurol. Published online July 06, 2020.
30) Babson, K.A., Sottile, J. & Morabito, D. Cannabis, Cannabinoids, and Sleep: a Review of the Literature. Curr Psychiatry Rep 19, 23 (2017).
31) Morgan CJ, Das RK, Joye A, Curran HV, Kamboj SK. Cannabidiol reduces cigarette consumption in tobacco smokers: preliminary findings. Addict Behav. 2013;38(9):2433-2436. doi:10.1016/j.addbeh.2013.03.011
32) McCartney D, Benson MJ, Desbrow B, Irwin C, Suraev A, McGregor IS. Cannabidiol and Sports Performance: a Narrative Review of Relevant Evidence and Recommendations for Future Research. Sports Med Open. 2020;6(1):27.
More than one-third of Americans do not sleep enough.(1) This lack of rest carries tremendous costs, as reduced sleep is linked to 7 of the 15 leading causes of death in the US.(2) In fact, insufficient sleep may increase the risk of premature mortality up to 10 times.(3) The sleep crisis also has huge economic impacts, as insufficient sleep is expected to detract somewhere between $299 billion and $433 billion from the US economy in 2020 alone.(4) Clearly, there is a dire need for better sleep solutions.
As people have experienced the adverse effects of under-sleeping, the sleep market has experienced significant growth. According to a recent report by Profshare Market Research, the global sleep aid market is projected to reach $112 billion by 2026.(5)
In this post, we’ll examine some of the causes and effects of the sleep epidemic in America. After that, we’ll look at some of the benefits and drawbacks of current treatment options. Finally, we will consider how cannabinoid-based supplements may be a formidable solution to our sleep problems.
Understanding the Sleep Epidemic
There are many different reasons that people do not get enough sleep. Several lifestyle choices contribute to insufficient sleep. For example, excessive soda, salt, and tobacco consumption have all been linked to insufficient sleep.(6)(7) Different environmental factors can also cause sleeping problems: Uncertainty about basic needs, such as food and housing, can make it harder to get sleep.(8) Acute stress and raising children have also been linked to poor sleep.(9) Genetic factors may also account for up to one-third of the cases of insufficient sleep.(10)
Sleep deprivation is a modern problem.
In 1910, most people got 9 hours of sleep per night.(11) However, by 1985, this figure plummeted to just 7.4 hours a night. Since then, the amount of sleep the average American gets has further declined, down to just 7.1 hours by 2012.(12)
A wide range of health problems can occur when you don’t get enough sleep.
Insufficient sleep has been associated with negative mental effects, including negative moods, higher risk of depression, daytime drowsiness, impaired memory, slower reaction time, less effective decision making, and impaired moral reasoning.(13)(14)(15)(16)(17)(18) Insufficient sleep may also manifest a number of physiological problems, like hypertension, diabetes, heart attacks, obesity, and cancer.(19)(20)(21)(22)
Insufficient sleep impacts all brackets of Americans.
According to the CDC, men and women are equally likely to suffer from insufficient sleep. And while middle-aged people are slightly more likely to suffer from inadequate sleep (39% of 45-54 year-olds sleep under 7 hours a night), all age groups are largely under-rested (32% of 18-24 years-olds also sleep under 7 hours nightly). Some races/ethnicities have been disproportionately impacted by the sleep epidemic, as Black Americans are now 37% more likely to suffer from sleep deprivation than White Americans.(23)
The Sleep Aids Market
Insufficient sleep can have disastrous personal and societal impacts. Given that a huge percentage of the American population does not sleep enough and that insufficient sleep is a relatively modern phenomenon, we would expect to see a thriving sleep aids market. Effective, safe, and accessible sleep aids would not just be good business, they would also be something of a public health service. Yet, as we see with the decreasing sleep health in America, the current sleep aids market has room to improve.
The sleep aids market is comprised of many smaller sectors. For example, special mattresses, premium pillows, CPAP devices, sleep aid software, and sleep labs all factor into the market. Sleeping medications and supplements are also one of the market’s most popular and accessible items.
According to a recent Marketdata survey, prescription sleep medications are on the decline. Insomnia drugs like Belsomra, Ambien, and Lunesta still lead the market. Yet, expiring patents, cheap generics, and readily available over-the-counter (OTC) medications are quickly changing the landscape. In particular, OTC options like diphenhydramine or doxylamine (more recognizable as Nyquil or Unisom) are enjoying more frequent use.(24)
More natural options, including melatonin, L-theanine, and tryptophan have also entered the market. Like the OTC options listed above, these supplements seem to offer reliable sleep support at an affordable price point. These may be a serious step in the right direction, as drugs like diphenhydramine and doxylamine are frequently used by older adults, even though they are classified as potentially inappropriate for that group because of health concerns.(25)
Despite all of the great new additions to the sleep aids market, one disruptor looms large over the industry. Cannabis.
In the early 2010s, the Colorado sleep aids market enjoyed the same kind of growth that sleep markets all over the country were experiencing. Things were trending well for OTC sleep medications, as the drugs were being sold at higher and higher frequencies. But when recreational cannabis entered the market, this trend reversed suddenly and severely.
As cannabis dispensaries opened up, OTC sleep meds suffered a staggering 236% decrease in market share growth.(26)
The authors of the study concluded, “These findings support survey evidence that many individuals use cannabis to treat insomnia. . . Investigations designed to measure the relative effectiveness and side effect profiles of conventional OTC sleep aids and cannabis-based products are urgently needed to improve treatment of sleep disturbances.” In other words, cannabinoids may be an extremely valuable addition to the sleep market, but this cannot be confirmed until they have been thoroughly studied.
Cannabinoid Based Sleep Support
While there is still limited research regarding cannabinoids’ role in sleep, the early studies have been promising.(27)
CBD for sleep?
Research published just last year revealed that CBD may be able to relieve anxiety and promote sleep. The study followed 103 adults with sleep and anxiety disorders who consumed daily doses of 25mg of CBD for three months. During the first month, the group reported less anxiety and higher quality sleep. As the study continued for two more months, anxiety continued to decrease significantly, while sleep quality maintained its improved state.(28)
This was a very exciting study because it suggested that CBD could offer quick and sustained relief from sleep and anxiety disorders at relatively low doses. Previous studies on CBD have used up to 600mg of CBD. And while these doses are plenty effective, they are prohibitively expensive for consumers. But, if 25mg of CBD or less is effective, cannabinoid sleep aids could soon be more affordable and just as accessible as other OTC options.
How does CBN help with sleep?
Beyond CBD, minor cannabinoids like CBN isolate appear to offer promising therapeutic benefits. As Dr. Andrew Salzman MD has explained, “CBN may mimic natural cannabinoid-like molecules within the body (endocannabinoids) which have been shown to promote rapid-eye-movement sleep by interacting with melanin-concentrating hormone neurons in the lateral hypothalamus.” Considering that a study this month linked less REM sleep to higher all-cause-mortality, continued research into more natural sleep aids like CBN seems more than worthy.(29)
Synthetic cannabinoids may also offer new and exciting treatment options. For example, the synthetic cannabinoid nabilone may offer short term benefits for sleep apnea, reduce nightmares associated with PTSD, and improve sleep among patients with chronic pain.(30)
There are plenty of other non-cannabinoid components of cannabis plants that could be used to support sleep. Different terpenes and flavonoids, for example, may provide a wide range of benefits. In an earlier post, we reviewed how terpenes like limonene and linalool have valuable sedative and relaxation properties.
Finally, it is important to consider how cannabinoids may help block certain barriers to sleep. For example, exercise has been shown to enhance sleep, while tobacco use has been shown to impair it.(31) Cannabinoids don’t solve either of these problems directly, but they can still help. In one study, CBD supplementation helped smokers cut back on cigarettes by 40%. Another study found that CBD could help reduce pain and inflammation in athletes to help facilitate exercise.(32) So, even if cannabinoids are not used to put you to bed, they may indirectly help you sleep.
While combating the sleep epidemic is a daunting challenge, there is a lot to be encouraged about when it comes to cannabinoids + sleep. The sleep aid market plays an important role in this fight, but so do deeply ingrained cultural and lifestyle factors like long work hours, poor diet, poor exercise habits, and an increasing addiction to screens. While cannabinoids are unlikely to fix those problems, they may be able to substantially improve what the current sleep aid market offers consumers.
References
1) Chattu VK, Manzar MD, Kumary S, Burman D, Spence DW, Pandi-Perumal SR. The Global Problem of Insufficient Sleep and Its Serious Public Health Implications. Healthcare (Basel). 2018;7(1):1. Published 2018 Dec 20. doi:10.3390/healthcare7010001
2) Ibid
3) Hafner M., Stepanek M., Taylor J., Troxel W.M., van Stolk C. Why Sleep Matters—The Economic Costs of Insufficient Sleep: A Comparative Cross-Country Analysis. RAND Corporation; Santa Monica, CA, USA: 2016.
4) Ibid
5) Profshare. Sleeping Aids Market by Product Type ( Medication, Mattresses and Pillows, Sleep Laboratories, Sleep Apnea Devices) by Application ( Insomnia, Restless Legs Syndrome, Sleep Apnea, Narcolepsy, Sleep Walking) by Industry Analysis, Volume, Share, Growth, Challenges, Trends and Forecast 2018. Profshare Market Research. 2018.
6) Franckle R.L., Falbe J., Gortmaker S., Ganter C., Taveras E.M., Land T., Davison K.K. Insufficient sleep among elementary and middle school students is linked with elevated soda consumption and other unhealthy dietary behaviors. Prev. Med. 2015;74:36–41.
7) Sabanayagam C., Shankar A. The association between active smoking, smokeless tobacco, second-hand smoke exposure and insufficient sleep. Sleep Med. 2011;12:7–11.
8) Liu Y., Njai R.S., Greenlund K.J., Chapman D.P., Croft J.B. Relationships between housing and food insecurity, frequent mental distress, and insufficient sleep among adults in 12 US States, 2009. Prev. Chronic Dis. 2014;11:E37.
9) Chapman D.P., Wheaton A.G., Perry G.S., Sturgis S.L., Strine T.W., Croft J.B. Household demographics and perceived insufficient sleep among US adults. J. Community Health. 2012;37:344–349.
10) Hublin C., Kaprio J., Partinen M., Koskenvuo M. Insufficient sleep—A population-based study in adults. Sleep. 2001;24:392–400.
11) US Department of Health and Human Services. Your Guide to Healthy Sleep. National Institute of Health. 2005. https://www.nhlbi.nih.gov/files/docs/public/sleep/healthy_sleep.pdf
12) Ford ES, Cunningham TJ, Croft JB. Trends in Self-Reported Sleep Duration among US Adults from 1985 to 2012. Sleep. 2015;38(5):829-832. Published 2015 May 1. doi:10.5665/sleep.4684
13) Olsen O.K., Pallesen S., Eid J. The impact of partial sleep deprivation on moral reasoning in military officers. Sleep. 2010;33:1086–1090.
14) Killgore W.D., Kahn-Greene E.T., Lipizzi E.L., Newman R.A., Kamimori G.H., Balkin T.J. Sleep deprivation reduces perceived emotional intelligence and constructive thinking skills. Sleep Med. 2008;9:517–526.
15) Saadat H., Bissonnette B., Tumin D., Raman V., Rice J., Barry N., Tobias J. Effects of partial sleep deprivation on reaction time in anesthesiologists. Paediatr. Anaesth. 2017;27:358–362.
16) Dinges D.F., Pack F., Williams K., Gillen K.A., Powell J.W., Ott G.E., Aptowicz C., Pack A.I. Cumulative sleepiness, mood disturbance, and psychomotor vigilance performance decrements during a week of sleep restricted to 4–5 hours per night. Sleep. 1997;20:267–277.
17) McCarthy M.E., Waters W.F. Decreased attentional responsivity during sleep deprivation: Orienting response latency, amplitude, and habituation. Sleep. 1997;20:115–123.
18) Beebe D.W. Cognitive, behavioral, and functional consequences of inadequate sleep in children and adolescents. Pediatr. Clin. N. Am. 2011;58:649–665.
19) Schlafer O., Wenzel V., Högl B. Sleep disorders among physicians on shift work. Anaesthetist. 2014;63:844–851.
20) Janszky I., Ljung R. Shifts to and from daylight saving time and incidence of myocardial infarction. N. Engl. J. Med. 2008;359:1966–1968.
21) Taheri S., Lin L., Austin D., Young T., Mignot E. Short sleep duration is associated with reduced leptin, elevated ghrelin, and increased body mass index. PLoS Med. 2004;1:210–217.
22) Markt S.C., Grotta A., Nyren O., Adami H.O., Mucci L.A., Valdimarsdottir U.A., Stattin P., Bellocco R., Lagerros Y.T. Insufficient sleep and risk of prostate cancer in a large Swedish cohort. Sleep. 2015;38:1405–1410.
23) Center for Disease Control. Sleep and Sleep Disorders. CDC.gov. 2017. https://www.cdc.gov/sleep/data_statistics.html
24) MarketData LLC. The U.S. Sleep Market. Market Research. 2018. https://www.marketresearch.com/Marketdata-Enterprises-Inc-v416/Sleep-11905635/
25) Abraham, O., Schleiden, L. & Albert, S.M. Over-the-counter medications containing diphenhydramine and doxylamine used by older adults to improve sleep. Int J Clin Pharm 39. 2017. 808–817.
26) Doremus JM, Stith SS, Vigil JM. Using recreational cannabis to treat insomnia: Evidence from over-the-counter sleep aid sales in Colorado. Complement Ther Med. 2019;47:102207.
27) Shannon S, Lewis N, Lee H, Hughes S. Cannabidiol in Anxiety and Sleep: A Large Case Series. Perm J. 2019;23:18-041. doi:10.7812/TPP/18-041
28) ^Ibid
29) Leary EB, Watson KT, Ancoli-Israel S, et al. Association of Rapid Eye Movement Sleep With Mortality in Middle-aged and Older Adults. JAMA Neurol. Published online July 06, 2020.
30) Babson, K.A., Sottile, J. & Morabito, D. Cannabis, Cannabinoids, and Sleep: a Review of the Literature. Curr Psychiatry Rep 19, 23 (2017).
31) Morgan CJ, Das RK, Joye A, Curran HV, Kamboj SK. Cannabidiol reduces cigarette consumption in tobacco smokers: preliminary findings. Addict Behav. 2013;38(9):2433-2436. doi:10.1016/j.addbeh.2013.03.011
32) McCartney D, Benson MJ, Desbrow B, Irwin C, Suraev A, McGregor IS. Cannabidiol and Sports Performance: a Narrative Review of Relevant Evidence and Recommendations for Future Research. Sports Med Open. 2020;6(1):27.
