Clinical Report: Cannabis Use May Be Tied to Worse Sleep
Overview
In a CARDIA analysis of middle-aged adults, cumulative and recent cannabis use were associated with several poorer objectively measured sleep outcomes, including lower sleep percentage, greater fragmentation, and longer wakefulness after sleep onset. Neither exposure measure was associated with self-reported sleep quality, and the observational study does not establish causation.
Background
Cannabis use has increased in the United States, including use by people seeking help with sleep, while sleep is recognized as an important determinant of health. The CARDIA study followed Black and White adults initially enrolled at ages 18 to 30 and repeatedly assessed cannabis exposure over 35 years. The current analysis compared cumulative and recent cannabis use with objective and subjective sleep measures collected at the 2020–2022 examination. The VA/DoD 2025 guideline suggests against cannabis or its derivatives for chronic insomnia disorder.
Data Highlights
| Exposure or comparison | Sleep outcome | Reported association |
|---|---|---|
| Each additional cannabis-year | Low sleep percentage; high fragmentation; prolonged wakefulness after sleep onset | 10%, 4%, and 21% higher odds, respectively |
| Each additional cannabis-year | Continuous objective measures | Sleep percentage lower by 0.18 percentage points; fragmentation higher by 0.20 percentage points; wakefulness after sleep onset higher by 0.85 minutes |
| Recent use vs never use | Low sleep percentage; high fragmentation; prolonged wakefulness after sleep onset | Odds ratios 4.12, 2.46, and 3.23, respectively |
| Recent use vs never use | Sleep duration and wakefulness after sleep onset | About 20 minutes longer sleep duration and 11 additional minutes awake after sleep onset |
| Recent use vs never use | Sleep percentage and fragmentation | Sleep percentage lower by 1.74 percentage points; fragmentation higher by 2.14 percentage points |
| Recent or cumulative exposure | Self-reported sleep quality | No significant association reported |
Key Findings
- The analysis included 1,266 CARDIA participants; 891 completed objective sleep assessment and 1,128 completed subjective assessment. Mean age among those with objective sleep data was 60.7 years.
- Objective sleep was measured by seven-day wrist actigraphy, including sleep duration, sleep percentage, fragmentation, and wakefulness after sleep onset; subjective sleep quality was assessed with the Pittsburgh Sleep Quality Index.
- Greater cumulative cannabis exposure was associated with poorer objective sleep measures after adjustment for demographic characteristics, health behaviors, comorbidities, depressive symptoms, and sleep medication use.
- Recent cannabis users had higher odds of low sleep percentage, high fragmentation, and prolonged wakefulness after sleep onset than never-users; they also had higher odds of sleeping more than eight hours rather than six to eight hours.
- Former users did not differ significantly from never-users on objective sleep measures. Neither recent nor cumulative exposure was associated with self-reported sleep quality.
- Associations were stronger among female participants and participants who were not current alcohol drinkers; no statistically significant interactions were reported by race or smoking status. The authors noted limitations including self-reported exposure, a single seven-day objective sleep assessment, possible residual confounding, and potential selection bias.
Clinical Implications
The study reports associations with objective sleep measures, not proof that cannabis use causes sleep changes, and it found no corresponding association with subjective sleep quality. The VA/DoD 2025 guideline suggests against cannabis or its derivatives for chronic insomnia disorder; the study authors call for longitudinal, mechanistic, and randomized studies with long-term follow-up and objective sleep assessments.
Conclusion
In this middle-aged cohort, cumulative and recent cannabis use were associated with poorer objectively measured sleep on several measures, while self-reported sleep quality was not associated with exposure. The observational design and stated measurement limitations constrain interpretation.
Related Resources & Content
- Vu TT et al., JAMA Network Open, 2026 — Recent and Cumulative Cannabis Use and Sleep in Middle-Aged Adults
- U.S. Department of Veterans Affairs and Department of Defense, 2025 — Clinical Practice Guideline for the Management of Chronic Insomnia Disorder and Obstructive Sleep Apnea
- American Academy of Sleep Medicine, Position Statement — Medical Cannabis and the Treatment of Obstructive Sleep Apnea
- MDSpire News — Cannabis Conundrum: One in Six Patients Tokes for Relief
- JAMA Network Open — Edible Cannabis and Pain, Sleep, and Mental Health Management in Older Adults
- MDSpire News — Cannabis Use May Be Associated With Higher Likelihood of Adverse Cardiovascular Events
- Recent and Cumulative Cannabis Use and Sleep in Middle-Aged Adults
- VA/DoD Clinical Practice Guideline for Chronic Insomnia Disorder and Obstructive Sleep Apnea
- AASM Position Statement: Medical Cannabis and the Treatment of Obstructive Sleep Apnea
- Effectiveness of cannabinoids on subjective sleep quality in people with and without insomnia or poor sleep: A systematic review and meta-analysis of randomised studies - PubMed
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