Clinical Scorecard: Cannabis use may be tied to worse sleep

At a Glance

Key Highlights

• Among 1,266 participants, greater cumulative cannabis exposure was associated with poorer objective sleep measures after adjustment for demographic, health, and other factors.
• Each additional cannabis-year was associated with 10% higher odds of low sleep percentage, 4% higher odds of high sleep fragmentation, and 21% higher odds of prolonged wakefulness after sleep onset.
• 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 8 hours rather than 6 to 8 hours.
• Neither recent nor cumulative cannabis exposure was associated with self-reported sleep quality, and former users did not differ significantly from never users on objective sleep measures.
• The observational design does not establish causation; exposure was self-reported and objective sleep was measured during one 7-day period.

Guideline-Based Recommendations

Diagnosis

• Objective sleep was assessed with 7-day wrist actigraphy, measuring sleep duration, sleep percentage, fragmentation, and wakefulness after sleep onset.
• Subjective sleep quality was assessed using the Pittsburgh Sleep Quality Index.

Management

Monitoring & Follow-up

• The study authors called for future longitudinal, mechanistic, and randomized studies with long-term follow-up and objective sleep assessments.

Risks

• The study found associations between cannabis exposure and poorer objective sleep measures, but did not establish that cannabis use caused these outcomes.
• Potential limitations included residual confounding, self-reported cannabis exposure, unavailable information on potency, administration method and timing, and possible selection bias related to reduced participation during the COVID-19 pandemic.

Patient & Prescribing Data

Participants were drawn from a cohort initially enrolling 5,115 Black and White adults aged 18 to 30 years at four US sites in 1985–1986. At the 2020–2022 examination, 891 underwent objective sleep assessment and 1,128 completed subjective sleep evaluation.

The study did not evaluate treatment or prescribing. Recent cannabis use was associated with longer sleep duration but also more wakefulness after sleep onset and poorer sleep percentage and fragmentation measures.

Clinical Best Practices

• Interpret the reported associations as observational findings, not evidence of causation.
• Distinguish objective sleep measures from self-reported sleep quality, which was not associated with cannabis exposure in this study.
• Consider the study's limitations when applying findings to younger populations or users of contemporary higher-potency cannabis products.

Related Resources & Content

• JAMA Network Open study (source named in article; article URL not provided)