Cannabis Use Associated With Poorer Objective Sleep in Middle-Aged Adults

Cannabis is often promoted as a sleep aid, but evidence on long-term sleep outcomes is limited. This cohort study in JAMA Network Open analyzed 1,266 CARDIA participants using cannabis exposure data collected over 35 years. Objective sleep was assessed with seven-day wrist actigraphy in 891 participants, whose mean age was 60.7 years; 1,128 completed subjective sleep assessments using the Pittsburgh Sleep Quality Index. Cumulative exposure was measured in cannabis-years, each equivalent to 365 days of use.

After multivariable adjustment, each additional cannabis-year was associated with higher odds of low sleep percentage, defined as less than 85% of time asleep (OR, 1.10; 95% CI, 1.06–1.14), high sleep fragmentation (OR, 1.04; 95% CI, 1.01–1.08), and wakefulness after sleep onset lasting at least 30 minutes (OR, 1.21; 95% CI, 1.10–1.34). Compared with never use, past-30-day use was associated with prolonged wakefulness after sleep onset (OR, 3.23; 95% CI, 1.44–7.27) and sleep duration exceeding eight hours rather than six to eight hours (OR, 4.60; 95% CI, 1.81–11.70).

Cannabis use was not associated with subjective sleep quality. The discrepancy supports considering both reported and objectively measured sleep when evaluating cannabis use and sleep concerns. These observational associations cannot establish that cannabis caused poorer sleep, and residual confounding remains possible. This update is based on the abstract; full-text methods and limitations were unavailable.