Daily associations with cannabis use and sleep quality in anxious cannabis users

Abstract

Introduction: Cannabis is increasingly used to self-treat anxiety and related sleep problems, without clear evidence of either supporting or refuting its anxiolytic or sleep aid effects. In addition, different forms of cannabis and primary cannabinoids ∆9-tetrahydrocannabinol (THC) and cannabidiol (CBD) have differing pharmacological effects.

Methods: Thirty days of daily data on sleep quality and cannabis use were collected in individuals who use cannabis for mild-to-moderate anxiety (n = 347; 36% male, 64% female; mean age = 33 years). Participants self-reported both the form (flower or edible) and the ratio of THC to CBD in the cannabis used during the observation period.

Results: Individuals who reported cannabis use on a particular day also reported better sleep quality the following night. Moderation analyses showed that better perceived sleep after cannabis use days was stronger for respondents with higher baseline affective symptoms. Further, respondents who used cannabis edibles with high CBD concentration reported the highest perceived quality of sleep.

Conclusions: Among individuals with affective symptoms, naturalistic use of cannabis was associated with better sleep quality, particularly for those using edible and CBD dominant products.

Figure 1.

Study recruitment flow (Panel A) and inclusion criteria (Panel B).

Figure 2:. Interaction plots for predicted daily sleep quality.

A) Line graph displaying predicted daily sleep quality (y-axis) as a function of daily cannabis use (lines) and baseline DASS scores (x-axis) in the sample (n=347). Dotted line indicates non-cannabis use days and black line indicates cannabis use days. B) Bar graph displaying predicted daily sleep quality (y-axis) as a function of cannabinoid ratio (high CBD vs THC+CBD) and form (flower vs edibles). White bars indicate use of high CBD dominant products (high CBD) and grey bars indicate products that contain average to high levels of THC and lower levels of CBD (THC+CBD); left bars indicate flower, right bars indicate edibles. Data points account for mixed effects model covariates (daily alcohol use, total number of cannabis use days, gender, age, race/ethnicity, education, employment, baseline cannabis dependence, baseline sleep quality, survey day, weekday vs weekend).