Associations of cannabis, alcohol, and tobacco use combinations with sleep health.

OBJECTIVES

Cannabis is often used alongside other substances, including cigarettes and alcohol. The objective of this study was to identify how the combination of these substances may affect sleep health.

METHODS

Data from an online, national survey of 518 adults (35.2 ± 13.4 years old; 65% female) were analyzed. Respondents reported their cannabis, cigarette, and alcohol use. Hazardous cannabis use was assessed using the Cannabis Use Disorder Identification Test - Revised (CUDIT-R). Sleep, insomnia, and daytime sleepiness were assessed using the Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), and Epworth Sleepiness Scale (ESS), respectively. Sleep health was assessed using PSQI and ISI items about sleep quality, satisfaction, trouble staying awake, bedtime, waketime, sleep efficiency, and duration. Linear regression models examined associations of CUDIT-R and substance use with sleep scales and the individual sleep items, adjusting for sociodemographic factors.

RESULTS

One-quarter used only cannabis, 45% alcohol and cannabis, 12% cigarettes and cannabis, and 19% all three substances (polysubstance use). Average scores were 10.4 ± 5.7 on the CUDIT-R, 8.0 ± 4.1 on the PSQI, 11.3 ± 6.2 on the ISI, and 6.4 ± 4.2 on the ESS. A higher CUDIT-R was associated with higher PSQI (β = 0.09, 95% CI = 0.01, 0.17) and ESS scores (β = 0.16, 95% CI = 0.07, 0.26). Compared to individuals who only use cannabis, individuals with polysubstance use had higher PSQI, ISI, and ESS scores and reported worse sleep quality and less sleep satisfaction.

CONCLUSION

Sleep quality and satisfaction were most impaired by polysubstance use, whereas hazardous cannabis use increased sleepiness. The combined use of substances is detrimental to sleep health and highlights an area for public health messaging and awareness.