Alcohol and cannabis problems initially predicted better sleep, but later predicted worse sleep in national US study | Research

The takeaway

In a nationally representative US sample tracked over five years, alcohol and cannabis use problems were associated with fewer sleep problems in earlier waves but more sleep problems in later waves, while people who co-used both substances consistently reported more sleep problems than the general population.

People who use alcohol or cannabis for sleep, and clinicians addressing substance use and sleep disorders.

Substance use problems predicted better sleep early but worse sleep later in a 5-year study

What the researchers found

Individual-level alcohol and cannabis use problems were associated with lower likelihood of sleep problems in earlier waves but greater likelihood of sleep problems in later waves. Co-use problems and sleep problems were not related across time points. However, participants reporting co-use consistently reported more sleep problems than the general population.

Why it matters

Many adults use alcohol and cannabis specifically to help with sleep, but this longitudinal data suggests the relationship reverses over time: what initially seems helpful eventually becomes associated with worse sleep. This temporal pattern could explain why people keep using substances for sleep despite worsening outcomes.

The numbers in context

26,072 adults across 4 waves (2013-2018). Alcohol and cannabis problems predicted lower sleep problems in earlier waves. Both predicted higher sleep problems in later waves. Co-users consistently had more sleep problems than the general population regardless of time point.

How the study worked

Secondary analysis of nationally representative adults (N=26,072 unweighted) from the first four waves (2013-2018) of the PATH Study. Three random intercept cross-lagged panel models investigated within-person bidirectional relations between sleep problems and alcohol problems, cannabis problems, and co-use problems.

What this study cannot tell us

PATH Study focused on tobacco and health, so sleep and other substance measures may not be as detailed as dedicated studies. Within-person effects do not imply causation. Sleep problems were measured broadly and may capture various sleep disorders. Four waves over five years provide limited temporal resolution.

How to read the evidence

Large nationally representative longitudinal study with within-person modeling, though limited by broad sleep measures and four assessment waves.

When this study was published

Published in 2025, using 2013-2018 PATH data.

The bigger picture

The early improvement followed by later worsening mirrors the tolerance and rebound patterns seen with many sedating substances. If alcohol and cannabis temporarily improve sleep but ultimately worsen it, people may increase their use to recapture the initial benefit, creating a cycle that leads to both substance use and sleep disorders worsening together.

Questions still open

At what point does the shift from sleep improvement to sleep worsening occur? Does this pattern differ by type or frequency of use? Would targeted sleep interventions reduce substance use, or vice versa?

Common questions

Does cannabis help with sleep or not?

This study suggests it may help initially but worsen sleep over time. In the earlier waves, cannabis problems were associated with fewer sleep problems, but by later waves, the association reversed. This pattern is consistent with tolerance and rebound effects.

Is combining alcohol and cannabis worse for sleep?

People who co-used alcohol and cannabis consistently reported more sleep problems than the general population at every time point, suggesting co-use is particularly problematic for sleep.

Read the original research

Within-Person Bidirectional Relations Between Sleep Problems and Alcohol, Cannabis, and Co-Use Problems in a Representative U.S. Sample.

Substance use & misuse, 60(12), 1923-1932

View on PubMed ↗Publisher’s paper ↗

Citation

Drazdowski, Tess K; Kelly, Lourah; Livingston, Nicholas R; Sheidow, Ashli J; McCart, Michael R. (2025). Within-Person Bidirectional Relations Between Sleep Problems and Alcohol, Cannabis, and Co-Use Problems in a Representative U.S. Sample.. Substance use & misuse, 60(12), 1923-1932. https://doi.org/10.1080/10826084.2025.2523458