Recent and Cumulative Cannabis Use and Sleep in Middle-Aged Adults.

Vu T.; Knutson K.; Auer R.; Jakob J.; Lloyd-Jones D.; Carnethon M. · JAMA network open · 2026

**Background & Methods** This cohort study analyzed 35 years of longitudinal data from the CARDIA (Coronary Artery Risk Development in Young Adults) study, examining 1,266 middle-aged adults (mean age 60.7 years; 63.3% female; 41% Black participants) at year-35 examination (2020-2022). Cumulative cannabis exposure was measured in cannabis-years, with recent use defined as past 30-day consumption. Objective sleep was assessed via 7-day wrist actigraphy measuring sleep duration, sleep percentage, sleep fragmentation, and wakefulness after sleep onset (WASO); subjective sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI). **Key Findings** - Each additional cannabis-year of cumulative exposure was independently associated with increased odds of low sleep percentage (OR 1.10; 95% CI 1.06-1.14), high sleep fragmentation (OR 1.04; 95% CI 1.01-1.08), and prolonged WASO ≥30 minutes (OR 1.21; 95% CI 1.10-1.34) after multivariable adjustment. - Recent cannabis users (past 30 days) compared to never users demonstrated substantially higher odds of prolonged WASO (OR 3.23; 95% CI 1.44-7.27) and excessively long sleep duration >8 hours (OR 4.60; 95% CI 1.81-11.70), indicating sleep dysregulation. - Notably, cannabis use showed no association with subjective sleep quality measured by PSQI scores, suggesting a dissociation between objectively measured sleep deterioration and self-perceived sleep quality. **Dosage & Administration** Not reported. **Safety & Adverse Effects** Cannabis use was associated with objective sleep impairment including reduced sleep efficiency, increased nighttime fragmentation, and prolonged awakening periods. No subjective complaints correlated with these objective findings, potentially indicating users may not perceive sleep quality deterioration despite measurable sleep architecture disruption. **Evidence Quality** This prospective cohort study provides moderate-to-good evidence due to longitudinal design, objective sleep measurement via actigraphy, and large sample size. However, limitations include potential selection bias in retention, inability to establish causation, lack of cannabis dose/potency/route specifications, and incomplete data (891 of 1,266 participants had objective sleep measurements). The discordance between objective and subjective sleep measures warrants cautious interpretation regarding user perception of harm.

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