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

<i>Background</i>: Despite associations between sleep problems and substance use, many adults use alcohol and cannabis as sleep aids. However, little is known about the potential reciprocal relations among problems with sleep, alcohol use, cannabis use, and their co-use over time. <i>Objectives</i>: This is a secondary analysis from a nationally representative adults (N[unweighted] = 26,072) from the first four waves (2013-2018) of the Population Assessment of Tobacco and Health (PATH) Study. Three random intercept cross-lagged panel models investigated within-person bidirectional relations between sleep problems and (1) alcohol problems, (2) cannabis problems, and (3) co-use problems. <i>Results</i>: Across models, individual-level sleep problems were generally related to next-wave sleep problems. Both individual-level alcohol and cannabis use problems were related to lower likelihood of sleep problems in earlier waves, but greater likelihood of sleep problems in later waves. Individual-level 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 in this sample. <i>Conclusions</i>: Large-scale sleep interventions are indicated and may impact alcohol or cannabis use problems over time. Higher rates of sleep problems among persons with alcohol and cannabis co-use warrant further investigation and indicate a need to disseminate sleep interventions to adults with co-use.