Dynamic associations between cannabis use and sleep in adolescents and young adults during a cannabis intervention trial

Improving cannabis treatment for adolescents and young adults (AYA) is a public health priority. Sleep difficulties may serve as a treatment barrier, as AYA may use cannabis as a sleep aid and cessation may induce withdrawal-related sleep problems. While research has identified associations between cannabis use, CUD, and sleep, few studies have examined these associations during AYA treatment, and no studies have conducted day-level analyses. The present study examined day-level, temporal associations between cannabis use and sleep difficulties during AYA CUD treatment. From 2009 to 2012, AYA (N = 65, 51% female, 15-24 years, 57% White) completed a 42-day ecological momentary assessment study while receiving cognitive behavioral therapy plus motivational enhancement therapy. Each day, participants reported on cannabis use quantity, sleep duration, and trouble sleeping. We used time-varying effect modeling to examine how day-level associations between cannabis use, sleep duration, and trouble sleeping changed across treatment, and if CUD severity moderated these associations. During the first week of treatment, cannabis grams were related to longer sleep among AYA with severe CUD and shorter sleep among AYA with mild CUD. During the second week, greater cannabis grams related to shorter sleep duration, regardless of CUD severity. Additionally, during these first 2 weeks, cannabis grams were related to reduced trouble sleeping. Cannabis use was otherwise unassociated with sleep duration and trouble. Findings suggest clinicians treating AYA CUD should provide greater sleep management skills early in treatment.