February 29, 2024

Frequent cannabis use linked to more severe insomnia in veterans: new study

New research suggests that while some military veterans may turn to cannabis to relieve stress, frequent cannabis use may actually lead to more severe insomnia in the long run. The findings have been published in the Journal of Sleep Research.

Insomnia is a sleep disorder that affects the quality and quantity of sleep, and veterans are particularly vulnerable to sleep problems due to various factors like irregular sleep schedules during active duty, combat-related stress, and mental health issues. The authors of the new study aimed to investigate the bidirectional associations between insomnia, cannabis use, and perceived stress, using a longitudinal approach.

“Veterans report some of the highest levels of stress and stress related problems and, unfortunately, are vulnerable to sleep problems, including insomnia,” said study author Jordan P. Davis, an incoming senior policy researcher at the RAND Corporation.

“There is a general belief that cannabis use can both alleviate stress and act as a sleep aid, yet little research has examined this, longitudinally. It was our hope that this study could shed light into the complex and dynamic associations between stress, insomnia, and cannabis use to inform individuals and clinicians on how cannabis may mitigate (reduce) or exacerbate (worsen) symptomology.”

To conduct the study, Davis and his colleagues recruited 1,230 veterans via social media advertisements and followed up with them at 6, 9, 12, and 18 months after the initial assessment. They collected data on participants’ age, sex, race/ethnicity, combat exposure, cannabis use, perceived stress, and insomnia symptoms. The researchers used validated questionnaires and scales to assess these factors.

The researchers found that veterans experiencing greater insomnia symptoms reported increased stress levels, and veterans with higher stress levels were more likely to increase their cannabis use. On the other hand, frequent cannabis use was associated with greater insomnia symptomology, suggesting that while some individuals may use cannabis to relieve stress, it could have detrimental effects on sleep in the long term.

The results provided evidence for both an “insomnia-driven model,” where insomnia exacerbates stress and other behavioral problems, and a “substance-induced model,” where frequent cannabis use leads to more severe insomnia. Veterans using cannabis to cope with stress might find themselves trapped in a cycle, where cannabis use initially provides relief but eventually worsens insomnia, leading to more stress.

“The bottom line is, there is a cost/benefit scenario when it comes to cannabis use and its association with stress and insomnia,” Davis told PsyPost. “In general, our results show that veterans reporting heightened stress may start to feel overwhelmed and the strongly held belief that cannabis use relieves stress is at the cost of worsening insomnia symptomology. Thus, some veterans may find themselves in an unhealthy perpetuating feedback loop of using cannabis to combat one problem (stress) only to experience worsening of another problem (insomnia).”

Interestingly, veterans with higher levels of insomnia symptoms also showed a reduction in their frequency of cannabis use over time. “Thus, over time it may be that while insomnia precipitates greater levels of stress, veterans may ultimately realize that cannabis use is not a useful tool for dealing with insomnia symptomology,” Davis said.

The study highlights the need for interventions to address the interplay between insomnia, cannabis use, and stress among veterans. Cognitive Behavioral Therapy for Insomnia (CBT-I) is recommended as a gold-standard psychological treatment that can concurrently address sleep problems and substance use.

As far as limitations, Davis noted that “there are always caveats to observational research – in this case, while we have a relatively large sample (1,230) and used sophisticated methodology to examine these associations, it is likely that these associations vary by other important factors such as pre-existing posttraumatic stress disorder. Our results may also vary across men and women, which is a vital next step – how do men and women differ in their cannabis use while experiencing sleep problems?”

The study, “Longitudinal associations between insomnia, cannabis use and stress among US veterans“, was authored by Jordan P. Davis, John Prindle, Shaddy K. Saba, Carl A. Castro, Justin Hummer, Liv Canning, and Eric R. Pedersen.

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