Cannabis Use and Sleep Quality in Daily Life: a Daily Diary Study of Adults Starting Cannabis for Health Concerns

Background Legalization of cannabis for medical uses has proceeded without well-controlled studies. Real world patterns of medical cannabis use are highly variable and rarely overseen by a physician. Smartphone assessments that capture ecologically valid patterns of medical cannabis use and health symptoms may help clarify risks and benefits. Methods As part of a larger, randomized trial ( NCT03224468 ), adults (N=181) seeking cannabis for insomnia, pain, or anxiety or depressive symptoms were randomized to obtain a medical cannabis card immediately (MCC) or to a waitlist control (WLC) and completed 12-weeks of daily web-based surveys on cannabis use and three health outcomes: sleep, pain, and depressive symptoms. Results Completion rates in this long-term, daily survey design were high (median completed assessments: 72 out of 90 days). Daily reports of cannabis use were consistent with monthly interview assessments and urinalysis. The MCC group increased cannabis use frequency following randomization, while WLC did not. Within the MCC group, self-reported sleep quality was significantly higher on cannabis use days, compared to nonuse days. The MCC group displayed long-term sleep improvements, paralleled by increased cannabis frequency. Daily associations between cannabis use and self-reported pain or depressive symptoms were not significant. Conclusion Cannabis use is associated with same day improvements in self-reported sleep quality, but not pain or depressive symptoms, although sleep improvements occurred within the context of potentially risky increases in use. Long-term, web-based assessments of cannabis appear valid and feasible, providing a robust method for future real-world effectiveness studies with expanded and objective measures. Funding/Support This work was funded by R01DA042043; PI: JMG.