What does this research mean for the field?

Polysubstance use, particularly involving cannabis, alcohol, and tobacco, is associated with worse sleep quality and greater sleepiness compared to cannabis use alone. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.CHALLENGES_CONSENSUS.

What question did this study set out to answer?

This research aims to determine how combinations of cannabis, alcohol, and tobacco affect sleep health.

February 24, 2026Open Access

Associations of cannabis, alcohol, and tobacco use combinations with sleep health

Key Points

This research aims to determine how combinations of cannabis, alcohol, and tobacco affect sleep health.
Analyzed data from an online national survey of 518 adults
Assessed substance use with the Cannabis Use Disorder Identification Test – Revised
Measured sleep quality and daytime sleepiness with validated scales
Conducted linear regression models to examine associations of substance use with sleep outcomes
Greater cannabis dependence linked with worse sleep quality and increased daytime sleepiness
Polysubstance users had elevated scores for sleep health indicators compared to cannabis-only users
Individuals using multiple substances reported lower sleep satisfaction and overall sleep quality

Abstract

• Greater cannabis dependence linked with worse sleep quality and greater sleepiness. • Polysubstance use linked with worse sleep satisfaction compared to cannabis alone. • Polysubstance use linked with worse sleep scale scores. Cannabis is often used alongside other substances, including cigarettes and alcohol. The objective of this study was to identify how the combination of these substances may affect sleep health. Data from an online, national survey of 518 adults (35.2 ± 13.4 years old; 65% female) were analyzed. Respondents reported their cannabis, cigarette, and alcohol use. Hazardous cannabis use was assessed using the Cannabis Use Disorder Identification Test – Revised (CUDIT-R). Sleep, insomnia, and daytime sleepiness were assessed using the Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), and Epworth Sleepiness Scale (ESS), respectively. Sleep health was assessed using PSQI and ISI items about sleep quality, satisfaction, trouble staying awake, bedtime, waketime, sleep efficiency, and duration. Linear regression models examined associations of CUDIT-R and substance use with sleep scales and the individual sleep items, adjusting for sociodemographic factors. One-quarter used only cannabis, 45% alcohol and cannabis, 12% cigarettes and cannabis, and 19% all three substances (polysubstance use). Average scores were 10.4 ± 5.7 on the CUDIT-R, 8.0 ± 4.1 on the PSQI, 11.3 ± 6.2 on the ISI, and 6.4 ± 4.2 on the ESS. A higher CUDIT-R was associated with higher PSQI (β = 0.09, 95% CI = 0.01, 0.17) and ESS scores (β = 0.16, 95% CI = 0.07, 0.26). Compared to individuals who only use cannabis, individuals with polysubstance use had higher PSQI, ISI, and ESS scores and reported worse sleep quality and less sleep satisfaction. Sleep quality and satisfaction were most impaired by polysubstance use, whereas hazardous cannabis use increased sleepiness. The combined use of substances is detrimental to sleep health and highlights an area for public health messaging and awareness.

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Cite This Study

Reichenberger et al. (Sun,) studied this question.

synapsesocial.com/papers/699d3f9ede8e28729cf64383 https://doi.org/https://doi.org/10.1016/j.abrep.2026.100680

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