Cannabis Initiation and Longitudinal Sleep Quality in Older Adults with Chronic Pain: An Analysis Based on Plasma Level THC and CBD

Jennifer Jean-Jacques, MPH
University of Florida

Co-authors: Jennifer Jean-Jacques¹, Yancheng Li¹, Kimberly T. Sibille¹, Zhigang Li¹, Siegfried O.F. Schmidt¹, Margaret C. Lo¹, Cristina Sempio², Jost Klawitter², Robert L. Cook¹, Yan Wang^1
1University of Florida, ²University of Colorado

Background: Although medical cannabis is an increasing treatment option to manage sleep problems among the aging population, longitudinal evidence evaluating its effectiveness is limited, particularly with consideration for concentration levels of THC, CBD, or the combination.

Objective: This study evaluated plasma-level of THC, CBD, and the combination and associations with sleep latency, sleep duration, and overall perceived sleep quality over six months among older adults with chronic pain.

Methods: We analyzed the baseline, 3-month, and 6-month survey data from 181 adults (≥50 years old) from the Study on Real-Time and Long-Term Effects of Medical Marijuana in Older Adults (SMILE). SMILE is a prospective cohort study investigating the effect of initiating medical cannabis on chronic pain and related outcomes (e.g., sleep) with a non-initiating comparison group. Cannabinoid type was quantified through plasma-level tests and categorized into 4 exposure groups:1) No THC or CBD 2) THC only, 3) CBD only, and 4) THC and CBD. Sleep latency, sleep duration, and overall perceived sleep quality were measured using the Pittsburgh Sleep Quality Index questionnaire. Descriptive analyses (e.g., mean, standard deviation, frequency, and percentages) were conducted to characterize the sample. ANCOVA assessed mean differences between the 4 exposure groups. Separate linear mixed effects models with random intercepts examined the longitudinal effects of cannabinoid group on self-reported sleep latency, sleep duration, and sleep quality, respectively. Covariates included baseline value of the corresponding sleep outcome, visit (3 vs. 6 months), age, sex, race, and income.

Results: Average age of the participants was 64.9 years old (SD=9.3); 64.6% identified as female.  After adjusting for covariates, over the six-month study period, the “THC and CBD” group had significantly better sleep quality (i.e., lower PSQI score) (β= -1.49, p<0.01) and longer sleep duration (e.g., slept more) (β = 0.73, p=0.01) at follow-up compared to the “no THC or CBD” group.  There were no significant differences between the 3-month and 6-month follow-up visits in both models, suggesting these changes were stable over time for both perceived sleep quality and sleep duration. Cannabinoid type was not significantly associated with sleep latency (all groups p>0.05).

Conclusions: Findings suggest that medical cannabis, specifically concurrent use of THC and CBD, may contribute to better sleep quality and longer sleep duration at follow-up among older adults with chronic pain. Future analyses using larger samples should include additional key covariates, such as pain intensity, to further evaluate these associations.