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Insomnia-Related Symptoms Possibly Linked to Frequency of Alcohol and Cannabis Use in Late Adolescence

Disease Spotlight | <b>Disease Spotlight: Insomnia</b>

A longitudinal study showed that there were higher levels of alcohol and cannabis use in late adolescent stages who had poor sleep health.

In a recent longitudinal latent class analysis study of 2995 late-growing adolescents, consistent poor sleep health was associated with higher levels of alcohol and cannabis use, as well as higher health consequences from substance use.1 This study was the first to use a latent class approach to identify the association of alcohol and cannabis use and adolescents.

Across four sleep classes, those considered poor sleepers had the highest levels of alcohol use which was highly significant in comparison with the good sleeper class (χ2 = 7.01, P =.008) and the untroubled sleeper class (χ2 = 12.17, P =.001).1 Notably, the troubled, moderately good sleeper class showed a higher alcohol use frequency than the untroubled poor sleeper class (χ2 = 5.51, P =.019).

As for cannabis use, the unhealthy sleepers group had greater consequences in comparison with the good sleepers group (χ2 = 4.93, P =.026) and the untroubled poor sleepers group (χ2 = 13.25, P =.0003). Furthermore, the troubled, moderately good sleepers had a similar result of having greater consequences compared with the good sleepers (χ2 = 7.17, P =.007) and untroubled poor sleepers (χ2 = 18.44, P <.0001). Consequences were considered as negative health outcomes across the lifespan including risk of substance use disorders, mental and physical health morbidity, and premature mortality.1

“Although our study did not focus specifically on insomnia disorder, what we found in looking at longitudinal profiles of sleep is that having poor sleep quality alone or in combination with other dimensions of disrupted sleep was associated with higher frequency of alcohol use at baseline and greater increases in alcohol use over time, as compared to other sleep profiles with good sleep quality,” lead investigator Wendy Troxel, PhD, senior behavioral scientist, RAND Corporation, told to NeurologyLive.

From six waves of data, the mean age of the sample was 18 to 24 years, with the majority being women (54%). The participants had data based on the sleep dimensions of quality, duration, and social jetlag. For the analysis, the frequency and consequence of alcohol or cannabis use among the sleep classes were examined in the latent class models both with and without controlling covariates. Additionally, the study was funded by the National Institute on Alcohol Abuse and Alcoholism.

The latent class analysis models categorized participants into four sleep groups which were the good sleepers (n = 451; 15.2%), the untroubled poor sleepers (n = 1024; 34.2%), the troubled, moderately good sleepers (n = 1056; 35.3%), and the suboptimal sleepers (n = 460; 15.4%).1 Out of all of the sleeping groups, the good sleepers had reported lower levels of alcohol or cannabis use and the health consequence of the substance use compared with the other sleep classes.

“Similarly, the poor sleep quality profile was also associated with greater initial cannabis use and greater consequences related to cannabis use, as compared to the other sleep profiles. In other words, the presence of poor sleep quality which is a common insomnia symptom, was more strongly associated with more frequent alcohol and cannabis use, as compared to other quantitative dimensions of sleep, such as sleep duration,” Troxel noted.

Limitations of this study included a possible self-report bias and the analysis adjustment for several of the relevant covariates. In addition, the analysis suggest several sociodemographic differences in longitudinal sleep profiles and there was no examination on the potential mechanisms between sleep health and substance use levels and trajectories.

The frequency of alcohol and cannabis use may be strongly associated with insomnia-related symptoms from poor sleep quality as previous research demonstrates that insomnia-related symptoms have been more significantly linked to negative health outcomes.2-4

Troxel wrote, “Results highlight the importance of addressing poor sleep quality in late adolescence, as a potential strategy to reduce the risk of continued use of alcohol and cannabis and associated consequences into adulthood.” More research is needed to investigate the potential bidirectional associations of sleep health and substance use across time for determining the most effective intervention for late adolescence.1

1. Troxel WM, Rodriguez A, Seelam R, et al. A latent class approach to understanding longitudinal sleep health and the association with alcohol and cannabis use during late adolescence and emerging adulthood. Addict Behav. 2022;134:107417. doi:10.1016/j.addbeh.2022.107417
2. Bin YS. Is Sleep Quality More Important Than Sleep Duration for Public Health?. Sleep. 2016;39(9):1629-1630. doi:10.5665/sleep.6078
3. DeSantis AS, Dubowitz T, Ghosh-Dastidar B, et al. A preliminary study of a composite sleep health score: associations with psychological distress, body mass index, and physical functioning in a low-income African American community. Sleep Health. 2019;5(5):514-520. doi:10.1016/j.sleh.2019.05.001
4. Clark AJ, Salo P, Lange T, et al. Onset of Impaired Sleep and Cardiovascular Disease Risk Factors: A Longitudinal Study. Sleep. 2016;39(9):1709-1718. Published 2016 Sep 1. doi:10.5665/sleep.6098