A new study suggests that regular cannabis users may report more signs of sleep-disordered breathing, such as loud snoring and pauses in breathing at night, even after accounting for factors like weight and tobacco use. The research appears in Sleep Health: Journal of the National Sleep Foundation and was led by Tyler J. Gallagher of the Keck School of Medicine, with co-author Matthew E. Lin of the David Geffen School of Medicine at UCLA.
Sleep-disordered breathing encompasses conditions characterised by abnormal breathing patterns or insufficient ventilation during rest, with obstructive sleep apnoea being the commonest form. In this condition the throat muscles relax excessively during sleep, narrowing or blocking the airway and often triggering snoring, gasping, or brief pauses in breathing.
Cannabis has become more accessible and is increasingly used as a sleep aid, though clinical results on cannabinoids and sleep have been mixed. The researchers sought to understand whether everyday cannabis use correlates with nocturnal breathing signs in the real world, rather than in tightly controlled trials.
The study used data from the 2017 to 2018 Behavioral Risk Factor Surveillance System, a state-based telephone survey run by the Centres for Disease Control and Prevention. Although nearly 900,000 adults completed the main survey in those years, only Minnesota and Tennessee included questions about both cannabis habits and sleep-breathing symptoms. From respondents with complete data, researchers drew a stratified random sample of 14,485 adults intended to mirror the broader US population.
Participants reported how many days they used marijuana or cannabis in the past month, their main method of consumption and whether use was for medical or recreational purposes. Respondents were grouped as non-users (zero days in the past 30), non-regular users (1 to 15 days) or regular users (16 to 30 days). Signs of sleep-disordered breathing were assessed via two yes-or-no questions about observed pauses in breathing during sleep or being told they snore loudly.
Of those studied, 13,461 reported no cannabis use, 438 were non-regular users and 364 were regular users—roughly 5.5 per cent of the sample. Smoking was by far the most common method among cannabis users, used by around 87 per cent of non-regular and regular consumers, followed by vapourising and edible forms. Among non-regular users, 61.6 per cent used cannabis strictly for recreation, while among regular users 37.6 per cent used it strictly for medical reasons and 24.7 per cent for both medical and recreational purposes.
Across the entire cohort, signs of sleep-disordered breathing were relatively common, with 44.7 per cent reporting either loud snoring or witnessed apnoeas. In unadjusted figures, 44.3 per cent of non-users reported at least one sign, compared with 48.4 per cent of non-regular users and 55.2 per cent of regular users. Witnessed apnoeas were reported by 15.3 per cent of non-users, 17.1 per cent of non-regular users and 19.8 per cent of regular users; loud snoring by 41.3 per cent, 44.5 per cent and 50.0 per cent respectively.
Using statistical models weighted to reflect the US adult population and adjusting for age, sex, race and ethnicity, education, income, health insurance, diabetes, body mass index, alcohol use, traditional cigarette smoking and electronic cigarette use, cannabis use remained independently associated with higher odds of sleep-disordered breathing symptoms.
Compared with non-users, non-regular cannabis users had 41 per cent higher odds of witnessed apnoeas, 26 per cent higher odds of loud snoring, and 33 per cent higher odds of experiencing either symptom. The association was stronger among regular users: those who consumed cannabis for 16 to 30 days per month had 73 per cent higher odds of witnessed apnoeas, 68 per cent higher odds of loud snoring and 82 per cent higher odds of reporting either sign. In raw terms, about 55 per cent of regular users reported at least one sign, versus around 44 per cent of non-users.
“While the impact of infrequent use is relatively small, the odds of irregular breathing during sleep almost double with more frequent cannabis use, making this a strong association worthy of consideration before frequent cannabis utilisation,” Gallagher explained.
The researchers also treated cannabis use as a continuous measure from zero to 30 days per month. In weighted models, each additional day of use was linked to roughly a 2 per cent increase in the odds of reporting any sign of sleep-disordered breathing. When the analysis was repeated without the weights, regular cannabis use remained associated with both signs, though the estimates were smaller; non-regular use, by contrast, was no longer linked to snoring or to either sign, and its link with witnessed apnoeas hovered at the edge of statistical significance.
Gallagher noted the results contrast with some clinical studies that have investigated cannabinoids as treatments for sleep apnoea, suggesting differences between isolated cannabinoids studied in trials and the effects of real-world cannabis use, including composition and method of consumption.
The authors propose two plausible biological mechanisms. First, since around 87 per cent of users in the sample smoked their cannabis, smoke exposure and heat could irritate throat tissues and contribute to airway inflammation. Second, cannabis may interact with the autonomic nervous system: small doses stimulate the sympathetic system, while higher doses activate the parasympathetic system, which could promote relaxation of upper airway muscles and make collapse during sleep more likely in frequent users who consume larger quantities.
The researchers caution that the study’s cross-sectional design cannot establish causation. It cannot determine whether cannabis use causes sleep-disordered breathing or whether people with sleep problems turn to cannabis. Limitations also include reliance on self-reported data, absence of dosage or potency details, and the fact that only two states were included because they were the only jurisdictions to pose both cannabis-use and sleep-breathing questions. Some symptoms may have predated current cannabis habits.
They emphasise that reporting symptoms is not the same as a medical diagnosis. “While obstructive sleep apnoea is a clinically defined and hazardous intermittent airway obstruction during sleep, this study cannot make conclusions about the association between cannabis use and sleep apnoea or other associated long-term risks,” Gallagher said.
Future research should incorporate objective sleep testing, such as polysomnography, to verify whether cannabis habits align with clinically diagnosed sleep apnoea. The scientists also urge examination of different delivery methods—edibles versus inhalation—to separate cannabinoid effects from tissue damage caused by inhaling smoke.
“Further research is required to examine the long-term effects of cannabis use on sleep and to determine the effects of cannabis dosage, different cannabis compositions, and different methods of consumption on sleep-disordered breathing,” Gallagher said. “Additionally, the long-term consequences of these impacts must be studied.”
They recommend clinicians counsel patients about potential respiratory risks, particularly for those with signs of sleep-disordered breathing. “People experiencing persistent snoring, pauses in breathing, or other symptoms of sleep apnoea should seek medical evaluation rather than trying to utilise cannabis to manage their sleep,” Gallagher advised.
“This study highlights the importance of evaluating the broader health effects of substances that people increasingly use for self-management,” Gallagher added. “Cannabis may have benefits for certain symptoms or conditions, but those potential benefits should be considered alongside possible risks. Sleep-disordered breathing is particularly important because it can go unrecognised for years while causing significantly worse quality of life. We hope these findings encourage further research and help clinicians have more informed conversations with patients who use cannabis for sleep-related concerns.”
The study, “Cannabis use and associated sleep-disordered breathing among US adults,” was authored by Tyler J. Gallagher, Matthew E. Lin, Ian Kim, Ziva D. Cooper, Sebastian M. Jara, and Eric J. Kezirian.
