Daily associations between sleep quality, stress, and cannabis or alcohol use among veterans

Abstract

United States military veterans face heightened vulnerability to sleep disturbances due to factors such as irregular sleep schedules, combat-related stress, and co-occurring mental health disorders. These sleep disturbances are often exacerbated by substance use, including alcohol and cannabis, as veterans may rely on these substances to self-medicate for stress and sleep issues. However, the interplay between sleep quality, substance use, and perceived stress remains poorly understood, particularly on a day-to-day basis. This study aimed to explore the dynamic associations between these factors using daily diary data collected over three months from 74 veterans with elevated PTSD symptoms and problematic cannabis use. Data from this study are secondary analysis. Dynamic structural equation modeling (DSEM) was employed to examine both within-day and day-to-day lagged associations between sleep quality, perceived stress, and substance use (alcohol and cannabis). Results showed that worse sleep quality was associated with higher perceived stress the next day, which in turn predicted greater alcohol consumption. Additionally, stress mediated the relationship between poor sleep quality and increased alcohol use. For cannabis, while no day-to-day lagged effects were observed, within-day analyses revealed that higher cannabis use was associated with lower stress and better sleep quality that same night. These results highlight the complex and bidirectional relationships between sleep, stress, and substance use among veterans, underscoring the need for interventions that address these dynamics holistically. Future research should further explore these interactions using real-time data to inform tailored interventions for improving sleep and mental health outcomes in this population.