Seeking relief or fueling the fire? Understanding the complex role of cannabis in PTSD, stress, and sleep dysregulation.

Objective: Cannabis use is common among U.S. military veterans, particularly those experiencing posttraumatic stress disorder (PTSD), poor sleep, and elevated stress. While often used to self-manage these symptoms, the impact of cannabis on day-to-day symptomology remains unclear. This study examined the daily associations among cannabis use, PTSD symptoms, perceived stress, and sleep quality using intensive longitudinal data.

Method: Seventy-four recently separated U.S. veterans (age = 33.5 years; 80% male; 61% non-Hispanic White) who endorsed past-month cannabis use and elevated PTSD symptoms completed a 3-month daily diary study. Participants provided 4,307 person-days of data via a mobile app. Measures included daily cannabis use (hours high), PTSD symptoms, perceived stress, and sleep quality. Dynamic structural equation modeling (DSEM) was used to estimate within-person lagged and same-day associations, adjusting for relevant covariates.

Results: Day-to-day analyses revealed that elevated PTSD symptoms and poor sleep quality each predicted greater perceived stress the following day. Greater number of hours high was associated with less perceived stress the following day. Perceived stress, in turn, predicted both higher PTSD symptoms and poorer sleep quality. In post hoc analysis, stress emerged as a significant mechanism of change in the day-to-day lagged model. In particular, we show greater cannabis use is linked to improved sleep and PTSD symptoms through lower perceived stress.

Conclusion: Cannabis may offer temporary relief and appears to interrupt the day-to-day cycle linking PTSD, stress, and poor sleep. (PsycInfo Database Record (c) 2025 APA, all rights reserved).