Older Adults Using Cannabis for Sleep Rely More on THC and Use It More Frequently, Small Clinic Survey Finds

A cross-sectional study of 82 cannabis-using geriatrics patients reveals distinct use patterns among those targeting sleep disturbance, but its very small subgroup and descriptive design cannot address whether cannabis actually improves sleep outcomes in this vulnerable population.

Why This Matters

Sleep disturbance affects 40 to 70 percent of older adults, and cannabis use in this age group is rising faster than in any other demographic. Despite this convergence, clinicians have had almost no data describing how older patients actually use cannabis when sleep is the target, including what products they choose, how often they consume them, and whether sleep is the sole focus or part of broader symptom management. This study provides the first descriptive characterization of those patterns, arriving at a moment when patient questions about cannabis for sleep are outpacing the evidence available to answer them.

Clinical Summary

Sleep disturbance is among the most common complaints in geriatric primary care, yet evidence-based pharmacological options carry significant risks in older adults, from benzodiazepine-related falls to anticholinergic burden. Against this backdrop, cannabis has gained popularity as a self-directed sleep aid, though the evidence supporting its efficacy and safety in older populations remains thin. A 2023 cross-sectional survey by Heinz and colleagues, published in Clinical Gerontologist, collected anonymous questionnaire data from 568 patients at a single UC San Diego geriatrics clinic. Of these, 82 reported current cannabis use, and 24 of those 82 identified sleep disturbance as a target condition. The study aimed to characterize product preferences, frequency, and co-targeted conditions in this sleep-using subgroup compared to cannabis users targeting other conditions.

Among the 24 sleep users, 62 percent reported using THC-containing products compared to 32 percent of non-sleep cannabis users (p less than .01), and 76 percent used cannabis daily or weekly versus 43 percent of the comparison group (p equals .01). Sleep users also targeted significantly more conditions simultaneously, with a mean of 3.17 additional conditions versus 1.12 (p less than .01), and 83 percent also used cannabis for pain. A non-significant trend toward female predominance was observed (75 percent vs. 53 percent, p equals .07). The study collected no objective sleep outcomes, used a relaxed significance threshold of p less than .10 without correction for multiple comparisons, and drew from a predominantly White, college-educated, single-site convenience sample. The authors acknowledge that larger, longitudinal studies with validated sleep measures are needed before any clinical recommendations can be made.

Dr. Caplan’s Take

This study captures something I see regularly in practice: older patients who start using cannabis for sleep rarely stop at sleep. The finding that sleep users targeted over three additional conditions on average confirms what many of us suspect, that cannabis for sleep in this population is part of a broader self-management strategy, often alongside chronic pain. The preference for THC-containing products is also unsurprising given THC’s sedating properties, but this is precisely where the gap between mechanistic plausibility and clinical evidence is widest. When a patient in their seventies tells me they are using THC nightly for sleep, honesty requires me to say that we do not yet have the data to know whether this is helping their sleep architecture, masking another treatable condition, or introducing risks we have not measured.

In practice, I prioritize a thorough sleep history and screening for treatable causes before discussing cannabis. When patients are already using cannabis for sleep, I document it, assess for daytime impairment and fall risk, review potential interactions with their medication list, and recommend periodic reassessment. I do not initiate cannabis for sleep in older adults based on evidence at this level, but I also do not dismiss patients who report benefit. The conversation has to stay open, grounded, and honest about what we do and do not know.

Clinical Perspective

This study sits at the very beginning of the research arc for cannabis and sleep in older adults. It confirms that a meaningful proportion of older cannabis users are targeting sleep and that their use patterns differ from those of other cannabis users, but it cannot tell clinicians whether these patterns produce benefit, harm, or neither. The absence of validated sleep outcome measures such as the Pittsburgh Sleep Quality Index or actigraphy data means the study describes behavior, not results. For now, there is no evidence from this work or from the broader literature that would support recommending cannabis as a first-line or adjunctive sleep intervention for geriatric patients.

From a pharmacological standpoint, THC use in older adults raises specific concerns. THC can impair balance and reaction time, increase fall risk, and interact with commonly prescribed medications including anticoagulants, benzodiazepines, and opioids through cytochrome P450 pathways. The finding that sleep users consume cannabis more frequently and prefer THC-containing products means this subgroup may carry disproportionate exposure to these risks. Clinicians should proactively ask older patients about cannabis use during medication reconciliation, specifically inquiring about product type and frequency, and document these details as rigorously as they would any other pharmacological exposure.

Study at a Glance

Study Type

Anonymous cross-sectional survey

Population

Older adults attending a single geriatrics outpatient clinic (UCSD); 82 cannabis users, 24 using cannabis for sleep

Intervention

None (observational; self-reported cannabis use patterns)

Comparator

Cannabis users targeting conditions other than sleep (N=58)

Primary Outcomes

Frequency of cannabis use, product type (THC vs. CBD), administration methods, number of conditions targeted

Sample Size

568 survey respondents; 82 cannabis users analyzed; 24 in sleep subgroup

Journal

Clinical Gerontologist

Year

2023

DOI or PMID

PMID: 36945134

Funding Source

Not reported

What Kind of Evidence Is This

This is an original cross-sectional survey study using self-reported, anonymous questionnaire data collected at a single outpatient clinic over approximately ten weeks. Cross-sectional surveys sit in the lower tiers of the evidence hierarchy, below cohort studies, controlled trials, and systematic reviews. The single most important inference constraint this design imposes is that no causal relationship can be established. The study describes associations between cannabis use for sleep and certain product and frequency patterns at one point in time, but it cannot determine whether these patterns cause, result from, or merely coincide with sleep disturbance.

How This Fits With the Broader Literature

Prior survey research has documented rising cannabis use among older adults generally, and several studies have identified sleep as among the most commonly cited reasons for use across age groups. A 2022 systematic review by Suraev and colleagues found that sleep improvement is frequently self-reported by cannabis users but that objective evidence from controlled trials remains sparse and inconsistent, particularly in older populations. The present study extends this literature by providing the first detailed characterization of product preferences and use frequency among older adults specifically targeting sleep. However, it does not challenge or confirm any efficacy findings because it collected no sleep outcomes. Its primary contribution is descriptive: it maps the terrain of a practice that is already widespread but poorly understood.

Common Misreadings

The most likely overinterpretation of this study is reading the association between cannabis use for sleep and THC product preference as evidence that THC is effective for sleep in older adults. The study measured what people use, not whether it works. Similarly, the higher frequency of use among sleep users could reflect perceived benefit, habit formation, tolerance development, or any combination of these. The relaxed significance threshold of p less than .10, the absence of multiple comparison correction, and the subgroup size of only 24 individuals mean that even the strongest statistical associations reported here could be unstable and should be treated as hypothesis-generating rather than confirmatory.

Bottom Line

This small, single-site survey establishes that older adults using cannabis for sleep prefer THC-containing products, use cannabis more frequently, and typically target multiple symptoms simultaneously. It does not and cannot establish whether cannabis improves sleep, is safe for nightly use, or should be recommended to older patients. Its value is descriptive: it maps a practice pattern that warrants rigorous investigation through controlled trials with validated sleep outcomes before any clinical guidance can responsibly follow.

References

1. Heinz AJ, Engstrom A, Engstrom CG, et al. Cannabis use for sleep disturbance among older patients in a geriatrics clinic. Clinical Gerontologist. 2023. PMID: 36945134.
2. Suraev AS, Marshall NS, Vandrey R, et al. Cannabinoid therapies in the management of sleep disorders: a systematic review of preclinical and clinical studies. Sleep Medicine Reviews. 2020;53:101339.