This study examined sleep patterns and sleep problems in relation to smoking and alcohol use in Chinese adolescents. A questionnaire survey of 2090 adolescent students was conducted in Lijin County, Shandong, China. A self-administered questionnaire was used to collect the data. After adjustment for demographics and internalizing and externalizing problems, poor sleep quality was associated with increased risk of smoking (odds ratio [OR], 2.59; 95% confidence interval [CI], 1.24-5.40), alcohol use (OR, 2.65; 95% CI, 2.81-3.89), and getting drunk (OR, 2.81; 95% CI, 1.72-4.57); sleeping 7 hours (OR, 1.64; 95% CI, 1.20-2.43) and sleeping 6 hours or less per night on weekdays (OR, 1.97; 95% CI, 1.25-3.10) were significantly associated with increased risk for alcohol use, and sleeping 6 hours or less per night on weekends (OR, 2.09; 95% CI, 1.18-3.70) were significantly associated with increased risk for getting drunk; and hypnotic medication use was significantly associated with ever smoking (OR, 1.80; 95% CI, 1.08-2.99). These findings highlight the potential role of sleep intervention in the prevention of adolescent substance use.