Sustainable Habits for Encouraging Even Teen Sleep (SHEETS): A Digital Intervention to Enhance Sleep Regularity and Psychiatric Health in Adolescents

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More than two-thirds of U.S. adolescents exhibit unhealthy sleep patterns. Sleep, which is a construct in the Arousal and Regulatory domain of RDoC, is a critical process supporting psychiatric health during adolescence. Specifically, sleep disturbances appear to represent a transdiagnostic risk factor for onset of internalizing and externalizing disorders as well as interfere with academic and social performance during this critical developmental period. Thus, preventative interventions to improve sleep among adolescents are necessary to support psychiatric health and functioning across the lifespan. Efficacious behavioral sleep strategies exist for adolescents. However, there has been limited translation of what is known to work in research and subspecialty care settings to community preventive and primary care practice settings, where most adolescents access social and health services. As well, much of the anticipatory guidance in primary care focuses on sleep duration, which may be difficult to improve upon for adolescents navigating multiple academic and extracurricular demands. In contrast, another critical aspect of sleep, the regularity of sleep-wake patterns, is associated with a range of psychiatric health and functional outcomes, and these relationships are shown to be independent of duration, suggesting enhancing sleep regularity may improve adolescent psychiatric outcomes even if duration remains constant. Recognizing the powerful connections between sleep, psychiatric wellness, and psychosocial function, there is a critical need to take efficacious behavioral strategies to improve sleep regularity among youth, and to optimize the delivery system to reach diverse youth in the primary care setting, the point of access for most youth seeking support for emotional and mental health. For the proposed project, we will evaluate the feasibility and acceptability of a 6-week digital sleep regularity intervention (Sustainable Habits for Encouraging Even Teen Sleep; SHEETS) among a diverse population of adolescents, ages 13-15 years, and will explore a range of socio-environmental drivers of sleep regularity as they relate to intervention uptake. SHEETS uses a digital platform to deliver education on sleep regularity as a health prevention tool, motivational messaging, support for setting goals for consistent bed- and wake-times, and self- monitoring. Wearable sleep sensors (Garmin wristwatches) provide real-time feedback to adolescents about their sleep regularity. We will also evaluate the short-term effectiveness of SHEETS on sleep regularity, sleep practices, and psychiatric health (i.e., internalizing and externalizing symptoms, psychosocial function) among adolescents receiving health services in a primary care pediatric practice compared to an active control group, and will explore sleep regularity as a mediator of the relationship between SHEETS participation and better psychiatric health. Findings from this study will inform proposal development for an adequately-powered randomized controlled trial (RCT) designed to optimize and evaluate scalable, easily disseminated digital sleep interventions that are acceptable and effective for youth living in a range of sociocultural contexts.