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.
