What helps and what hurts adolescents’ sleep? An intense longitudinal ecological momentary assessment of daily facilitators and barriers of sleep on school and non-school nights

Background: A myriad of modifiable cognitive and behavioural factors influence adolescent sleep. Using an intense longitudinal design, we investigated adolescents’ perceptions of factors facilitating (i.e., facilitators) and hindering (i.e., barriers) sufficient and good quality sleep in their everyday life. Methods: 205 (54.2% female, 64.4% non-white) Year 10-12 adolescents (Mage = 16.9 ± 0.9) completed daily morning surveys and wore actigraphs over 2 school-weeks and 2 subsequent vacation-weeks (5162 total observations). Daily morning surveys assessed self-reported sleep and use of 8 facilitators and 6 barriers of sleep from the previous night. Linear mixed-effects models examined the contribution of facilitators/barriers to actigraphy and self-reported total sleep time (TST) and sleep onset latency (SOL), controlled for age, sex, race, place of birth, and study day. School/non-school day status was included as a moderator. Results: Seven facilitators and two barriers were endorsed by >30% of adolescents as frequently (≥50% nights) helping/preventing them from achieving good sleep. Overall, facilitators or barriers explained 1-5% (p-values <.001) of unique variance above and beyond the covariates. Facilitators, predicting longer TST and shorter SOL, were following body cues, managing thoughts and emotions, creating good sleep environment, avoiding activities interfering with sleep, and bedtime planning (only TST on school nights). Barriers, predicting shorter TST and longer SOL, were pre-bed thoughts and emotions, unconducive sleep environment, activities interfering with sleep, inconsistent routines, and other household members’ activities. Conclusions: Adolescents use a range of sleep facilitating behaviours and a number of factors prevent sufficient and good quality sleep in their everyday life. These factors are predictive of their sleep duration and onset latency and require further research to understand their functions and clinical implications.