Co-Creating Sleep Hygiene Plans With Adolescent Patients
Endlessly scrolling on a device late at night can be detrimental to anyone’s mental health, but for young patients aged 10 to 20 years, rising depression rates correlate with increased screen time, especially before bed.
“The majority of my research has been focused on sleep and adolescents with depression, and why it is so important that we talk about this,” David Thibault, DNP, APRN, FNP-BC, PMHS, told The Clinical Advisor. “What we found is that those adolescents who have good sleep habits — who aren’t scrolling on their phones late at night, staying up into the late hours of the night, and waking up early — have fewer depressive symptoms.”
Dr Thibault presented his research on personalized sleep hygiene interventions for adolescents at the American Association of Nurse Practitioners (AANP) annual meeting, held from June 17 to 22, 2025, in San Diego, California. He is an assistant professor at Utah Tech University whose work focuses on adolescent mental health.
Low Cost, High Impact Solution
Implementing personalized sleep hygiene plans with teenage patients is a low-cost, high-impact way to improve depression symptoms, Dr Thibault explained.
Barriers that may complicate this objective include academic demands, electronic use, mental health symptoms, environmental factors, and lack of motivation. Therefore, clinicians must empower adolescents to take control of their sleep schedule to support their mental health, according to Dr Thibault.
“The biggest thing to remember with this is how important it is to empower [teenagers] so that they feel this is their plan and their idea,” he said. “Let them feel that they can make a change to make themselves happier in a way that doesn’t require medicine. Once we get that buy-in, it can definitely make a difference and make our children happier.”
Sleep Hygiene Intervention Improves Adolescent PHQ-9 Scores
Dr Thibault and his colleagues designed a sleep hygiene study that included 16 patients aged 10 to 20 years with a Patient Health Questionnaire-9 (PHQ-9) score of 5 or greater. There were 7 patients in the group taking psychiatric medication, and 9 who were not taking medication. All participants were White; 10 identified as female and 6 were male. Patients with active suicidal ideation were not included in the project.
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What we found is that those adolescents who have good sleep habits, who aren’t scrolling on their phones late at night, staying up into the late hours of the night, and waking up early, have fewer depressive symptoms.
David Thibault, DNP, APRN, FNP-BC, PMHS
Providers encouraged the patients to plan ahead for sleep hygiene and track their results. Using a worksheet called “My Plan for a Great Night’s Sleep,” patients listed what a “great” night of sleep meant to them, and the steps they aimed to take to achieve one.
Overall, 14 of 16 patients (87.5%) participated in the plan. All 7 patients taking medication participated; the 2 patients who were not taking medication and did not participate cited forgetfulness and school obligations as their reasons for not adhering to their sleep hygiene plan, respectively.
Among the 9 patients in the non-medication group, 55.6% had a moderate PHQ-9 score at their initial visit. This dropped to 33.3% after implementing the sleep hygiene plan. More than half (55.6%) had a PHQ-9 score of “none/minimal” after completing the sleep hygiene intervention.
For the 7 patients taking medication, 71.4% had moderate PHQ-9 scores, 14.3% had moderately severe scores, and 14.3% had severe PHQ-9 scores at their initial visit. Post-intervention, 85.7% had moderate PHQ-9 scores and 14.3% had “none/minimal” PHQ-9 scores.
Sleep Hygiene Case Example
Dr Thibault presented the case of a 15-year-old female patient with an initial PHQ-9 score of 15, indicating moderately severe depression. She reported a habit of sleeping with her phone under her pillow; she would typically stay on her phone until approximately 2 am before going to sleep.
After she co-created a sleep hygiene plan with her health care provider, her PHQ-9 score drastically improved. The plan indicated that she would stop all screen time by 10 PM and be in bed with the lights out by 11 PM.
At 6 weeks, the patient’s PHQ-9 score dropped to 6. She stated that her sleep quality improved.
“I didn’t realize how much sleep changed everything,” the patient said, relayed by Dr Thibault.
Tips for Clinicians and Patients
Dr Thibault shared tips for both clinicians and patients to help adolescents achieve healthy sleep habits.
Table. Sleep Hygiene Tips for Clinicians and Adolescent Patients
| Tips for Patients | Tips for Clinicians |
| Aim for 9.5 hours | Start conversations about sleep hygiene even if the patient does not bring it up during their visit |
| Stick to regular sleep and wake times | Normalize the link between mental health and sleep |
| Try not to use screens before bed and, if possible, put devices into “night shift” mode to reduce blue light emissions | Use brief, targeted questions |
| Sleep in a dark, cool, and quiet environment | Co-create a sleep hygiene plan with the patient |
| If possible, do not do daily activities in the bedroom and prioritize it as a place strictly for sleeping | Keep sleep hygiene plans realistic and simple |
| Avoid naps, especially late in the day | Track progress over time and adjust plans when necessary |
| Avoid caffeine (especially after 3 PM), smoking, alcohol, or drugs | Frame sleep hygiene adjustments as an empowering opportunity for patients |
| Don’t watch the clock or put too much focus on trying to sleep | |
| Keep a pen and paper next to the bed to write down worries that can be addressed in the morning | |
| Find a few calming rituals to complete nightly | |
| Stick to the sleep hygiene plan even after a bad night’s sleep | |
| Eat healthy and exercise |
Hear directly from Dr David Thibault about his work on the link between adolescent sleep hygiene and depressive symptoms, including his top tip for clinicians:
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