Sleep Hygiene and Mental Health in Young Adults

Restorative sleep often takes a backseat for young adults, overshadowed by the demands of a fast-paced and socially pressured phase of life. However, with research showing a clear link between quality sleep and emotional resilience, focus, and overall well-being, it’s essential that we take sleep into account when a young person is struggling with their mental health.

This raises important questions for mental health professionals: What factors most commonly disrupt sleep for our college-aged clients? How can we guide them toward self-motivated, practical solutions to improve sleep and prevent related disorders?

This was the focus of conversation during a recent collaborative Roundtable Dinner with The Lindner Center of Hope. Drawing together mental health professionals from multiple domains, we were honored to welcome Michael Groat, PhD, President and CEO, and Francisco Romo-Nava, MD, PhD, Associate Chief Research Officer. Below, we recap key insights discussed during the event, on both the science of sleep and practical strategies for introducing sleep hygiene to this population.

The Dorm: Thank you both for being here with us today. Let’s start from the beginning – how do you usually open up conversations about the topic of sleep hygiene?

Dr. Francisco Romo-Nava: I usually start with trying to define sleep, because although all living things have a form of rest – actually defining sleep is not trivial, and actually can be quite challenging.

Most researchers agree that sleep is a cyclical, physiological state that includes a transition from a wakefulness state to a non-wakeful state. When the brain changes its state, so does the body, and we can see measurable changes in:

• Blood pressure 
• Beart rate
• Temperature

These changes are what we call the sleep-wake cycle. In humans, this period occurs during the night, and we know that it is driven by an internal timing system that is called the circadian system. We now know (based on the work of research that was awarded the Nobel Prize in 2017) that all living beings actually have a molecular clock that functions to alert many systems in the body. This system is governed by the suprachiasmatic nucleus in the hypothalamus, a small cluster of neurons capable of maintaining a near-24-hour rhythm independently, which senses light and coordinates physiological timing across the body.

The Dorm: So how does this system come into play for young adult sleep patterns?

Dr. Michael Groat: For young adults, depending on one’s socioeconomic background and family background, there can be all kinds of pressures to be high achieving and really push oneself psychologically. This can introduce many sleep disruptors into daily life.

Romo-Nava: Yes, when it comes to social pressures in university or in first job settings, psychosocial stress can be a big sleep disruptor. Other examples include:

• Using more substances such as nicotine, alcohol, and caffeine. 
• Using caffeine or energy drinks later in the day, for studying or going out. 
• Navigating new relationships and new social stressors outside of the family system for the first time.
• Experiencing increased exposure to light at night.

Groat: On this last point, we’re finding more and more that light exposure at night has a big impact on sleep. We’re not living in an era where the sun goes down and everyone goes to bed, so there are many layers of challenges for maintaining sleep hygiene. There is growing awareness about this, but we still have a long way to go to have research on how light exposure is impacting young adults and patients in general.

The Dorm: What is the relationship between the circadian rhythm and sleep hygiene?

Romo-Nava: We can use our knowledge about the circadian rhythm to coach young adults on building a sleep hygiene practice. Therapists can start with educating them about their chronotype or “diurnal preference” – your preference for the best time to work, sleep, or perform activities. 

As researchers, we typically classify these preferences into three chronotypes: morning, intermediate, or evening types. It can be interesting to ask clients what their preferences might be, and share how they fit into the general population.

• Morning types:  Account for about 5% to 15% of the population
• Evening types: Account for approximately 5% of the population
• Intermediate types (no strong preference):  Approximately 70% of the population

Most societal schedules cater to intermediate or early morning types, so those with evening types suffer the most from the current societal norms. Knowing this can help validate clients who are struggling with needing to wake up early for classes or work, and are experiencing more physiological stress from adapting to the timing of others. 

The Dorm: What happens if a young adult’s schedule doesn’t align with their diurnal preference?

Romo-Nava: It can have major impacts on mental health. For just one example, a study we conducted with young adult medical students showed that during exam season, those with evening chronotypes had a higher likelihood of experiencing depressive symptoms, especially when combined with high academic stress. This doubled the likelihood to ten times for depressive symptoms, reaching thresholds for major depressive episodes.

The Dorm: How can clinicians assess and support healthy sleep patterns in young adults?

Groat: Whether you’re in an outpatient practice, an assessment service, or inpatient unit, you can begin by asking people about their preferences for sleep, and what they notice about their sleep patterns—something we actively do at The Lindner Center of HOPE. 

Another aspect, though, is that in inpatient and residential environments, people may present with mood disorder symptoms, hypomanic or manic symptoms. At intake and as we work to stabilize them, we sometimes see they are experiencing a day-night reversal.

For example, it’s common to see young adults staying up nearly all night, with families expressing concerns about them sleeping most of the day and getting stuck in these patterns. One of the advantages of a residential environment would be that direct observation, providing another way to understand sleep patterns. 

Alongside talking with the patient, gathering information from families, significant others, or roommates, helps illuminate sleep patterns, offering valuable clinical insights. Particularly in cases where we see a propensity to stay up very late, we can engage in incremental interventions to gradually shift those patterns. 

The Dorm: What are some of the most common interventions clinicians use to address disrupted patterns?

Groat: One intervention I’ve been really encouraged by, and that we’ve found effective clinically, is the promotion of exercise, which we’ve seen help patients with bipolar illness or those who struggle with staying up late. 

Beyond this, there are several tools clinicians can use to address sleep disrupters:

• discussing sleep with patients
• collecting collateral information, including observations from family members
• observing sleep hygiene practices and routines 
• providing education about chronotypes or sleep preferences
• identifying risk factors
• addressing disruptors to sleep

After reviewing these baselines, it’s important to also carefully review a client’s dietary patterns, including what they’re drinking. One thing we see a lot is young adults who have a habit of consuming energy drinks in the afternoon, so adjusting their diet and lifestyle can be crucial. (This includes taking a careful look at exercise patterns, medication use, and possible sleep disruptors.)

At The Lindner Center of HOPE, our environment is structured to reinforce sleep hygiene. We set specific phone and TV hours, turn off electronics at a designated time, and dim lights on inpatient units and in residential programs, all signaling the body to wind down. Outpatient clinicians can also talk through these lifestyle approaches, such as setting up an environment for sleep, preparing for rest, and actively working to reduce sleep disruptors.

The Dorm: How long can it take to really start to see some positive outcomes and changes during treatment?

Groat: Anecdotally, from what I observe in our practice: 

• It usually takes several weeks to observe sleep patterns and possible disrupters. 
• Then, we begin developing a plan to incrementally address disruptions through medication, sleep hygiene practices, and a new environment of structure and routine around sleep.
• Eventually, once things have stabilized, we address lifestyle changes getting them involved in exercise, refining their diet, and tweaking their intake of any stimulants. 

Once all of these things are working together, we can begin to see an improvement over the course of three or four weeks. However, it’s important to note that buy-in from the client is crucial to success.

For a quick case example, we recently had a client who was routinely up until 6:00 AM, came in hypomanic, and was struggling with sleep and related mental health disturbances. Over the course of only five weeks he was going to bed at 11:00 PM and getting up around 7:00 AM. 

That took his active involvement in helping change these patterns: 

• He exercised every day. 
• He stopped all coffee after 10 AM. 
• He was engaged and really took ownership for his role in helping change. 

Of course it can vary from person to person, depending on engagement with their treatment, but in my experience it’s very encouraging that we can see lasting change begin within weeks of treatment.

Romo-Nava: The key aspect to what you mentioned, Dr. Groat, is how different each individual’s experience or clinical presentation can be. 

Some patients, for example, with bipolar disorder, may experience extreme shifts during the symptomatic episodes of the disorder; during the depressive episodes patients tend to shift towards a delay in their timing system, whereas during the hypomanic or manic episodes they tend to advance. 

So, there’s a very large shift that accompanies what we’re starting to identify as a form of circadian phase instability, as a feature of bipolar disorder and potentially other psychiatric disorders. This can be more challenging during treatment. 

So how to address this? As researchers looking at individual cases like this, we are currently trying to develop personalized approaches or interventions that respond to this variability in each individual’s timing system. 
To understand how variable clients can be when it comes to their internal timing systems (and improve future treatments for difficult diagnoses including bipolar disorder), we’re now working on a clinical trial funded by the NIMH.

Romo-Nava: In summary –

• We are first trying to identify the internal timing system by using a “dim light melatonin onset approach”. 
• Then we are using that information to plan a combined chrono-biological intervention that responds to that timing, and attempt to shift it according to that individual’s need.
• Ultimately, we’re attempting to understand if there is any benefit towards a personalized approach based on diagnoses for helping clients improve their circadian rhythms.

How long can it take for more difficult cases? Well, what we know is that, as Dr. Groat mentioned, sleep patterns or the circadian system start to stabilize after a few weeks. You’ll see that this correlates or runs in parallel with the improvement in the other symptomatic domains. 

So, is this a consequence of targeting the other symptoms and then secondarily improving circadian system function? Or is it because we are facilitating the organization of the circadian system that it improves the other symptomatic domains? That we still, it’s still unclear. But it’s certainly a very important part of recovery. 

The Dorm: Thank you both for giving us some insight into the tremendous role sleep has within mental health treatment.

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About Sleep Hygiene at The Dorm and dWELL Recovery

At The Dorm, sleep hygiene skills are interwoven into several programming options designed specifically for young adults, including our Executive Functioning Skills Groups, individual therapy sessions, clinical coaching (skills therapy), and mindfulness and meditation groups.

Our affiliate, dWELL Recovery, a residential program in New York City, also extends this commitment by providing affirming, around-the-clock mental health support. In particular, our team at dWELL emphasizes fostering a healthy relationship with technology and helping clients build specific lifelong skills around daily sleep hygiene practices. 

About Sleep Hygiene and The Lindner Center of Hope

Dr. Romo-Nava’s ongoing research specializes in the brain-body connection within psychiatric disorders through a “Neuroscience of the Body” framework, providing a unique lens for understanding why sleep is more than just rest—it’s an active, vital process for mental health recovery and long-term treatment outcomes. Discover more about The Lindner Center of HOPE’s research into sleep and mental health.