Malin Jakobsson started out as a school nurse, with a great interest in adolescents and their health. In her work on her doctoral thesis, she has focused on adolescents’ perspectives on sleep and the factors that make difficult or promote a good night's sleep. As 55 per cent of adolescents sleep less than the recommended eight hours per night, this affects how they feel and perform at school. Too little sleep affects adolescents’ daily lives and can increase the risk of depression and anxiety. Lack of sleep is an imminent health problem.

“There is no one explanation for why adolescents sleep poorly; it is individual and complex. That is why it is very important to really listen to your adolescents, to ask open-ended questions,” said Malin Jakobsson.

The results from her four sub-studies are based on surveys of 937 and 475 adolescents, respectively; in-depth interviews with 16 adolescents; and interviews in eight focus groups with a total of 43 adolescents. All participants were between 15–16 years old.

Digital technology and school stress

The adolescents spoke about how a lack of routines, school stress, and the use of technology prevent them from getting to bedtime. Once they have gone to bed, it is difficult to sleep due to difficulty in unwinding, the silence that occurs, and thoughts and worries.

“It will be a struggle to accommodate all the thoughts and feelings that come at night, they become big and existential. Adolescents may think that difficulty sleeping is normal for this time in life and is just something to suffer through. This can mean that they do not ask for help,” said Malin Jakobsson.

Targeted advice better than general tips

Something that surprised her in the interviews with the adolescents is that they so clearly asked for support from parents, school nurses, or other significant adults to deal with their sleep difficulties. They describe that sleep is better if their parents are involved, help them with routines and structure, and create a feeling of security.

“The adolescents want to be guided to a balance in everyday life, a balance between school and leisure, movement and rest, and between silence and constant input. To make informed decisions in relation to their sleep, they also demand more knowledge about sleep,” said Malin Jakobsson.

The adolescents feel that they receive knowledge, tips, and advice best if they are given by someone they have a relationship with. Then the advice feels personal, targeted, and well-meaning, which adolescents think is better than general tips.

Science-based advice

Malin Jakobsson's hope is that the perspectives of the interviewed adolescents will contribute to a deeper understanding and more knowledge about adolescent sleep. In her doctoral thesis, she details clinical implications and science-based advice that may be helpful in promoting adolescent sleep:

• Do not just ask whether your adolescents sleeps well, but let the adolescents talk about their sleep and what affects it.
• Listen genuinely to each individual adolescents. Perhaps adolescents have not thought about their sleep as lacking. Perhaps adolescents think that difficulty sleeping cannot be addressed.
• Be open to existential thoughts. Thoughts and worries can make it difficult for adolescents to sleep.
• Prioritise creating a relationship with adolescents, then advice and efforts can be more targeted.
• Involve adolescents in decisions.
• Involve parents early in the prevention work.
• Activate adolescents in school education about sleep.
• Those who work with adolescents should make sure to stay up to date on sleep and sleep difficulties. Knowledge instils security.

More detailed clinical implications can be found in the doctoral thesis I want to sleep, but cannot. Adolescents' perspectives on factors that hinder and promote their sleep. 

Malin Jakobsson defended her doctoral thesis in Caring Science at the University of Borås on 20 May 2022.

Principal supervisor: Professor Karin Josefsson
Assistant supervisor: Senior lecturer Karin Högberg

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Read the news article Anxiety and struggle: New study on adolescent sleep difficulties  

Read more about the research area The Human Perspective in Care