Copyright is owned by the Author of the thesis. Permission is given for a copy to be downloaded by an individual for the purpose of research and private study only. The thesis may not be reproduced elsewhere without the permission of the Author. Taking interest in versus disregarding sleep information: Qualitative study exploring the adolescent perspective A thesis presented in partial fulfilment of the requirements for the degree of Master of Health Science in College of Health at Massey University, Wellington, New Zealand Isabelle Ellen Silk Ross 2025 2 Abstract Adolescents in Aotearoa New Zealand (AoNZ) face unique biological, societal, and environmental challenges in obtaining sufficient sleep, which is essential for their overall health and well-being. Within AoNZ there is limited qualitative research exploring adolescent perspectives on sleep and their sleep behaviours. This study explored how adolescents engage with sleep-related messaging, aiming to understand their access to, interpretation of, and the impact of such information on their sleep practices. Using a qualitative design, three semi- structured focus groups were conducted with 19 adolescents (13 females, 6 males) from two schools in AoNZ. The analysis constructed two key themes: Taking interest in sleep information and Disregarding sleep information, which reflect the dynamic and individualised relationship adolescents have with sleep-related messaging. Participants reported engaging with information from both digital and real-world sources, with personal relevance and source types influencing their engagement with and acceptance of advice. Advice that resonated with their lived realities, particularly around academic and athletic commitments, as well as messaging on formats such as social media platforms were more likely to capture their interest. However, adolescents frequently dismissed messages perceived as impractical, irrelevant, or contradictory. This scepticism usually stemmed from conflicting advice or a lack of actionable strategies. While some participants demonstrated curiosity and trialled sleep advice, these efforts were generally short-lived due to perceived ineffectiveness and barriers such as school schedules, societal norms, and competing priorities. This study emphasises the interplay between personal agency, societal expectations, and environmental constraints, providing critical insights into the factors that may shape adolescent engagement with sleep health messaging. The small sample size limits the diversity of perspectives captured however this study offers initial insights on the context of 3 adolescent sleep in AoNZ. It lays a foundation for future work exploring the nuances of engagement across different adolescent sub-groups. The findings have broader implications for the development of targeted, contextually relevant health promotion interventions to better align with adolescents' complex realities. These interventions have the potential to support adolescents navigate the challenges of maintaining healthy sleep practices while addressing structural and systemic barriers, ultimately contributing to improved adolescent sleep health outcomes. 4 Acknowledgements Firstly, I want to acknowledge my participants, without whom this research would not have been possible. Thank you for sharing your experiences and perspectives so openly with me. I hope your willingness to share will contribute to a deeper understanding of the importance of placing adolescent voices at the centre of adolescent research, ultimately enriching our knowledge of the adolescent experience. I would like to express my gratitude and appreciation to my supervisors, Rosie Gibson and Leigh Signal. The time, expertise, and support you have both provided over the last few years have been instrumental in shaping my knowledge and approach. Leigh, thank you for your steady guidance, trust, and positivity throughout my Master’s journey. Your encouragement has been invaluable and has significantly contributed to my growth as a researcher. Rosie, your consistent support and mentorship over the years have opened doors to research and career opportunities I would not have had otherwise. I am incredibly grateful for the trust you placed in me by involving me in your projects. Your encouragement has made a lasting impact on my academic, professional, and personal development. I would also like to acknowledge the scholarship and funding provided by the Marsden Fund, which made the completion of this project possible and is critical to ongoing research. My sincere thanks go to the team on the Sensationalising Sleep: Discourses and Practices of Sleep in Aotearoa project. Your constructive feedback and insightful guidance were invaluable throughout the completion of my research. Additionally, I want to extend my gratitude to the teams at the Sleep/Wake Research Centre and WellSleep Centre. Your interest in my work, kind words, and encouragement truly helped motivate me throughout this period. To my parents, family, and friends—your understanding, patience, and ability to provide welcome distractions when I needed them most meant the world to me. Thank you 5 for your enthusiasm and genuine excitement for my work; it has been a constant reminder of how fortunate I am for this opportunity. 6 Table of contents Abstract ___________________________________________________________________ 2 Acknowledgements __________________________________________________________ 4 Table of contents ___________________________________________________________ 6 CHAPTER 1: Introduction ___________________________________________________ 8 Background ___________________________________________________________________ 8 Positioning of the research ______________________________________________________ 13 CHAPTER 2: Literature Review ______________________________________________ 15 Sleep ________________________________________________________________________ 15 Adolescent sleep health _________________________________________________________ 23 Sleep and society ______________________________________________________________ 35 Sleep in the media _____________________________________________________________ 43 CHAPTER 3: Methods _____________________________________________________ 53 Design _______________________________________________________________________ 53 Sample ______________________________________________________________________ 53 Focus group format ____________________________________________________________ 56 Procedure ____________________________________________________________________ 57 Data analysis _________________________________________________________________ 59 CHAPTER 4: Findings _____________________________________________________ 61 Sleep experiences ______________________________________________________________ 61 Taking interest in sleep information ______________________________________________ 66 Disregarding sleep information __________________________________________________ 79 Summary ____________________________________________________________________ 93 CHAPTER 5: Discussion ___________________________________________________ 95 Research objectives and key findings _____________________________________________ 95 Sources of information _________________________________________________________ 97 Engagement with sources _______________________________________________________ 99 Types of messaging ___________________________________________________________ 100 Gender differences ___________________________________________________________ 102 Evaluation of messaging _______________________________________________________ 103 Selective engagement with messaging ____________________________________________ 105 Lack of behaviour change _____________________________________________________ 108 7 ‘Addiction’, FOMO, and reclaiming time ________________________________________ 111 Impact of waking life _________________________________________________________ 114 Considerations _______________________________________________________________ 115 Theoretical implications _______________________________________________________ 123 Practical implications _________________________________________________________ 125 Conclusion __________________________________________________________________ 127 References ______________________________________________________________ 130 Appendices ______________________________________________________________ 161 Appendix A – Original Study Invitation __________________________________________ 161 Appendix B – Original Study Advertisement ______________________________________ 164 Appendix C – Original Study Consent Form ______________________________________ 165 Appendix D – Original Focus Group Guide _______________________________________ 166 Appendix E – Altered Focus Group Guide ________________________________________ 168 Appendix F – Ethical Approval _________________________________________________ 170 8 CHAPTER 1: Introduction Background Research demonstrates that sleep plays an essential role in health outcomes and quality of life, and its importance is being increasingly recognised (Knutson, 2022; Wickham & Amarasekara, 2020). Adolescence is a developmental stage of life during which sleep has a vital role in emotional regulation, cognitive development, and overall well-being (Beebe et al., 2010; Owens et al., 2014; Shochat et al., 2014; Short et al., 2020). During this period of life, adolescents face unique biological and social challenges that make it difficult to obtain adequate sleep (Crowley et al., 2007; Hagenauer et al., 2009; Tarokh et al., 2019). Adolescent sleep disturbances have been increasingly reported and explored in academic literature over the last 20 years (Owens et al., 2014). In AoNZ, adolescents frequently get less sleep than the recommended duration for their age group (Dorofaeff & Denny, 2006; Galland et al., 2017; Smith et al., 2020). Additionally, in AoNZ, there are ethnic inequities in adolescent health and well-being (Simon-Kumar et al., 2022; Sutcliffe et al., 2023), including mental health. Adolescents in AoNZ have relatively high suicide rates (UNICEF Innocenti, 2020), which appear to be getting worse over time (Fleming et al., 2020). Research has demonstrated that sleep is an important modifiable feature of mental health in adolescents (Bruce et al., 2017). Therefore, given sleep’s association with many health outcomes, supporting healthy sleep in the adolescent population of AoNZ is essential for their overall health and well-being. Traditionally, sleep research has focused on the chronobiological, physiological, and medical aspects of sleep (Assefa et al., 2015; Dement, 2008). However, the social influencers on sleep are being increasingly recognised across the social sciences and humanities disciplines (Williams & Bendelow, 1998; Wolf-Meyer, 2012). For instance, international sociological research has examined how social structures, practices and cultural contexts influence sleep (Meadows et al., 2018; Williams, 2011; Williams, 2005). Sociological views 9 on sleep frame it as a 'practice' that is 'negotiated' with oneself, others, and society. This view considers when, where, and with whom we sleep with which influence physiological features of sleep health (Billings et al., 2020; Staton & Smith, 2019; Williams, 2007). Sociological inquiry into sleep highlights the complexities of sleep patterns and the broader social influences on sleep, which has enhanced our understandings of how sleep functions in society (Williams, 2005) (Taylor, 1993). Framing sleep through a sociological lens has highlighted how different groups of people experience sleep in various ways and has underscored the significance of social norms on sleep practices (Meadows, 2005; Meadows et al., 2018; Wolf-Meyer, 2012). For instance, research has shown that many adolescents stay up late texting, using social media and gaming (Smith et al., 2020; van den Eijnden et al., 2021). Furthermore, research shows that adolescents engaging in these activities before sleep often experience shorter sleep duration and poorer sleep quality (Tarokh et al., 2019), which is partly explained through technology displacing sleep (van den Eijnden et al., 2021). Together, these findings show how social norms in this population can shape sleep behaviours and practices and leading to inadequate sleep. It is well established that adolescents exhibit unique sleep/wake patterns, behaviours, and demands that can impact their ability to meet their biological sleep needs. Biological changes during this period, which delay the timing of sleep, partially contribute to the inability to meet sleep needs. Alongside this are environmental and social factors such as early school start times, technology use, and cultural expectations (Crowley et al., 2007; Hagenauer et al., 2009; Moore & Meltzer, 2008; Owens et al., 2014; Tarokh et al., 2019). These environmental and social factors can either exacerbate or conflict with adolescent biology and further challenge an adolescents’ ability to get enough sleep. The complex 10 interaction of factors influencing adolescent sleep underscores the importance of understanding such influences on sleep in this population (Tarokh et al., 2019). In AoNZ, the socio-demographic factors that impact sleep health are increasingly recognised, as are the diversity of sleep practices, beliefs, and attitudes at different life stages (Crestani et al., 2022; Cronin et al., 2017; Elder et al., 2023; Muller et al., 2023; Muller et al., 2017). However, this body of research has focused primarily on infant and children's sleep practices within the family context and variations in perceptions and practices across Māori, Pacific, and Pākehā populations. This literature has less thoroughly represented the adolescent population (Ross et al.) and adolescent sleep behaviours have primarily been explored using quantitative methods (Dorofaeff & Denny, 2006; Galland et al., 2020; Smith et al., 2020). The prominence of quantitative research means there is limited understanding of adolescents' perspectives on their sleep behaviours. Internationally, qualitative methods have been employed to examine adolescent and young adult sleep behaviours (Godsell & White, 2019; Orzech, 2013; Paterson et al., 2019). Qualitative studies which employed focus groups (Godsell & White, 2019; Paterson et al., 2019) and interviews (Orzech, 2013), found that adolescents and young adults recognise the importance of sleep and want to improve their sleep. However, due to distractions and competing demands, most were unable to get the recommended amount of sleep. Barriers to achieving good sleep included technology, time pressure due to academic demands, extracurricular activities, and social interactions, as well as inconsistent routines due to social and environmental factors. Furthermore, in Godsell and White (2019) gender differences in sleep behaviours were highlighted. The studies stated that the participants were getting information on sleep from sources such as parents, peers, the media, and schools (Godsell & White, 2019; Orzech, 2013; Paterson et al., 2019). In some cases, the participants felt that the information presented to them was not very detailed and strategies around improving sleep 11 were not practical or appealing, which meant there was limited behaviour change (Orzech, 2013; Paterson et al., 2019). The findings from these studies help to expand the understanding of adolescent sleep behaviours and provide nuanced insights from adolescents themselves. However, as these are international studies, the insights they provide may not always be relevant in AoNZ. It is evident that there are many factors that influence sleep practices and behaviours. Health beliefs and behaviours are shaped by the information available to use, meaning that media messaging has a role in shaping these perspectives (Dew et al., 2016; Lyons, 2000). There has been an increase in the representation of sleep in the media that has fuelled a growing public interest in sleep in conjunction with the advancements in sleep science (Breheny et al., 2023; Dew et al., 2016) (Wright et al., 2019). International literature investigating how sleep is portrayed in the media has enhanced understanding of beliefs, perceptions, and behaviours around sleep in different populations (Boden et al., 2008; Kroll‐ Smith, 2003; Seal et al., 2007; Varallo et al., 2022; Williams & Boden, 2004; Williams et al., 2008a, 2008b; Zarhin, 2021). The literature in this field has shown how the media frames sleep as both a personal responsibility and a commodity. Furthermore, how sleep is framed has provided a lens for understanding broader societal pressures around productivity and performance (Barbee et al., 2018; Williams et al., 2008a). It has been shown that sleep-related media messages are often disconnected from scientific evidence and the realities of individual and social circumstances (Boden et al., 2008; Breheny et al., 2023; Robbins et al., 2019; Williams et al., 2008a). In AoNZ, a study looking at the representation of sleep and ageing in the media showed that messages around sleep for this population often oversimplified sleep solutions, focused on individual responsibility, and neglected to consider social and environmental factors. In line with international research, these findings suggest media representations of sleep in AoNZ are 12 misaligned with scientific understandings, as well as not representing the complexity of issues, suggesting the need for more nuanced representations (Breheny et al., 2023). The disconnect between sleep-related media messages and the realities of individual and social circumstances could have important implications for populations such as adolescents. This group often spends a significant amount of time engaging with media platforms which could lead to inaccurate information influencing their sleep behaviours (Kruzan et al., 2022; Smith et al., 2020). Furthermore, adolescents may be especially susceptible to messages they encounter online. Research has indicated they are more likely to be influenced by what they see on social media platforms, and are prone to adopting behaviours presented to them without fully understanding the complexities behind these messages (Alpert et al., 2020; Auxier & Anderson, 2021; O'Keeffe & Clarke-Pearson, 2011). Despite the growing body of research on adolescent sleep, qualitative investigations into adolescent perceptions of sleep, and the sleep-related messages they receive and their sleep behaviours, remain scarce. While research in AoNZ has documented adolescent sleep behaviours through quantitative methods, there is a gap in understanding the subjective experiences and influences on sleep and sleep behaviours from adolescent perspectives. The international research that has explored adolescent sleep practices and behaviours through qualitative methods has given some insights into where adolescents access sleep information, how adolescents feel about this information, and the influence on their behaviours. Therefore, research using similar methods to explore adolescent sleep practices, as well as adolescents' access to and perceptions of sleep-related information that may inform these practices in AoNZ, could enhance our understanding of sleep health in this population. Research such as this could also help address understandings of the social and cultural factors that shape sleep practices in AoNZ and provide a deeper understanding of the barriers and facilitators influencing adolescent sleep health. 13 Positioning of the research My approach as a researcher undertaking this work has been informed by a blend of personal and professional experiences. Personally, my interest in health-related topics dates back to my own adolescence, a time when I attempted to navigate through the overwhelming array of health information available. This personal journey has made me particularly aware of the challenges that adolescents face in accessing, understanding and acting upon health-related information. On a professional level, I have been involved in several projects since 2022 as part of a larger project that aims to expand existing perspectives of sleep in AoNZ. As part of those projects, I have been involved in examining the media’s representation of sleep and different populations including older adults and adolescents. I also conducted a scoping review of the literature in AoNZ that considers sleep as socio-culturally variable. These projects have provided me with a prior understanding of sleep as not just a biological phenomenon but as an essential aspect of our daily lives significantly influenced by broader contexts. My professional background has also provided me with a unique and critical lens to examine how sleep is portrayed and understood in various contexts, which is important to consider in the current study as I aim to explore the adolescent perspective. Acknowledging my positionality is crucial for maintaining the integrity of this research. I am aware that as a researcher with advanced education, there exists a power dynamic between myself and the adolescent participants. This awareness was critical as it influenced how I engaged with the participants, ensuring that I approached the research process with an openness to learn from their experiences. My methodological choices, particularly the use of qualitative focus groups allowed for deeper engagement and enabled participants to express their perspectives in their own words, thus minimising the influence of my own biases and assumptions on the research outcomes. Throughout the completion of this 14 project, I have tried to respect the voices and experiences of the adolescents involved, and continuously reflected on how my background and assumptions might have shaped the research process and outcomes. 15 CHAPTER 2: Literature Review The review of the literature presented in this chapter offers a comprehensive exploration of the complexities of adolescent sleep and the factors impacting adolescent sleep. The chapter begins by discussing the fundamental physiological and circadian processes that govern sleep, providing the necessary context to understand the distinct changes occurring during adolescence. Building upon this foundation, the review progresses to examine adolescent sleep health, discussing both local and international literature on its status and exploring the relationship between sleep and both physical and mental health outcomes to underscore the importance of sleep during this life stage. It also addresses the broader factors influencing adolescent sleep. The interconnectedness of sleep with society is then explored; considering how social and cultural factors shape sleep practices and attitudes across different populations, with a particular focus on adolescents. This section emphasises the variability in sleep experiences among different groups and the importance of recognising and understanding these differences. The final section discusses how sleep is represented in the media, which plays a critical role in shaping public perceptions and behaviours concerning sleep, underscoring the significance of this influence in the context of adolescence. By integrating insights from diverse disciplines, this literature review characterises the multifaceted nature of sleep and underscores the significance of adolescent sleep research that explores the broader factors that impact sleep at this life stage. Sleep Defining sleep Sleep is identified by looking at physiological and behavioural factors that, in combination, are used to determine if sleep is occurring. There is no single test or metric that can fully define or measure sleep on its own (Krueger et al., 2016). Behaviourally, sleep is a state that is temporary and reversible. During this state, individuals are disengaged from their 16 environment, show reduced responsiveness, and experience minimal bodily movement (Sejnowski & Destexhe, 2000; Sullivan et al., 2022). Sleep stages and architecture Sleep is understood as an active process involving two distinct states. These states are non- rapid eye movement (NREM) sleep and rapid eye movement (REM) sleep, which alternate in cycles throughout the night (McCarley, 2007; Sullivan et al., 2022). During NREM sleep physiological systems remain active, and body movements are possible, but the electroencephalogram (EEG) demonstrate slower levels of brain activity (Berry et al., 2020; Rechtschaffen & Kales, 1968). The EEG is one metric used in polysomnography (PSG), which refers to the gold standard method for recording sleep. Eye movements and muscle tone are also normally recorded using PSG (Kryger et al., 2022). NREM is further divided into three stages: N1-N3. The progression from N1 to N3 sleep is considered the progression from light to deep sleep. N3 is often also referred to as slow wave sleep (SWS) which is the deepest stage (Berry et al., 2020; Rechtschaffen & Kales, 1968). N1 sleep serves as the transition phase between wakefulness and sleep. N1 is marked by slow rolling eye movements, hypnic jerks, which are sudden involuntary muscle contractions, and a disengagement from the surrounding environment (Mindell & Owens, 2015; Sullivan et al., 2022). During N2 sleep, EEG activity shows sleep spindles during this stage. Sleep spindles are brief high-frequency EEG activity (Berry et al., 2020; De Gennaro & Ferrara, 2003; Sullivan et al., 2022), that are associated with learning and memory processes (Fogel & Smith, 2011). K-complexes are also seen in EEG activity during this sleep stage. K-complexes follow the rhythm of a brief positive voltage spike, which is followed by a large negative deflection. This activity in the brain waves can happen on its own or in response to outside stimuli. K-complexes are also thought to aid the preservation of 17 sleep and contribute to memory consolidation (Berry et al., 2020; Cash et al., 2009; Sullivan et al., 2022). N3 sleep is characterised by slower, more regular breathing as well as a further decrease in heart and respiratory rate. As N3 sleep is considered the deepest sleep, individuals are often hard to wake during this stage (Mindell & Owens, 2015; Sullivan et al., 2022), and research shows that this stage of sleep aids in several restorative processes (Krueger et al., 2011; Van Cauter et al., 2000; Xie et al., 2013). REM sleep is characterised by high frequency brain activity, rapid eye movements and muscle atonia. Muscle atonia is the loss of muscle tone that prevents voluntary movement (Berry et al., 2020; Sullivan et al., 2022). Research has shown that REM sleep is also the stage from which dream recall is most likely (Malinowski et al., 2019; Scarpelli et al., 2019). During sleep, individuals may experience brief awakenings or arousals. These brief awakenings or short periods of increased brain activity are a normal part of the sleep cycle and unless they are very frequent, aren’t considered to disrupt sleep or impact overall sleep quality (Sullivan et al., 2022). Awakenings can often be seen to occur in individuals as they transition to light stages of NREM sleep or when they transition to or from REM sleep, and are often forgotten by individuals once awake (Sullivan et al., 2022). Sleep architecture refers to the organisational structure of sleep, meaning the patterning and cycling between NREM and REM sleep stages. At the start of the sleep cycle, healthy adults often experience NREM sleep, progressively transitioning from N1 to N3 sleep and then progressively transitioning back through to NREM stages to N1 sleep before entering REM sleep. This ‘sleep cycle’ repeats approximately every 90-110 minutes (Bathory & Tomopoulos, 2017; Mindell & Owens, 2015; Sullivan et al., 2022). During the first third of the night, NREM sleep accounts for about 20% of total sleep time, whereas later in the night 18 REM sleep increases and accounts for around 25% of the total sleep time (Sullivan et al., 2022). Changes in sleep with age Sleep pattern, cycles, and architecture change significantly across the lifespan, with shifts in infancy, adolescence, and adulthood that reflect the developmental needs of each stage (Kocevska et al., 2021; Stolarski & Gorgol, 2022). Across childhood and adolescence, the percentage of REM stabilises, while SWS declines, and lighter sleep stages increase (Tarokh & Carskadon, 2010). Longitudinal studies demonstrate that slow-wave sleep reduces by 40- 60% in adolescents as they transition from early to mid-adolescent years (Campbell & Feinberg, 2009; Tarokh & Carskadon, 2010). This transition reflects the maturation of the brain and the change in sleep regulatory systems, including the circadian and homeostatic processes (Miner & Lucey, 2022). Sleep spindles peak in adolescence and begin to decline afterwards, reflecting brain maturation and the development of the thalamocortical system responsible for spindle generation (Purcell et al., 2017; Tarokh & Carskadon, 2010). Regulation of sleep Two primary biological mechanisms govern the sleep-wake cycle: the circadian process (Process C) and the homeostatic process (Process S) (Czeisler & Buxton, 2017). The circadian process is regulated by a "master clock" which is located in the suprachiasmatic nuclei (SCN) in the brain. This clock regulates physiological rhythms such as the sleep-wake cycle (Kurth et al., 2015; Vetter, 2018). Research shows that in conditions free of time cues circadian rhythms run on a cycle that is slightly longer than 24 hours. However, time cues (known as zeitgebers) provide information that is used to adjust this cycle to align with the 24-hour day-night cycle. Zeitgebers are external environmental cues that entrain our internal circadian rhythms to the 24-hour cycle (Roenneberg & Merrow, 2016; Vetter, 2018). Light is the strongest zeitgeber, however, social and physical activities are also zeitgebers (Czeisler & 19 Buxton, 2017; Duffy & Wright Jr, 2005). Circadian misalignment occurs when our internal circadian rhythms do not match the zeitgeber time cues. Circadian misalignment has been found to lead to potential health risks (Boege et al., 2021). In addition to regulating the sleep-wake cycle, circadian rhythms regulate core body temperature, which follows a daily rhythm, peaking in the late afternoon/early evening and decreasing into the early morning (Sullivan et al., 2022). Furthermore, the circadian system also regulates the secretion of hormones such as melatonin and cortisol. Melatonin and cortisol play a part in maintaining sleep-wake cycles. Melatonin peaks in the evening, which signals sleepiness and helps sleep onset, and then decreases over the night (LeBourgeois et al., 2013; Tähkämö et al., 2019). On the other hand, cortisol exhibits a contrasting trend, reaching its peak in the morning to encourage alertness and subsequently diminishing throughout the day (Oster et al., 2017). The homeostatic process regulates the body's need for sleep. Sleep pressure builds throughout the day, peaking in the evening, and dissipating during N3 sleep (Achermann, 2004; Borbély & Achermann, 1992). The two-process model of sleep regulation was first proposed by Borbély (1982). The model suggests that sleep is facilitated when Process S reaches the upper threshold of Process C. As sleep progresses, Process S decreases, and the brain is ready for wakefulness when it reaches a lower threshold of Process C (Beersma & Gordijn, 2007; Borbély et al., 2016). Sleep-wake regulation in adolescents Adolescence has been defined as the period between ages 10 and 19, as outlined by the World Health Organization (WHO) (Sawyer et al., 2018). This period is characterised by significant physical, psychological, and social changes, and these changes contribute to the unique sleep regulation observed in this developmental stage of life (Crowley et al., 2018). The adolescent period can be further separated into younger adolescence, which is ages 10- 20 14, and older adolescence, which is ages 15 to 19. These stages reflect distinct developmental milestones (Patton et al., 2016). While younger adolescents begin to experience shifts in sleep patterns due to the onset of puberty (Crowley et al., 2018), older adolescents experience more pronounced changes that result in later sleep onset and reduced sleep duration due to biological and environmental factors (Gradisar et al., 2011). The later sleep onset seen in older adolescents is marked by the later release of melatonin (Crowley et al., 2018). For instance, a review highlighted that the secretion of melatonin occurred approximately one hour later in older adolescents than younger adolescents and that older adolescents take longer to fall asleep even after extended periods of wakefulness (Malone, 2011). Furthermore, compared to earlier hypotheses, a more recent review suggests that the endogenous circadian period, meaning the circadian period that exists without external cues, does not lengthen during adolescence. This contrasts with earlier work suggesting that during adolescence, the endogenous circadian clock might naturally shift to a longer duration (Tarokh et al., 2019). At the same time, the homeostatic system accumulates more slowly in response to sleep deprivation in post-pubertal adolescents compared to adults and pre- or early-pubertal adolescents. This slower accumulation of homeostatic sleep pressure throughout the day results in adolescents feeling less sleepy and staying up later, contributing to their delayed sleep/wake cycles (Crowley et al., 2007) (Hagenauer et al., 2009; Tarokh et al., 2019). Sleep latency data indicates that prepubertal adolescents fall asleep faster than postpubertal adolescents, lending further support to the finding that homeostatic sleep pressure builds up more slowly (Crowley et al., 2007). It has been demonstrated that females present the delay in sleep earlier than males, which is thought to be due to the earlier onset of puberty (Crowley et al., 2007; Hagenauer et al., 2009). 21 The Perfect Storm model was introduced by Carskadon (2011) and updated by Crowley et al. (2018)to illustrate how biological and environmental factors work together to impact adolescent sleep patterns. The model describes the later sleep onset often experienced by adolescents and demonstrates the role of delayed circadian phase and slower buildup of sleep pressure. The model also highlights the external environmental factors that impact adolescent’s delayed sleep patterns, such as academic demands, social activities, and exposure to electronic devices. According to the model, the "perfect storm" of poor sleep is caused by both biological and environmental factors. The "perfect storm" refers to adolescents having a biological predisposition to stay awake later, which is exacerbated by external factors, and then factors such as early school start times truncate the opportunity for sleep resulting in shorter sleep (Crowley et al., 2018). Adolescents sleep needs’ Research shows that despite changes to sleep over the adolescent period the dissipation of this sleep pressure does not change during the adolescent period, indicating that their sleep needs remain consistent during this period (Crowley et al., 2007; Tarokh et al., 2019). A review of current evidence on adolescent sleep Tarokh et al. (2019) discusses the historical lack of empirical research to support previous recommendations on adolescent sleep duration needs. Early recommendations, such as those by Terman and Hocking (1913), lacked scientific validity due to the absence of data-driven evidence. However, in an attempt to create more accurate guidelines, organisations such as the National Sleep Foundation (Hirshkowitz et al., 2015) and the American Academy of Sleep Medicine (Paruthi et al., 2016) provide more comprehensive guidelines on the recommended sleep duration for adolescence. These guidelines are based on expert opinions and literature reviews and recommend that adolescents aged 13-18 get 8-10 hours of sleep a night. 22 Despite these recommendations, it is challenging to accurately estimate sleep need in this population due to the widespread prevalence of chronic sleep restriction (Tarokh et al., 2019). Research shows that there is often a difference in sleep duration between weekdays and weekends in adolescents (Olds et al., 2010). This difference can be explained by the concept of ‘sleep debt’ recovery (Gradisar et al., 2011). Sleep debt refers to the cumulative loss of sleep across a number of days, experienced when an individual fails to meet their sleep needs (Van Dongen et al., 2003). In adolescents, there is a pattern of shorter sleep on weekdays and longer sleep on the weekends. This is in part due to adolescents’ delayed sleep onset and early wake times due to environmental impositions such as early school start times, which results in shorter total sleep duration in the weekdays. In contrast, on weekends adolescents’ sleep start times and rise times are often later, shifting the entire sleep episode. They also tend to have a longer total sleep duration on weekends to compensate for the shorter sleep duration on weekdays (Gradisar et al., 2011). In a recent U.S. study, Thompson et al. (2024) demonstrated an increase in night-to- night variability in sleep duration in adolescence compared to those in childhood. In that study, they noted that night-to-night variability in sleep duration in adolescents is often influenced by social jetlag and irregular schedules. Furthermore, it is demonstrated that night- to-night variability in sleep duration commonly experienced by adolescents is associated with poorer mental health outcomes, such as anxiety and depression, and behaviours, such as aggressive behaviour. Significant ethnic and sex differences were also found, with all African Americans as well as male youth showing more pronounced declines in sleep duration and efficiency over time. These findings point to the complexity of evaluating adolescent sleep needs accurately, as sleep patterns in this population are highly variable and influenced by external factors. 23 Adolescent sleep health Several lines of evidence demonstrate that sleep problems are prevalent in the adolescent population. For instance, an international review conducted by Owens et al. (2014) found that adolescents do not get enough sleep, with this problem worsening across the adolescent period. Furthermore, according to a meta-analysis of sleep patterns and problems among adolescents across the globe, daytime sleepiness is prevalent in this population, as is difficulty initiating sleep (Gradisar et al., 2011). Significant variations in adolescent sleep patterns have been reported internationally (Gradisar et al., 2011; Olds et al., 2010; Owens et al., 2014). For instance, Gradisar et al. (2011) states that there are variations across different regions and age groups in bedtimes on school nights and that younger adolescents often had earlier bedtimes and had longer total sleep durations than older adolescents. Between different ethnic groups, Asian adolescents had later bedtimes and shorter total sleep durations on school nights compared to North American and European adolescents. However, across all regions, adolescents often had shorter total sleep durations on school days compared to weekends, which Gradisar et al. (2011) attributes to social jetlag. Findings from Olds et al. (2010) and Owens et al. (2014) support the observations on adolescent’s sleep patterns in Gradisar et al. (2011), butOlds et al. (2010) additionally adds that females tend to sleep more than males. Research in AoNZ has also explored sleep problems among adolescents. Several studies indicate that adolescents frequently obtain less sleep than recommended for their age group (Dorofaeff & Denny, 2006; Galland et al., 2017; Smith et al., 2020). A study involving 4,192 NZ adolescents revealed that 39% slept less than 8 hours a day and 57% reported poor sleep quality (Galland et al., 2020), a finding consistent with earlier research (Galland et al., 2017). Furthermore, an examination of 1,388 students revealed that 37.2% experienced significant symptoms of sleep problems lasting longer than one month. Sleep problem 24 symptoms were reported as any sleep disorders or sleep issues significantly affecting an individual’s life or sleep (Fernando et al., 2013). Female adolescents in AoNZ report higher rates of insufficient sleep, poorer sleep quality, increased daytime dysfunction, longer sleep latency, and a higher likelihood of experiencing prolonged sleep problems compared to males (Dorofaeff & Denny, 2006; Fernando et al., 2013; Galland et al., 2017). At the same time, a higher prevalence of delayed sleep-phase disorder has been observed among male adolescents compared to female adolescents (Fernando et al., 2013). In AoNZ, similar trends to the international findings on adolescent sleep patterns have been observed. Adolescents have been found to sleep longer on weekends compared to weeknights, with a study reporting that adolescents slept on average 8 hours and 40 minutes on weeknights compared to an average of 9 hours and 23 minutes on weekends (Dorofaeff & Denny, 2006). Furthermore, this study showed that the older adolescent participants exhibited later bedtimes and less total sleep time than the younger adolescent participants (Dorofaeff & Denny, 2006). Another study in AoNZ, on competitive adolescent athletes demonstrates how early morning trainings contribute to insufficient sleep. In this study, participants often had a significantly reduced total sleep duration on nights before their weekday morning training sessions. On these nights, participants had an average total sleep duration of 6 hours and 44 minutes. In comparison, on weekends when participants did not have training sessions, they slept significantly longer and tended to go to bed and wake up later (Steenekamp et al., 2021). The results from Dorofaeff and Denny (2006) and Steenekamp et al. (2021) show how adolescents in AoNZ sleep. They show how their sleep patterns are similar to those in other countries and how common social jet lag is in this group, especially among older adolescents. International and local research shows socioeconomic and ethnic inequities in adolescent sleep. Owens et al. (2014) highlights that internationally, adolescents from lower socioeconomic backgrounds or ethnic minorities are at heightened risk of experiencing 25 insufficient sleep. Similarly, Guglielmo et al. (2018) demonstrates that adolescent minorities in the U.S. are more likely to experience shorter total sleep duration and sleep-related issues, even after considering covariates. In AoNZ, Dorofaeff and Denny (2006) found Māori and European high school students to have the longest total sleep duration, with Asian high school students having the shortest total sleep duration. Galland et al. (2020) had similar findings in relation to Asian adolescents exhibiting the shortest sleep duration but also found Māori and Pacific adolescents to have later bedtimes than European adolescents. A more recent study in AoNZ, illustrates different findings to those of Dorofaeff and Denny (2006) and Galland et al. (2020). In this study, Māori, Pacific, Asian, Middle Eastern, Latin American, and African adolescents were significantly more likely to experience shorter total sleep duration, later bedtimes, and earlier wake times compared to European adolescents. This study discusses that the inequities seen in adolescent sleep health in AoNZ can in part be explained by social determinants such as neighbourhood deprivation, housing insecurity, and exposure to racism (Muller et al., 2024). These findings are similar to other research conducted in AoNZ on adults that showed factors such as socioeconomic position and health status to in part contribute to ethnic inequities in sleep duration (Paine & Gander, 2016). In summary, the widespread occurrence of sleep problems in adolescents is evident in studies both internationally and in AoNZ (Dorofaeff & Denny, 2006; Fernando et al., 2013; Galland et al., 2017; Gradisar et al., 2011; Muller et al., 2024; Olds et al., 2010; Owens et al., 2014; Smith et al., 2020). International and local studies on adolescent sleep patterns and the differences between weekdays and weekends show the same pattern(Dorofaeff & Denny, 2006; Gradisar et al., 2011; Olds et al., 2010; Owens et al., 2014; Steenekamp et al., 2021). Furthermore, it is evident that ethnic differences and inequities in adolescent sleep exist (Dorofaeff & Denny, 2006; Fernando et al., 2013; Galland et al., 2020; Guglielmo et al., 2018; Muller et al., 2024; Owens et al., 2014). Research underscoring the prevalence of sleep 26 problems in this population has resulted in increased attention on adolescent sleep, as sleep problems can have severe health and well-being consequences as well as implications for general functioning (Gradisar et al., 2011; Olds et al., 2010). Sleep, health and functioning The literature on the consequences of poor adolescent sleep indicates a bidirectional relationship between sleep and health. It is well established that inadequate sleep can cause daytime sleepiness and fatigue in adolescents. However, research also highlights relationships between sleep and mental and emotional well-being, physical health, and cognitive functioning (Brand & Kirov, 2011; Bruce et al., 2017). A cross-sectional survey of 1,111 young adults from AoNZ and the U.S. found that sleep quality and quantity predict mental health and well-being, with sleep quality being more important than physical activity and dietary factors (Wickham & Amarasekara, 2020). A UK study found that poor sleep quality and habits were associated with higher mental health risks, with gender differences showing that males had a broader range of problems whereas females were more likely to develop mood disorders (Qiu & Morales- Muñoz, 2022). In a meta-analysis, adolescent sleep and mood were linked with shorter sleep durations increasing the risk of mood deficits (Short et al., 2020). Similarly, a U.S. study that used a sleep manipulation protocol showed more irritability and behaviour regulation problems during the periods that participants had shorter sleep duration (Beebe et al., 2008). Insufficient sleep has also been shown to impact emotional processing, as sleep-deprived adolescents have been found to be vulnerable to mood changes and adverse emotional reactions (Shochat et al., 2014; Tempesta et al., 2018). Furthermore, various studies have also illustrated that poor sleep often coexists with psychiatric disorders in adolescents. The relationship between poor sleep and psychiatric disorders is complex, with poor sleep acting both as a risk factor and as a consequence of conditions such as depression and anxiety 27 disorders (Brand & Kirov, 2011; Moore & Meltzer, 2008; Owens et al., 2014). Sleep quality and quantity have been shown to significantly predict depressive symptoms (Wickham & Amarasekara, 2020). Although a meta-analysis showed sleep disturbances often precede depression, but not the other way around (Lovato & Gradisar, 2014), other research indicates a bi-directional relationship (Moore & Meltzer, 2008; Owens et al., 2014; Roberts & Duong, 2014; Shochat et al., 2014). The relationship between inadequate sleep and mental health problems is particularly noteworthy in the context of AoNZ. According to Fleming et al. (2020), adolescent emotional and mental health is on the decline, and the mental health gap is widening between Māori and other ethnic groups. Furthermore, sleep loss has been reported to increase the risk of suicidal thoughts in adolescents (Owens et al., 2014), and the adolescent population in AoNZ exhibits a relatively high suicide rate (Shahtahmasebi, 2008; UNICEF Innocenti, 2020). Fragmented or disrupted sleep has been associated with impaired adolescent cognition (Bruce et al., 2017). Oversleeping on weekends coupled with insufficient sleep during the week, has been found to impact individuals’ judgement, motivation, attention, and executive functions (Owens et al., 2014). Furthermore, poor sleep can have significant implications for the academic performance of adolescents. A study in the United States of 16 adolescents who were tested in a simulated classroom after five nights of sleep restriction and compared to after five nights of sufficient sleep showed that chronic sleep restriction leads to inattentive behaviours, poorer learning, and diminished arousal in the classroom (Beebe et al., 2010). The findings from the U.S. study are supported by review articles that also describe the effects of insufficient sleep on academic performance (Moore & Meltzer, 2008) (Shochat et al., 2014), with Shochat et al. (2014) stating that while prospective data is limited, cross- sectional studies consistently find associations between sleep loss and poorer academic performance. 28 The consequences of inadequate sleep and risk-taking behaviours are also highlighted in sleep and cognitive functioning research. In the literature, risk-taking behaviours as a result of poor sleep include substance use, risky sexual behaviours, delinquency, violence, and drowsy driving (Bruce et al., 2017; Moore & Meltzer, 2008; Shochat et al., 2014). Shochat et al. (2014) highlights that sleep disturbances can predict future risk-taking behaviours, although this relationship is complex and influenced by other factors such as gender, socioeconomic status, and psychosocial factors. Furthermore, Moore and Meltzer (2008) indicates that daytime sleepiness and delayed weekend bedtimes are also linked to a higher likelihood of risk-taking behaviours. Less total sleep time has been associated with increased substance use (Moore & Meltzer, 2008), with sleep loss increasing the risk of alcohol, tobacco, and drug consumption, which in turn leads to worse sleep (Owens et al., 2014). Another risky behaviour of interest in this population is drowsy driving with sleep deprivation and drowsy driving contributing to motor vehicle accidents among young drivers (Bruce et al., 2017; Moore & Meltzer, 2008; Owens et al., 2014). In AoNZ, a report in 2021 showed that 26% of all road fatalities were attributed to drivers aged 15-24 years (Te Manatū Waka [Ministry of Transport, New Zealand], 2023). However, the extent to which sleep or fatigue contributes to these AoNZ statistics is unknown pointing to an area that needs further exploration. Studies have also linked adolescent sleep to adverse physical health outcomes. Poor sleep has been shown to contribute to and affect somatic conditions like diabetes, cardiovascular disorders, juvenile idiopathic arthritis, headaches, asthma, cancer, and epilepsy (Brand & Kirov, 2011; Bruce et al., 2017). Shochat et al. (2014) showed an association between sleep disturbance and somatic conditions but also found that insufficient sleep duration did not predict any somatic outcomes. The literature also highlights sleep’s impact on adolescent obesity risk. A review of 15 studies found inconclusive evidence 29 (Guidolin & Gradisar, 2012), however, other studies link insufficient sleep to increased obesity risk in this age group (Brand & Kirov, 2011; Bruce et al., 2017; Owens et al., 2014; Shochat et al., 2014). The relationship between sleep and obesity is thought to be bi- directional and influenced by various other health and lifestyle factors (Brand & Kirov, 2011; Shochat et al., 2014). Furthermore, gender differences have been noted in the association between sleep duration and obesity risk in adolescence, with males potentially at higher risk (Owens et al., 2014). A study in AoNZ, found significant relationships between sleep and body composition in males but not females and suggested that more sleep may be linked to a leaner body composition in males (Skidmore et al., 2013). Despite links demonstrated between sleep and physical health outcomes in adolescents, such relationships in AoNZ are yet to be explored from a behavioural or social perspective which could help provide a more in depth understanding of these links. In summary, this section's extensive body of research highlights the critical importance of good sleep health for adolescents. It is evident that sleep has profound impacts on adolescents’ health, well-being, and overall functioning (Brand & Kirov, 2011; Bruce et al., 2017). The relationship between sleep and various aspects of health is often bidirectional, which highlights the interconnectedness of sleep with adolescent development. Recognising the significance of sleep and its links to health and well-being alongside the knowledge that adolescents often struggle to get adequate sleep points to the need to understand the underlying factors contributing to their sleep patterns and behaviours. Factors influencing adolescents’ sleep There has previously been a physiological and medical approach to exploring adolescent sleep and sleep problems (Assefa et al., 2015; Dement, 2008). For instance, as discussed in an earlier section, the physiological factors that drive the delay in adolescents’ sleep and contribute to adolescent sleep deprivation are well documented and understood in the 30 literature (Crowley et al., 2007; Hagenauer et al., 2009). However, literature also shows that adolescent sleep is deeply intertwined with multi-level contextual factors (Becker et al., 2012; El-Sheikh et al., 2015). Multiple models have explained the complexity of adolescent sleep by highlighting the various factors that influence sleep (Becker et al., 2015; Grandner, 2019; Orzech, 2013). Grandner (2019) proposes a theoretical model based on a social-ecological framework that identifies individual, social, and societal determinants of sleep and their relationship with health outcomes. Individual factors include genetics, beliefs, attitudes, behaviours, and health status; social factors encompass family, work, school, neighbourhood, cultural, ethnic, and social networks; and societal factors comprise globalisation, public policy, technology, economics, and the natural environment (Grandner, 2019). Orzech (2013) considers adolescent sleep from an anthropological point of view, and consider historical, political-economic contexts, local environmental conditions, and biological and cultural adjustments individuals make in response to these factors. Orzech’s model emphasises that both biological and environmental factors influence sleep and are socially prescribed and culturally patterned. Becker et al. (2015) adds that adolescent sleep is intertwined with biological, psychosocial, and contextual factors, stressing the importance of understanding their interplay to understand the influences on adolescent sleep patterns and behaviours. Together, these models underscore the importance of considering more than the biological influences to better understand what informs and influences adolescent sleep. Two prominent lines of research into the broader factors that influence adolescent sleep include electronic media use and school start times (Tarokh et al., 2019). Excessive screen time in adolescence has been associated with various negative consequences such as night awakenings, daytime sleepiness, anxiety, depression, and musculoskeletal issues (Silva et al., 2022). Furthermore, international reviews have indicated that electronic use before bedtime is associated with disrupted sleep patterns such as later bedtimes, later wake times on 31 weekends, shorter total sleep times, poor sleep quality, and greater daytime sleepiness (Cain & Gradisar; Moore & Meltzer, 2008; Owens et al., 2014; Silva et al., 2022). Despite the increase of research around electronic use and sleep, the literature would benefit from more nuanced consideration. For instance, investigating the duration and purpose of technology use could yield additional understanding of its influence on adolescent sleep. In AoNZ, technology in bedrooms significantly increased from 1999 to 2008 (Borlase et al., 2013). More recently, a study of 4,811 adolescents found that most participants used electronics before bed and reported that they “agreed” they spent too much time on screens, with this perception increasing with age across the adolescent period, however the pressure to communicate with friends was perceived as a barrier to reducing this screen time (Smith et al., 2020). It has also been shown in AoNZ that technology use before bed is negatively associated with sleep quantity and quality (Borlase et al., 2013; Galland et al., 2020). Previously, researchers have indicated several mechanisms behind the adverse impact of electronics on adolescent sleep. These mechanisms include the displacement of sleep, increased arousal, a delayed circadian rhythm due to evening light exposure, and electromagnetic radiation from mobile phones (Cain & Gradisar; Owens et al., 2014; Reid Chassiakos et al., 2016). Research also highlights that during adolescence, the perceived demands of social interactions can result in frequent electronic communication, which can impact their sleep (Moore & Meltzer, 2008). Scott and Woods (2018) and Woods and Scott (2016) highlight that the fear of missing out (“FOMO”) is associated with social media usage and can drive adolescents to engage with social media during the night. Furthermore, these studies have linked feelings of FOMO to self-esteem issues and social anxiety, further impacting adolescents' sleep (Scott & Woods, 2018; Woods & Scott, 2016). A more recent review published in 2024 provides new insights into the relationship between technology use and sleep (Bauducco et al., 2024). In this review, it is demonstrated 32 that compared to previous understandings, the effect of bright light from screens, especially blue light, on melatonin suppression and delayed sleep onset is minimal. Furthermore, the impact of highly engaging online content on sleep is also minimal, with only small impacts on arousal and delayed sleep onset seen. However, the review did highlight that technology use, frequent notifications, and alerts can interrupt sleep and displace sleep time, leading to shorter durations. The review goes on to illustrate potential moderators of the associations found between technology use and sleep. These moderators included individual vulnerabilities such as risk-taking behaviour and low self-control, which were stated to exacerbate the adverse effects of technology on sleep. In contrast, protective factors on technology’s effects on sleep included self-control and parental rules around technology (Bauducco et al., 2024). School start times are another prominent line of research on the broader factors influencing adolescents’ sleep. Research shows a strong association between early school start times and insufficient sleep, which strengthens as adolescents age (Dahl & Lewin, 2002; Malone, 2011; Moore & Meltzer, 2008; Tarokh et al., 2019). As discussed earlier it has been demonstrated that adolescents often sleep later, wake later and obtain more sleep on weekends compared to weekdays (Gradisar et al., 2011). Richter et al. (2023) conducted a systematic review that showed that during lockdown periods over the COVID-19 pandemic, adolescent sleep quality deteriorated, but that adolescents obtained more sleep and were less sleepy due to the lack of early school start times. Research has demonstrated that delaying school start times can improve adolescent sleep duration, reduce daytime sleepiness, and enhance academic performance, attendance, and safety (Malone, 2011; Moore & Meltzer, 2008; Owens et al., 2014). Despite the established benefits of delaying school start times for adolescents, there are logistical and financial challenges that exist. Stakeholder support has successfully combated these 33 challenges, demonstrating positive results in the USA, UK, Canada, and South Korea (Tarokh et al., 2019). In AoNZ, a study showed that by delaying school start times, students obtained more sleep and experienced less sleepiness (Borlase et al., 2013). Furthermore, a viewpoint article expressed the sleep health and well-being benefits of delaying school start times in AoNZ, for senior high school students. This article also states that this could benefit students of all ethnicities and socioeconomic positions (Barber et al., 2022). Therefore, delaying school start times in AoNZ, is particularly important to help address the ethnic inequities in adolescent sleep health noted in research(Muller et al., 2024). Other overarching factors in the literature that have been identified as influencing adolescent sleep include part-time employment (Dahl & Lewin, 2002; Dorofaeff & Denny, 2006; Moore & Meltzer, 2008), and extracurricular activities (Dahl & Lewin, 2002; Moore & Meltzer, 2008) as they can lead to later bedtimes and reduced sleep time. For instance, early morning trainings imposed on adolescent athletes have been shown to disrupt sleep patterns and reduce sleep duration (Steenekamp et al., 2021). Increasing academic demands and pressures as adolescents age have also been linked to insufficient sleep (Dahl & Lewin, 2002; Malone, 2011). This link can be observed in part when individuals delay the completion of homework until later in the evening, which results in the reduced opportunity to sleep (Moore & Meltzer, 2008). Several studies have also shown that high caffeine intake in adolescents is associated with shorter sleep duration, increased sleep onset latency, daytime sleepiness, and slow-wave and REM sleep disruptions (Moore & Meltzer, 2008; Owens et al., 2014). Moreover, caffeine consumption has been correlated with other behaviours that impact sleep, such as late-night technology use (Owens et al., 2014). The transition from parent-managed bedtimes to personal responsibility is another factor that typically impacts sleep as it can have negative effects on adolescents’ sleep habits (Malone, 2011). 34 Quantitative approaches have been prominent in the international and local research exploring the broader factors that impact adolescent sleep, and therefore there is less qualitative research in this area (Orzech, 2013), especially in AoNZ. Internationally, a few qualitative studies have been published that explore adolescents’ perceptions of their sleep behaviours and factors influencing their sleep. For instance, a United Kingdom (UK) study conducted focus groups with 33 adolescents, investigating adolescents’ perceptions of their sleep behaviour and the facilitators and barriers to sleep. The participants identified various obstacles to achieving good sleep, such as their bedroom environment, electronic devices, and social pressures. Gender differences were also found in the inhibitors of sleep. Watching videos and gaming were reported to distract the male participants more, while communicating with friends on digital devices were reported to distract the female participants more (Godsell & White, 2019). An Australian study also conducted focus groups to investigate adolescents and young adults’ willingness to modify their sleep behaviour and the factors that enable or inhibit change. Participants stated that the barriers to improving their sleep included time demands around social and academic activities, technology use, difficulty switching off, and unpredictable routines. However, participants did express a desire to change their sleep habits by improving sleep timing, consistency, and quality to improve their daytime functioning. However, when they attempted this, they often had limited success (Paterson et al., 2019). The local and international research reviewed in this section on adolescent sleep has discussed the state of adolescents’ sleep and the various factors that impact their sleep and put them at risk of inadequate sleep. The literature focuses on adolescent sleep patterns, especially around sleep timing and duration (Dorofaeff & Denny, 2006; Fernando et al., 2013; Galland et al., 2017; Gradisar et al., 2011); the impact of poor sleep on adolescence health and well-being (Brand & Kirov, 2011; Bruce et al., 2017; Skidmore et al., 2013; 35 Wickham & Amarasekara, 2020); the bioregulatory changes that occur to adolescents circadian and homeostatic systems (Crowley et al., 2007; Dahl & Lewin, 2002; Hagenauer et al., 2009; Malone, 2011; Moore & Meltzer, 2008; Tarokh et al., 2019); and the environmental and social influences on their sleep (Borlase et al., 2013; Galland et al., 2020; Tarokh et al., 2019). This body of literature underscores that influences on adolescent sleep are multi- faceted and that there is an increasing emphasis on the investigation of the wider environmental, social, and cultural factors that impact sleep. The literature exploring these broader factors aids in providing a comprehensive understanding of adolescent sleep and demonstrates the importance of these understandings in addressing sleep issues in this population. Despite the increasing work in this area, there is a notable gap in qualitative work exploring adolescents’ perceptions of their sleep and sleep behaviours. The limited international research in this area has underscored the significance of qualitative inquiry in comprehensively exploring adolescents’ sleep and providing more nuanced understandings of adolescents’ perceptions of their sleep and influences on their sleep. However, as the research is conducted elsewhere, it is of interest to consider adolescent’s perspectives in AoNZ. Sleep and society Sleep, a universally experienced state, is not just a biological necessity but a phenomenon deeply intertwined with social, cultural, historical, and political contexts. The intersection of various social science and humanities disciplines has framed sleep as multidimensional, enriching our understanding of sleep (Williams & Bendelow, 1998; Wolf-Meyer, 2012). ‘Sleep health’ is often considered a public health issue and refers to factors such as the regularity, timing, efficiency, and satisfaction of sleep as well as one’s alertness (Hale et al., 2019). Grandner (2019) provides a social-ecological framework of sleep health that demonstrates the interplay between upstream factors, such as social and societal factors, and 36 downstream individual factors. This framework illustrates the complex relationship between sleep and health outcomes. Furthermore, Hale et al. (2019) explains that a range of factors impact sleep health, such as socio-demographic factors, interpersonal relationships, community environments, and policies. The impact of these factors underscores the necessity for multi-level approaches to effectively address sleep health. For instance, the consideration of socio-demographic factors has demonstrated that these factors can be risk factors for poor sleep as well as consequences of inadequate sleep. Considerations such as this help to illustrate societal inequities and underlying political influences (Billings et al., 2020; Grandner, 2019; Paine & Muller, 2023; Staton & Smith, 2019). Research shows how sleep science and medicine have been constructed over time and across cultures, underscoring the social and political implications in shaping how sleep is understood and governed (Wolf-Meyer, 2012). Ekirch (2018) explores the historical evolution of sleep patterns, emphasising the influence of cultural, technological, and social factors. In this exploration, the author notes the segmentation of sleep into ‘first sleep’ and ‘second sleep’ in pre-industrial societies. Activities such as prayer would often occur in between these periods of sleep. However, in modern times, sleep patterns have been consolidated into a single sleep period. Ekirch explains this through factors such as the influence of artificial lighting and societal shifts towards efficiency and productivity. Further explorations into sleep and society have provided a lens into broader social dynamics such as time-use priorities, power relations, and disciplinary practices that reflect cultural values and attitudes towards time(Steger, 2017). For instance, in workplaces, expectations and organisational practices can significantly influence an individual’s sleep patterns, which highlights time-use priorities in contemporary society (Barnes & Spreitzer, 2015). Research exploring how sleep is embedded in social, cultural, historical, and political contexts has revealed cultural variations in the social factors influencing sleep (Glaskin & 37 Chenhall, 2013). For instance, studies have illustrated distinct differences between Indigenous and Western cultures in the perceptions and experiences around sleep, nighttime, and dreaming (Airhihenbuwa et al., 2016; Brunt & Steger, 2004; Glaskin, 2011). The following sections further explore the need to consider cultural diversity in understandings of sleep, as these findings demonstrate the different experiences of sleep. Sociological perspectives of sleep Sociological perspectives of sleep have expanded with the increased interest in sleep within social science and humanities disciplines (Ross et al.). Sociology, as a social science discipline, dedicates itself to the exploration of human society, with a particular focus on group formation, organisation, and their evolution over time (Barry & Yuill, 2011; Crawford, 1971). Sociologists go beyond individual analysis and explore how people interact within groups and the broader environments surrounding them. This field examines how external societal influences shape behaviours and beliefs and encompass both cooperative and conflicting dynamics. Altogether, sociology investigates human groups, their interaction, and their organisational dynamics and covers various aspects of society and their impact, including social relationships, institutions, cultures, and social changes (Barry & Yuill, 2011; Crawford, 1971). Historically, sociology has tended to focus on waking and conscious concerns, but we have increasingly seen an argument for the sociological significance of sleep (Williams, 2005). Sociologists exploring sociological perspectives of sleep have argued that sleep is not only a biological necessity but also is a social phenomenon, intricately woven into society. Therefore, it is recognised that biological, psychological, environmental, and socio-cultural factors, such as power dynamics, social norms, and economic factors, shape sleep as a behaviour. Sociologists have said that societies organise and regulate both waking and 38 sleeping life, which shows how important it is to understand sleep in the context of society (Taylor, 1993; Williams, 2002, 2005; Williams & Bendelow, 1998). During its formative years, there are distinctive sociological areas of sleep that emerged in the literature (Meadows, 2005). One of these areas is the potential for sociological inquiry into the social dimensions of sleep (Taylor, 1993). Another is the sleeper's rights and duties, or the expectations that people have about when, where, and how they sleep, as well as their corresponding freedoms and restrictions, which are shaped by things like social situations (Goldberg-Hiller; Meadows, 2008a; Schwartz, 1970; Williams & Bendelow, 1998). Furthermore, the commodification of sleep, which illustrates the commercialisation of sleep as it has become a marketed consumer product, has been explored, and reflects broader consumerism and capitalism trends (Williams & Boden, 2004). Williams (2005) proposed three interrelated levels of the sociological exploration of sleep. The first level encompasses the individual phenomenological aspects of sleep, such as the experience of sleep in both non-conscious activities (e.g. snoring) and conscious activities (e.g. the feeling of sleepiness). The second level concerns social and interactional aspects of sleep, focusing on the ‘doing’ of sleep. This level encompasses aspects such as gendered and life course meanings, methods, motives, and the management of sleep in everyday life, highlighting the negotiation and social dynamics around sleep. The third level highlights the relationship between sleep and societal factors. This third level encompasses the broader sociological issues around the social organisation of sleep in public and private settings, which include the consideration of risk, regulation, medicalisation, and surveillance. Williams (2005) states that these levels are not mutually exclusive or exhaustive but rather that sleep may be seen to operate on these three levels. Another key area is the medicalisation of sleep, which involves defining and treating sleep-related issues within a medical framework. This approach reflects the influence of 39 medical institutions and professionals on societal understandings and responses to sleep, as noted by (Williams, 2003a), (Williams, 2003b), and (Hislop & Arber, 2003c). More recently, the sociological inquiry into the medicalisation of sleep has highlighted how sleep has begun to be optimised for performance through practices such as workplace napping and wakefulness-promoting drugs, rather than merely addressing sleep and its health risks through a medicalised approach. The optimisation of sleep for performance has been discussed to be of concern as it may have impacts on societal perceptions of sleep and sleep’s role in daily life (Williams et al., 2013). Furthermore, sociological literature has explored the intersection of sleep practices and gender roles. These explorations have highlighted how societal norms around gender roles can reinforce inequalities in nighttime caregiving and emotional labour, which impacts sleep (Hislop, 2003a) (Hislop & Arber, 2003b, 2003c) (Burgard & Ailshire, 2013) (Venn et al., 2008). Literature in this area has also pointed to how the experience of sleep disorders, symptoms, and help-seeking behaviours differs between genders (Arber et al., 2009; Krishnan & Collop, 2006; Meadows et al., 2008b). In summary, sociological perspectives of sleep expand the notion of sleep beyond a biological necessity to frame it as a socio-culturally variable phenomenon. Sociologists frame sleep as a ‘practice’ in which individuals negotiate the how, why, where, and with whom they sleep. Sleep is acknowledged as being influenced by individual needs and beliefs, the sleep of others, and the discourses, schedules, and politics of broader society. The points raised in this section's literature suggest that sleep is a profoundly social and cultural phenomenon. Furthermore, sleep can be seen to reflect and reinforce societal norms, values, and power dynamics. Altogether, this framing of sleep provides a more nuanced understanding of sleep and how it functions within broader social frameworks (Meadows, 2005; Meadows et al., 2018; Williams, 2005, 2007). 40 Sleep and society in Aotearoa New Zealand Sleep literature in AoNZ has made significant strides in understanding the socio-demographic influences on sleep health. A scoping review was conducted as a precursory project to the present thesis that synthesised local sleep literature, exploring sleep as a socio-culturally variable practice, and revealed a noticeable scarcity of research directly addressing the social and cultural aspects of sleep compared to elsewhere. Māori and Pacific cultures were explored in the reviewed literature in terms of how these cultures influence sleep-related perspectives, expectations, experiences, and practices (Ross et al.). The literature in this area highlights that Māori and Pacific populations’ cultural practices and beliefs around sleep and dreaming differ from Western norms (Crestani et al., 2022; George et al., 2021; Haami et al., 2024). It has further been revealed throughout literature in AoNZ that Māori and Pacific communities face higher risks of poor sleep or sleep disorders due to socioeconomic gaps, substandard living conditions, and limited healthcare access (McLay et al., 2023; Muller et al., 2020; Paine & Gander, 2013; Paine et al., 2004). This work highlights the link between ethnicity and sleep health, highlighting the importance of considering socio-cultural influences on sleep health in AoNZ. The prior scoping review also revealed that numerous topics and populations are yet to be thoroughly investigated or represented (Ross et al.). For instance, there is some literature on the diverse experiences and perspectives regarding sleep, related issues, and their management across different life stages (Crestani et al., 2022; Cronin et al., 2017; Elder et al., 2023; Muller et al., 2023; Muller et al., 2017), however the focus was on infant and children's sleep, highlighting gaps in the exploration of other life stages. Furthermore, the review showed only a small amount of literature that explored how gender roles and sexuality intersect with sleep practices (Ross et al.). The review indicated that in AoNZ, the adoption of a social science approach to sleep is still in the early stages compared to elsewhere. 41 Therefore, the need to conduct additional research using qualitative research methodologies to delve deeper into the lived experiences and perspectives of the identified key populations is identified. The review points to the need for broader social considerations in examining how sleep is represented and practised to provide a comprehensive understanding of sleep within the unique socio-cultural context of AoNZ (Ross et al.). Social perspectives of adolescent sleep Similarly to the literature on the intersection of sleep and society explored above, research on adolescent sleep shows how sleep is intertwined with various biological, environmental, cultural, and societal factors (Becker et al., 2015; El-Sheikh et al., 2015; Tarokh et al., 2019) underscoring the importance of considering broader influences on sleep practices in this population as discussed previously. International research shows that time demands and heightened expectations can impact adolescents' sleep patterns, as exemplified by high school students in Japan. In Japanese culture, it is socially accepted for high school students to sacrifice nighttime sleep to meet academic demands and cope with this loss in sleep through ‘inemuri’. ‘Inemuri’ is the practice of napping in public or semi-public places (Steger, 2006). In Mediterranean cultures such as Greece, adolescents often still practice siestas, which are midday naps used to help deal with sleepiness and late bedtimes (Paraskakis et al., 2008). Together, these studies show how different cultures practice sleep according to their unique challenges and contexts. Broader societal expectations around time, work, and rest shape sleep behaviours in both examples. However, within AoNZ literature exploring cultural differences in adolescent sleep practices is limited as demonstrated in Ross et al. (2024). Hsu’s (2013) paper on ‘social acceleration' proposes that contemporary society is marked by an increased pace of life. In this paper, sleep is used as a measure or lens for social acceleration, as it is argued that sleep patterns reflect broader societal changes. This idea is 42 explored through examples of the widespread use of technology before bed and upon waking, which is said to suggest a societal trend toward increased connectivity. This trend, which blurs the boundaries between work and personal time for adults, could also apply to adolescents. As discussed in earlier sections, the use of technology before bed is highly prevalent among adolescents. Adolescents often have digital devices in their bedrooms (Cain & Gradisar, 2010; Smith et al., 2020) and, due to social expectations felt by adolescents, they frequently communicate electronically, which can disrupt their sleep (Moore & Meltzer, 2008). Another example of the exploration into adolescent sleep and society is research by Wolf-Meyer (2015) which examined how social structures, as well as biological, cultural, and technological factors, shape adolescent sleep practices and attitudes. This literature discusses the challenges adolescents face in managing sleep within social structures, such as school start times, and how these structures contribute to sleep deprivation seen in this population. Furthermore, they explore the pathologisation of adolescent sleep, which refers to how sleepiness during classes is often framed as a behavioural problem rather than considered a consequence of societal demands and individual sleep needs. The authors discuss potential consequences of this pathologisation, which include self-medicating to maintain alertness so that individuals can meet expectations imposed on them. This research demonstrates the profound influence of societal factors on adolescent sleep patterns and the urgent need to address these factors to promote healthier adolescent sleep habits. The interdisciplinary literature explored in these sections illustrates how sleep transcends its biological necessity by intertwining with social, cultural, and historical contexts. These approaches demonstrate the broader societal influences on sleep, including the socio-demographic factors and cultural practices that have varied over time and can shape aspects such as sleep duration, structure, environment, and quality (Ekirch, 2018; Wolf- 43 Meyer, 2012) (Meadows et al., 2018; Williams, 2005). In the context of AoNZ, sleep literature has increasingly recognised the diversity of sleep perspectives, experiences, and practices (Crestani et al., 2022; Cronin et al., 2017; Elder et al., 2023; Muller et al., 2023; Muller et al., 2017). However, it is evident that a gap remains in the nuanced understandings of adolescent sleep and the broader influences on their sleep. International research has offered insights into how social and cultural norms shape adolescent sleep practices (Hsu, 2013; Steger, 2006; Wolf-Meyer, 2015), however the AoNZ context is yet to be explored. Therefore, the adoption of various social science disciplines could aid in advancing our understandings of sleep and its nuances within AoNZ. Furthermore, these approaches could inform appropriate support and solutions for sleep health among populations such as adolescents. Sleep in the media Health-related topics in the media When considering sleep in the media, consideration must also be given to the importance of the media and its concentration. The media has considerable influence over public discourse and the perceptions of important issues. Throughout the 21st century, the media has encountered significant growth, transformation, and consolidation. As Dew (2016) discussed, the expansion of the media through globalisation has enabled a global exchange of information, broadening access to knowledge about distant events and cultures. However, a crucial aspect of the 21st century media transformation revolves around media ownership and the concentration of control over media platforms by a few powerful corporations. This concentration of power can raise concerns about the diversity of viewpoints available to the public. Furthermore, it demonstrates how the media is both an informer and a gatekeeper, as it has the power to shape which narratives the public sees, which can influence the public's opinion (Dew et al., 2016). 44 Abroms and Maibach (2008) highlights how the internet has impacted the distribution and consumption of information. This paper explains how the increasing usage of digital platforms has blurred the lines between mass and interpersonal communication. Furthermore, as digital platforms facilitate easy access to a broad range of audiences, they have transformed media communications, resulting in the hearing of more diverse voices and opinions. An example of this can be seen in how health professionals and other professionals engage with the public more effectively without the traditional gatekeepers such as broadcasters or publishers that earlier media platforms had (Abroms & Maibach, 2008). The media is recognised as a significant unofficial source of health information that helps shape public understanding and engagement with health-related topics (Abroms & Maibach, 2008{Dew, 2016 #8163). Its broad reach and easy access, position media as a source for health communication that can promote or diminish healthy behaviours and lifestyles (Bunton, 2002; Gabe et al., 2017; Nelkin, 1996). Research has demonstrated that how the media portrays health information is important to understand, as it has an impact on the public’s perceptions of issues. For example, how health information is presented can change how people think about health problems, who is responsible for them, and how to solve them, shaping the public discourse of what is considered important (Crawford et al., 2019) (Breheny & Severinsen, 2018; Lyons, 2000). Research shows that the way the media talks about public health issues can change the way politicians talk about and make decisions about policy. This is because it can encourage or discourage people from taking action on complicated policy issues (Breheny & Severinsen, 2018; Crawford et al., 2019). Together, these findings show how the media shapes how the public perceives health issues and responds to them. In contemporary society, there has been a shift from the previous dominance of medical practitioners primarily conveying health-related information to a greater variety of 45 voices from sources such as journalists, product advertisers, alternative therapists, and individuals providing real-life accounts (Lyons, 2000). While a wider variety of voices can be found in health-related media communications and on social messaging platforms, Abroms and Maibach (2008) observes that these messages frequently concentrate on individual behaviours. The health-related media messages attempt to influence individual knowledge, beliefs, and self-efficacy and therefore miss the opportunity to use mass media communications to assist in changing community norms and public health policies. Crawford et al. (2019) discusses how digital media platforms encourage public engagement with the information the public consumes by enabling discussions, opinions, and interactions through features like comment sections. Interactive features such as comment sections show how the media not only delivers information to the public but also engages with them. Individuals interpret, resist, or accept media messages based on their own perspectives, which creates a feedback loop either reinforcing or challenging the message they are engaging with (Breheny & Severinsen, 2018). Furthermore, it has been noted that there is an increased use of social media platforms for the dissemination of health information as well as health promotion activities, which is thought to be partly due to the ability of such platforms to engage audiences directly and interactively, which is less characteristic of traditional news platforms (Wright et al., 2019). Despite the literature highlighting this change, there is a noticeable lack of research comprehensively documenting and evaluating the role of social media in providing health information. This gap points to the challenge of accurately assessing social media’s role in providing health-related information. Through the literature examined above, the role of the media in shaping public discourse and perceptions of health-related topics is demonstrated. The rise of digital platforms, with their distinctive features that facilitate discussion and interaction, has transformed media communication, enhancing its influence and engagement with the public. 46 This mode of communication enables audiences to be active interpreters who reinforce or inspire new insights based on their own perceptions, experiences and prejudices (Breheny & Severinsen, 2018; Crawford et al., 2019). Therefore, the media’s societal impact on health beliefs and behaviours underscores the importance of understanding media portrayals of health topics and audience interpretations (Breheny & Severinsen, 2018; Lyons, 2000). Sleep’s portrayal in the media As sleep science has rapidly grown, public interest has increased, leading to more sleep- related health messages in the media. International analysis of sleep’s portrayal in the media demonstrates that sleep is often framed as adaptable to waking life and is essential for productivity(Barbee et al., 2018; Boden et al., 2008; Williams & Boden, 2004). Furthermore, the media describes good sleep as a crucial factor for optimal performance in a hyper- productive, globalised marketplace. This description of sleep can be seen to reflect neoliberal values of self-optimised and individual responsibility (Barbee et al., 2018). The media often plays a role in fuelling and reacting to moral panic around sleep by pushing solutions like workplace programmes, consumer products, and medical treatments while also stressing the need to balance work and rest (Barbee et al., 2018; Boden et al., 2008). Qualitative studies that use discursive and content analysis reveal that the media frequently depicts 'sleepiness' as a major public health issue. The media presents sleep as a risky state, encouraging people to be aware of its impact and take personal responsibility for managing it (Kroll‐Smith, 2003; Kroll‐Smith & Gunter, 2005). This framing often ‘medicalises’ or ‘healthicises’ sleep (Williams et al., 2008a). Medicalisation transforms sleep from a biological need into a medical issue by treating sleep problems as diseases or disorders. In contrast, healthicisation presents good sleep as an individual responsibility, promoting self-surveillance and the use of sleep-promoting products, aids, and techniques (Barbee et al., 2018; Seal et al., 2007; Williams et al., 2008a). More recently, an analysis of 47 magazine articles shows how sleep is often commodified by presenting it as something that can be actively pursued through effort, planning, and financial investment. The analysis goes on to describe this commodification of sleep as often gendered, as for men, sleep is often linked to performance and health. Whereas for women, it is framed to be something that enhances beauty and emotional well-being(Zarhin, 2021). Together, the literature that explores the portrayal of sleep in the media illustrates how sleep is portrayed as a personal responsibility essential for health and well-being, encouraging management through various lifestyle choices and good sleep practices based on gender (Williams et al., 2008a; Zarhin, 2021). It has been noted that there is a disconnect between media portrayals of sleep, the nuanced understanding within sleep science, and the realities of individual and social circumstances. Although the media claims to promote personalised sleep strategies, it often provides only generic advice (Boden et al., 2008; Robbins et al., 2019; Williams et al., 2008a; Zarhin, 2021). Robbins et al. (2019) points out that the media can perpetuate misinformation about sleep, as they identify through peer and media sources, widely held false beliefs about sleep. These key myths include “being able to fall asleep anytime, anywhere is a sign of a healthy sleep system,” “many adults need only five or fewer hours of sleep for general health,” and “your brain and body can learn to function just as well with less sleep” (p.19). These findings indicate that media messages often don’t align with scientific understandings about sleep. The literature illustrates how the media disseminates medical knowledge about sleep and its role in promoting consumerist attitudes towards sleep health (Barbee et al., 2018). For instance, the media promotes sleep-tracking devices as ‘must-haves’ for health and well- being through ads and articles stating the benefits of these devices. The benefits stated include better sleep quality, improved health, and increased productivity (Kolla et al., 2016; 48 Williams et al., 2015). Positive portrayal of these devices drives public demand for them as the media influences which issues gain attention and play a role in shaping public beliefs and behaviours (Rozanova, 2010; Seal et al., 2007). Furthermore, the devices are framed to be a part of everyday practices that normalise the use of these devices and can impact perceptions and behaviours around sleep (Kolla et al., 2016; Williams et al., 2015). In AoNZ, investigations into the portrayal of sleep on popular media sites have begun. For example, two studies examined Stuff.co.nz, focusing on how messages around sleep and ageing and sleep and pregnancy are constructed (Breheny et al., 2023; Ladyman et al., 2022). These studies revealed the tensions and contradictions in how the media presented sleep. The media portrayed good sleep as essential for maintaining health and promoted simplistic solutions as a reasonable goal, emphasising it as an individual responsibility. However, the media also acknowledged the complexities involved in achieving good sleep and the inevitable difficulties with sleep in these populations, a view that contradicts the solution- based messages about achieving good sleep (Breheny et al., 2023; Ladyman et al., 2022). For instance, the research on media representations of sleep and pregnancy found that media narratives often sensationalised the topic and gave conflicting messages, discouraging harmful sleep practices but also asserting that poor sleep is inevitable and will worsen after birth (Ladyman et al., 2022). These studies highlight the need for more nuanced messaging that considers the broader context of sleep practices. Furthermore, they demonstrate that research on audience consumption and interpretation of these messages is needed (Breheny et al., 2023). This could be especially interesting for groups like adolescents who may be exposed to or affected by media messages on a regular basis. There is limited literature that examines how audiences consume and interpret sleep- related media messages. Research in this area mostly focuses on how the media shapes public perceptions about topics rather than exploring how individuals or groups engage with and 49 interpret these messages. An example can be found in a UK study that focuses on the public's interpretations of messages around the risks of hypnotic sleeping pills in the media (Gabe et al., 2017). This study demonstrated that audiences actively engaged with the content, interpreting or reacting to the messages according to their personal experiences and social contexts. This active engagement either reinforced existing biases on topics or triggered further scrutiny and discussion (Gabe et al., 2017). Collectively, this literature underscores the media’s role in influencing behaviours around sleep. The research explored in this section demonstrates the diverse ways in which individuals consume and react to messaging, which points to the need to understand how audiences interpret and respond to media messaging about sleep. Furthermore, many of these studies focus on mainstream news media sites, and it is suggested that there is a need to explore sleep issues in other forms of media (Boden et al., 2008). For instance, Seal et al. (2007) and Williams et al. (2008a) highlight how various types of media represent sleep differently by looking at the differences between broadsheet newspapers and tabloid newspapers, which suggests that different sources may represent sleep and sleep problems in different ways. Adolescence consumption of media and health-related information on media sites As discussed in previously sections, technology usage among adolescents in AoNZ is widespread with activities such as social media, texting, and instant messaging before bed being common among this population (Smith et al., 2020). Internationally, it has been found that social media is increasingly becoming a central part of young people’s lives (Auxier & Anderson, 2021; Kruzan et al., 2022). Reports indicate that adolescents and young adults show higher use of social media platforms compared to older adults (Auxier & Anderson, 2021). These platforms provide spaces for young people to exchange information, connect with peers and communities, and develop their identities, making them an integral part of 50 their daily lives (Kruzan et al., 2022). Unlike other forms of technology or traditional media platforms, social media is easily accessible via smartphone apps. Their ease of accessibility facilitates engagement throughout the day alongside other activities. It has been reported that adolescents tend to use social media sites multiple times a day (O'Keeffe & Clarke-Pearson, 2011), and engagement with these platforms is heightened as they are specifically designed to keep users engag