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MANUSCRIPT 

The Bidirectional Impact of Irregular Sleep 

Patterns on Cognitive Function in 

Adolescents Aged 14–17: A Developmental 

Perspective  
 

Marisol Acosta1, Daphne Aldape1,2, Gael Garcia1,2, Cruz Ortiz1,3, Michelle  Richaud1,3, Alondra 

Rodriguez1,2, Helen Rodriguez1,2, Valeria  Segura1,3  

 
1  DHR Health High School and Community Outreach  
2 South Texas ISD Medical Professions  
 3 South Texas ISD Health Professions  

 

Received: July 3, 2024  

Accepted for publication: January 24, 2025  

Introduction 

Adolescence, ages 10 to 19, is a period of significant biological, psychological, and social 

change.1 This developmental stage is characterized by a natural shift in circadian rhythms, 

leading to a later sleep-wake phase preference.2,3 However, societal demands, such as early 

school start times and extracurricular activities, often conflict with these biological changes, 

resulting in chronic sleep restriction.4 This sleep disruption has profound and bidirectional effects 

on cognitive function, impacting academic performance, emotional well-being, and overall 

health.4,5 This literature review examines the bidirectional relationship between irregular sleep 

patterns and cognitive function in adolescents aged 14–17, focusing on the interplay of 

biological, environmental, and psychosocial factors. 

Biological Factors Influencing Sleep and Cognition 

During adolescence, hormonal changes associated with puberty significantly impact sleep 

architecture and timing.5,6 Melatonin, a hormone regulating sleep-wake cycles, is delayed in 

adolescents, contributing to later sleep onset.4 This "sleep phase delay" is often exacerbated by 

increased exposure to artificial light from electronic devices and late-night social activities.7,8 

Furthermore, the developing brain undergoes significant structural and functional changes during 

this period, making it particularly vulnerable to the negative consequences of sleep deprivation.9 

Insufficient sleep has been linked to impaired prefrontal cortex (PFC) function, a brain region 

crucial for executive functions such as attention, working memory, and decision-making.9,10 



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Studies have shown that sleep restriction in adolescents leads to deficits in these cognitive 

domains.11,12 Conversely, adequate sleep supports PFC development and optimal cognitive 

performance.9 The impact of sleep on brain regions involved in emotional processing is also 

substantial, with poor sleep quality linked to increased negative affect and reduced emotional 

regulation.10-13 

The interplay between sleep and hormonal changes is complex and not fully understood. For 

example, while melatonin release is delayed during puberty, other hormones, such as cortisol and 

growth hormone, also affect sleep regulation.1 Further research is needed to elucidate the precise 

mechanisms through which hormonal fluctuations interact with sleep and affect cognitive 

function. Additionally, the impact of genetic factors on sleep patterns and their susceptibility to 

cognitive impairment requires further investigation.2 Individual differences in sleep needs and 

responses to sleep deprivation are also not fully understood.14 

Environmental and Psychological Factors  

Beyond biological factors, environmental and psychosocial factors significantly contribute to 

irregular sleep patterns and their impact on cognition. The widespread use of electronic devices, 

particularly smartphones and tablets, before bedtime disrupts sleep through the suppression of 

melatonin production and the stimulation of the nervous system.8,15 This increased screen time is 

frequently associated with later bedtimes and reduced sleep duration, leading to daytime 

sleepiness and impaired cognitive performance.3-4,16 Furthermore, academic pressure, 

extracurricular activities, and social engagements can contribute to irregular sleep schedules and 

insufficient sleep.3,17 The pressure to succeed academically can lead to late-night studying, 

reducing sleep time and impacting cognitive function.4 Similarly, social activities, such as 

socializing with peers or attending events, can extend bedtime and result in sleep debt. 

 The influence of socioeconomic status (SES) on sleep patterns and cognitive outcomes is also 

worthy of note. Children and adolescents from lower SES backgrounds often face environmental 

stressors such as noise pollution and overcrowding, which can negatively impact sleep quality.16 

These stressors can further exacerbate the already increased risk of sleep disturbance among 

adolescents from minority groups.16,18 Furthermore, access to healthcare and resources to address 

sleep problems may be limited for families with lower SES, potentially leading to untreated sleep 

disorders and their associated cognitive consequences. The interaction between environmental 

factors, psychosocial stress, and sleep-related problems needs further exploration, particularly 

considering the cumulative effect of these factors on cognitive development.8 

Bidirectional Relationships: Sleep and Cognitive Function 

The relationship between irregular sleep patterns and cognitive function in adolescents is 

bidirectional. Sleep deprivation impairs cognitive function, as discussed previously. 11,12  However, 

pre-existing cognitive difficulties, such as those associated with neurodevelopmental disorders like 

attention-deficit/hyperactivity disorder (ADHD), can also contribute to sleep problems. 



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Adolescents with ADHD often experience difficulties with sleep initiation, maintenance, and 

consolidation.2,19 This disrupted sleep can further exacerbate ADHD symptoms, creating a vicious 

cycle of impaired cognition and sleep disturbance. The bidirectional nature of this relationship is 

supported by studies showing that sleep problems are associated with increased risk of mental 

health issues such as depression and anxiety in adolescents, which can further disrupt sleep 

patterns.20-22 

The impact of sleep problems on specific aspects of cognitive function has been extensively 

studied. Executive functions, including attention, working memory, and inhibitory control, are 

particularly vulnerable to sleep deprivation.10-11 Studies have demonstrated that sleep-restricted 

adolescents show impairments in tasks assessing these functions.12 Moreover, sleep disturbances 

are associated with reduced academic performance, suggesting a direct link between sleep and 

cognitive skills needed for learning.4,5  The complex interplay between sleep and various aspects 

of cognitive function, particularly the impact on executive functions and academic performance, 

requires further study to fully understand the mechanisms involved. Longitudinal studies are 

crucial to disentangle the causal relationships and identify potential intervention targets.20 

The Role of Mental Health  

Mental health plays a significant role in the bidirectional relationship between sleep and 

cognition in adolescents. Sleep problems are frequently comorbid with anxiety and depression, 

and these conditions can exacerbate each other.20-23 Anxiety and depression can disrupt sleep 

through physiological mechanisms such as increased arousal and worry, leading to insomnia and 

poor sleep quality.23 Conversely, sleep deprivation can worsen symptoms of anxiety and 

depression, potentially increasing the risk of self-harm and suicidal ideation.20-24 The impact of 

sleep disturbance on mental health is further complicated by the influence of social and 

environmental factors, such as peer victimization.25 Exposure to bullying or other forms of peer 

victimization can significantly disrupt sleep and contribute to mental health problems, creating a 

cascade of negative effects on both sleep and cognition. 

Studies have highlighted the need for further research to fully understand the complex interaction 

between sleep, mental health, and cognition in adolescents. Longitudinal studies are needed to 

determine the causal relationships and identify effective interventions.20 It is important to 

consider the interplay of biological, environmental, and psychosocial factors when addressing 

sleep problems and their impact on mental health and cognitive function in adolescents. The 

bidirectional nature of these relationships highlights the importance of early intervention and 

treatment to mitigate long-term consequences. Furthermore, the potential impact of specific sleep 

disorders, such as delayed sleep-wake phase disorder (DSPSD), on both mental health and 

cognition warrants further investigation.2 The co-occurrence of DSPSD with other 

neurodevelopmental and psychiatric disorders needs to be explored further to understand the 

potential mechanisms and develop effective treatment strategies. 

  



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Interventions and Future Directions  

Given the significant impact of irregular sleep patterns on cognitive function and mental health 

in adolescents, the development and implementation of effective interventions are crucial. 

Promoting healthy sleep hygiene practices, such as establishing a consistent bedtime routine, 

limiting screen time before bed, and creating a conducive sleep environment, is a primary 

intervention strategy.26 Cognitive behavioral therapy for insomnia (CBT-I) has also shown 

promise in improving sleep quality and reducing daytime sleepiness in adolescents.19 This 

approach focuses on identifying and modifying maladaptive thoughts and behaviors that 

contribute to sleep problems. In addition to CBT-I, other interventions, such as chronotherapy 

(gradually shifting bedtime and wake time to align with the desired sleep schedule) and 

melatonin supplementation, may be beneficial for adolescents with specific sleep disorders.2 

However, the efficacy of pharmacological interventions for sleep problems in adolescents 

requires further research.27 

Future research should focus on several key areas. Large-scale longitudinal studies are needed to 

further elucidate the bidirectional relationship between sleep and cognition, considering the 

influence of various biological, environmental, and psychosocial factors.7 These studies should 

investigate the impact of specific sleep disorders on different cognitive domains and mental 

health outcomes. Moreover, research should explore the effectiveness of different interventions 

in diverse adolescent populations, taking into account factors such as age, gender, ethnicity, and 

socioeconomic status.16 The development of culturally sensitive and accessible interventions is 

crucial to ensure equitable access to effective sleep care. Finally, research should examine the 

long-term consequences of adolescent sleep disruption on cognitive function and mental health, 

highlighting the need for early intervention and prevention strategies.28 Studies exploring the 

effectiveness of school-based interventions in promoting healthy sleep habits and addressing the 

societal pressures that contribute to sleep problems are also essential. 

Conclusion 

Irregular sleep patterns have a profound and bidirectional impact on cognitive function in 

adolescents aged 14–17. This relationship is influenced by a complex interplay of biological, 

environmental, and psychosocial factors. Sleep deprivation impairs cognitive performance, 

particularly in executive functions and academic achievement, while pre-existing cognitive 

difficulties can contribute to sleep problems. Furthermore, mental health conditions such as 

anxiety and depression are frequently comorbid with sleep disturbances, creating a vicious cycle 

of negative effects. Effective interventions, including promoting healthy sleep hygiene and CBT-

I, are crucial for improving sleep quality and mitigating the negative consequences of sleep 

disruption. Future research should focus on large-scale longitudinal studies to further elucidate 

these complex relationships and develop culturally sensitive and accessible interventions to 

promote healthy sleep and optimal cognitive development in adolescents. The long-term 

consequences of adolescent sleep deprivation and the effectiveness of school-based interventions 



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are also important areas for future research. Addressing the global issue of insufficient sleep in 

adolescents requires a multi-pronged approach that considers the interplay of biological, 

environmental, and psychosocial factors and promotes a culture of prioritizing sleep for optimal 

health and well-being. 

Acknowledgements: 

Nori Zapata, MSN, RN, is the Senior Vice President of Education and Career Development; 

Vanessa Vera, MS, is the Senior Manager of High School and Community Outreach; and Anisa 

Mirza is the intern Program Coordinator.  

Funding: 

Funded  by  DHR  Health High School and Community Outreach;    DHR    Health; South Texas 

Independent School District.  

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