Slumber Solution

The statistics on sleep among America’s children are scary enough to keep a grownup awake at night. According to the U.S. Centers for Disease Control and Prevention (CDC), 37% of six- to 12-year-olds get less than the nine to 12 hours of shut-eye recommended for that age group, and over 70% of teenagers get less than the eight to 10 hours they need. In low-income communities of color, the numbers are even worse, for reasons including uncomfortable sleeping conditions and anxieties over housing insecurity or an unsafe neighborhood. 

Although our national sleep-deprivation epidemic afflicts adults as well, with 35% averaging less than seven hours nightly, the impacts are especially worrisome for kids. Insufficient slumber can impair their brain development, immune function, metabolic health, and academic performance; it also increases their risk of depression, obesity, impulsive behaviors, attention issues, car accidents, and substance use. “Getting too little sleep can alter the course of a child’s life,” says Jean-Marie Bruzzese, PhD, a professor of applied developmental psychology at Columbia Nursing, “and not for the better.” 

The tide of sleeplessness has risen steadily in recent years, driven by factors ranging from the distractions of mobile devices to the disruptions of the COVID pandemic and its turbulent aftermath. Bruzzese, however, is leading a groundbreaking effort to reverse that trend. With colleagues from across the Columbia campus, she developed an initiative called Sleeping Healthy, Living Healthy—an evidence-based program that has shown promising results in controlled trials at the three New York City schools where it has been piloted. 

Sleeping Healthy, Living Healthy is the first behavioral intervention for children and adolescents to blend training in healthy sleep practices with mind-body integrative health (MBIH) stress reduction techniques. Designed in consultation with teens, teachers, and school-based health providers, the program is also among the first to address the sleep disparities that plague many urban communities. 

If further research confirms the team’s preliminary findings, Bruzzese and her collaborators hope their project will become a model for others nationwide. “Students’ sleep is a big issue for every school administrator I’ve spoken with,” she says. “When I tell them about this program, they all want to try it.”  
Bruzzese is known for her decades of influential research aimed at reducing health care disparities in children and adolescents. Her passion grew out of her own childhood in the inner-city neighborhood of Sunset Park, Brooklyn. Raised in poverty by a single mother, she and her brother have both gone on to fulfilling lives and careers, while some of their friends ended up in prison or dead of drug overdoses. “That got me interested in resilience,” she explains. “I wanted to know, how can you help more kids do as well as we did?” 

Bruzzese majored in psychology at Brooklyn College and earned a PhD in applied developmental psychology at Fordham. After completing her doctorate in 1997, she did stints as a researcher at Columbia’s College of Physicians and Surgeons and as a faculty member at New York University (NYU)’s Grossman School of Medicine. At first, she focused mainly on asthma, designing and evaluating school-based behavioral interventions and examining the environmental, familial, and psychological factors that affected management of the disease in low-income communities. Later, she contributed to similar research on conditions such as irritable bowel syndrome, obesity, and sickle cell disease.  

Meanwhile, Bruzzese grew fascinated by the links between sleep and other health issues. In 2015, she published a study showing that stress, asthma symptoms, and sleep disruptions could create a vicious circle, resulting in daytime drowsiness that often sabotaged teens’ schoolwork.  

At an asthma conference that same year, she ran into a friend—Maureen George, PhD, a professor of nursing at Columbia University Irving Medical Center (CUIMC). When Bruzzese confessed that she was growing restless at NYU, George urged her to consider relocating to Columbia Nursing. “I wondered, ‘What does a psychologist have to do with nursing?’” Bruzzese says. “We started talking, and that’s when I learned how interdisciplinary nursing is.” She joined the Columbia faculty—and the field of nursing—soon afterward. 

The seed for Sleeping Healthy, Living Healthy was planted in 2017, when Melanie Gold, DO, a professor of pediatrics and of population and family health at CUIMC, approached Bruzzese about developing a school-based sleep health intervention. Gold envisioned a course combining basic sleep hygiene techniques (regular bedtimes, avoiding nighttime screen use, and so forth) with MBIH practices. Such practices—including modalities like acupuncture, acupressure, yoga, and mindfulness meditation—had been shown to improve sleep in adults, but they hadn’t been studied extensively in adolescents. “She knew I’d studied sleep,” Bruzzese recalls, “so she said, ‘Why don’t we think about doing something together?’”  

At the time, Gold was also medical director of NewYork-Presbyterian Hospital’s six school-based health centers (SBHCs), part of a national network of clinics affiliated with local health care systems and offering primary and preventive care and health education at schools in underserved communities. Both women agreed that NYP’s SBHCs would make an ideal setting to pilot an innovative sleep course and to study its feasibility. 

Bruzzese and Gold joined forces with Samantha Garbers, PhD, then an assistant professor of population and family health at Columbia’s Mailman School of Public Health. They also recruited a research assistant from Columbia Nursing, April Ancheta, PhD ’22, who at that time was still a doctoral student.  

“It was an incredible learning experience,” recalls Ancheta, who’s now a postdoctoral fellow at the Children’s Hospital of Philadelphia, focusing on school-based delivery of health care for LGBTQ+ kids. “Helping to develop a randomized, controlled study from conception through delivery gave me skills I’ll be able to use throughout my career.” 

The first stage of the project was a needs assessment. The team surveyed 167 high school students recruited in SBHC waiting rooms, asking them to fill out questionnaires on sleep quality, sleep-related stressors (for example, how often they went to bed feeling worried or upset), their likelihood of participating in a program including MBIH techniques, and their preferences regarding the format of the course. A robust 77% said they’d be likely to participate; most said that they would attend four or more sessions and that they preferred a mix of group and one-on-one instruction. 

Next, the researchers conducted a literature review, sifting through hundreds of studies until they found 12 on interventions using MBIH approaches to improve sleep in participants aged 10 to 24. Half, they found, reported significant improvements in subjective sleep quality, but only one reported the participants’ race or ethnicity (81% were non-Hispanic white). Ancheta also interviewed some of the studies’ authors on their findings. The review identified several features associated with positive results, such as using mindfulness techniques and targeting kids identified as having poor sleep habits rather than a broader population.  

After bringing on a project manager, a graphic designer, and a pair of advisors with lived experience (two high school girls), the team began designing the course, including a manual for instructors and handouts for students. To guide the process, they held focus groups with 25 teens in grades nine to 11 and conducted interviews with SBHC nurse practitioners, mental health providers, and health educators. Over six months, the team members met weekly to write and refine the intervention, with continuing feedback from the teens and staffers. 

The completed manual for Sleeping Healthy, Living Healthy called for seven sessions, delivered weekly—five 40-minute group meetings and two 20-minute individual conferences for addressing participants’ personal issues and fine-tuning their skills. Only students who reported sleeping less than eight hours a night were eligible. Each group session would combine lessons on behaviors that foster or undermine healthy sleep with instruction on one MBIH technique, plus discussions of students’ experiences with the past week’s method. After class, participants would get handouts summarizing the session and providing instructions for home exercises. They would be asked to complete daily online check-ins reporting how well they’d slept and which methods they’d used.  

The curriculum included five MBIH techniques: mindful breathing, borrowed from Buddhist meditation practice; acupressure, a traditional Chinese method that involves pressing on points in the body thought to balance energy flow, or qi (studies have shown that it can also lower cortisol levels and release endorphins); emotional freedom techniques tapping, a therapy that pairs gentle tapping of acu-points with calming statements; body scanning, in which knots of tension are identified and released; and mindful awareness, a relaxation technique adapted from a popular meditation app. The final session would consist of a content review, a discussion of how to maintain good sleep habits going forward, and a send-off celebration. 

“I wish I’d had something like that when I was in high school,” says Ancheta, a diligent student who was often sleep-deprived herself. “I definitely would have benefited from it.” 

Sleeping Healthy, Living Healthy debuted in the fall semester of the 2021-22 academic year at two New York City SBHCs. Scheduled during the regular school day, the course was taught by a health educator at one clinic and a psychologist at the other. All classes were recorded so that the researchers could gauge the instructors’ fidelity to the manual. The 28 students who completed the intervention were given detailed surveys on their experiences.  

Based on their responses, the curriculum was tweaked slightly for the spring semester, when the course enrolled another two dozen students. This time, there were six group sessions and a single individual session, and a technique for letting go of sleep-discouraging thoughts and anxieties was added to the MBIH mix. The online check-ins were nixed (students found them bothersome) and supportive daily text messages were added. 

The feedback from participants, reported last year by Bruzzese and her team in Sleep Health, the journal of the National Sleep Foundation, was enthusiastic. Over 90% of the participating students said they’d learned something of value. Most found the MBIH practices helpful—ranging from 92% for mindful breathing to 55% for tapping—and were still using them at the time of the 10-week follow-up. Compared to a control group, students who were randomized to take the course reported significant improvements in sleep quality, daytime alertness, and perceived stress. 

One key to those positive results, Bruzzese believes, is how carefully the intervention was tailored to the population it served. “An important reason that urban Black and Hispanic kids have poorer sleep health than their white counterparts is the disparities in their living environments,” she explains. “We gave the teens ear plugs and eye masks, which is important if they don’t have a door to their bedroom or have a lot of noise or light coming in from the street. We also taught them how to talk to family members to help them support the changes they’re making to sleep better.” 

Soon after testing Sleeping Healthy, Living Healthy with high school students, Bruzzese collaborated with Ellen Fahey, DNP ’11, an assistant professor and director of Columbia Nursing’s Family Nurse Practitioner Program, to adapt it for younger kids.  

Fahey had recently launched an initiative called the Brain Health Program at PS-128 Audubon, an elementary school across the street from Columbia Nursing. The program was designed to provide DNP students with pediatric experience by teaching an after-school course for second and fourth graders on how sleep, nutrition, screen time, mood, and exercise affect children’s brains. They were given broad topics on which to base lesson plans, but the course had no formal curriculum.  

“I’d done a presentation on Brain Health for a faculty meeting,” Fahey recalls. “Jean-Marie came up and said, ‘How would you like to do a pilot study to see if merging elements of our two programs can improve sleep in elementary school students?’” The idea thrilled Fahey, a veteran family nurse practitioner and specialty clinic director, who’d learned the importance of healthy slumber as a way to treat conditions ranging from concussions to ADHD. “When you fix a young person’s sleep, it changes the outcome of their life 100%. I said yes immediately.”  

So Fahey teamed up with Bruzzese and Gold to develop a manual integrating the Sleeping Healthy, Living Healthy approach into the Brain Health framework. Once again, the document underwent multiple iterations, based on feedback from kids and teachers, before achieving its final form.  

The new program, dubbed Sleeping Healthy, Living Healthy for Children (SHLH-C), would be delivered in six 45-minute sessions. Its curriculum used simpler language than the high school version, and two MBIH techniques were swapped out for child-friendlier approaches; box breathing (based on a counting formula) replaced mindful breathing, and progressive muscle relaxation (a more straightforward method) replaced body awareness. The team designed a set of cartoony handouts, along with thumbs-up or thumbs-down paddles to signify responses when an instructor asked whether a behavior—say, phone use in bed—was a “sleep helper” or “sleep buster.” 

Julia Klein, DNP ’25, and Natalia Valles, DNP ’25, delivered the SHLH-C intervention last spring to a class of 14 fourth graders. Each week, the pair would sit in a circle with their charges, following the script while also allowing for spontaneity and laughter. “We threw a lot of information at them, but we wanted it to be digestible and fun,” says Klein, who’s now working as a pediatric nurse practitioner at a Federally Qualified Health Center in the Bay Area. “It helped that Natalia and I had both taught these same kids earlier in the Brain Health program. They trusted us, which made them more willing to pay attention.” 

Klein was particularly taken by an exercise that required the pupils to teach a sleep-health technique to a family member. “They’d come back and say proudly, ‘My mom told me it really helped!’ To me, that drove home an important point: When you reach out to a child, you’re connecting to a whole web of people. By investing in kids, you’re investing in their families and communities, too.” 

As with the teen program, SHLH-C produced very encouraging results. In a paper published in the Journal of School Nursing, the team reported that 94% of participants liked the program and would recommend it to other children. More than 63% said they’d made positive changes to their sleep routines. “Before the program, I used to convince my parents [to let me] stay up,” one wrote. “Now I try to go to bed earlier.” Almost all said they’d found at least one of the MBIH techniques helpful. Over 64% reported improvements in overall sleep quality, and 78% cited a reduction in sleep disturbances.  

Buoyed by the successes of both pilots, Bruzzese is now working to bring Sleeping Healthy, Living Healthy to more kids. She recently submitted a grant proposal to the National Institutes of Health for a larger study in New York City high schools, bolstered by letters of support from 10 administrators. This time, she hopes to hire and train staff herself to deliver the intervention, with the goal of assessing its efficacy under strictly controlled conditions. And in the last year of the grant, she aims to present an adaptable model of the program to potential partners across the country.  

“I was talking to a friend in rural Vermont who said, ‘You’ve got to bring it here. You wouldn’t believe the sleep problems our kids have,’” Bruzzese says. “This isn’t just an urban concern. It’s happening everywhere you go.” 

Illustrations by Moogy Logan; Photographs by Jörg Meyer

This article originally appeared in the Spring 2026 issue of Columbia Nursing Magazine.