Exploring the Association Between Psychological Inflexibility, Experiential Avoidance and Sleep-Related Problems Among Adolescents: The EHDLA Study

Background: Adolescence is a sensitive period during which sleep undergoes substantial change, increasing vulnerability to sleep disturbances and their health consequences. Psychological inflexibility (PI) and experiential avoidance (EA), operationalized through the Acceptance and Action Questionnaire-II (AAQ-II), have been associated with poorer sleep among adults; however, evidence in adolescents remains scarce. This study examined the association between PI, EA, and sleep-related problems in a representative sample of Spanish adolescents. Methods: A cross-sectional analysis was conducted using data from 623 adolescents (aged 12–17 years; 56.7% girls) from the Eating Healthy and Daily Life Activities (EHDLA) study, conducted in the Valle de Ricote (Murcia, Spain) during 2021–2022. PI and EA were assessed with the Spanish-validated AAQ-II; sleep-related problems were screened using the BEARS (B = Bedtime problems, E = Excessive daytime sleepiness, A = Awakenings during the night, R = Regularity and duration of sleep, S = Snoring) questionnaire across five domains. Generalized linear models were adjusted for sex, age, socioeconomic status, physical activity, sedentary behavior, body mass index (BMI) z-score, energy intake, and sleep duration. Results: Higher AAQ-II scores were significantly associated with increased probabilities of bedtime problems (+0.9% per point; 95% confidence interval [CI]: 0.6–1.1%), excessive daytime sleepiness (+1.0%; 95% CI: 0.7–1.2%), nocturnal awakenings (+0.7%; 95% CI: 0.5–1.0%), and problems with sleep regularity and duration (+0.8%; 95% CI: 0.5–1.1%). Each additional AAQ-II point increased the probability of reporting any sleep-related problem by 1.2% (95% CI: 0.9–1.5%; p < 0.001). Corresponding adjusted odds ratios ranged from 1.04 to 1.06 per point. No significant association was found for snoring. Conclusions: In this cross-sectional study, psychological inflexibility and experiential avoidance were positively associated with several sleep-related problems among adolescents. Longitudinal and intervention studies are warranted before causal or clinical recommendations can be made.