Observing Sleep Health as a Pillar of Lifestyle Medicine through Behavioral, Structural, and Clinical Pathways to Provide Evidence for Its Integration in Clinical and Public Health Practices

Abstract

Sleep is a foundational determinant of physical, mental, and cognitive health that is often overlooked clinically and in public health settings despite its strong links to chronic disease. Modern patterns of work, technology use, and social organization have contributed to widespread sleep deficiency that disproportionately impacts overworked and underserved populations. In clinical practice, sleep disturbances are frequently addressed through pharmacological treatment rather than by targeting the behavioral, environmental, and structural factors that can cause sleep disturbances. Lifestyle medicine, a field centered on evidence-based behavior change to prevent and treat chronic disease, offers a promising framework for restoring sleep health through non- pharmacologic, integrative interventions. This thesis presents a comprehensive review of the literature examining sleep through the lens of lifestyle medicine. Through the compilation of literature regarding sleep and lifestyle medicine, three core aims are prominent in this work: (1) to identify the most efficient lifestyle components for promoting restorative sleep; (2) to examine population characteristics that influence sleep health and responsiveness when introducing lifestyle interventions; and (3) to evaluate how different measurement strategies affect observed sleep outcomes. The findings indicate that sleep health is most strongly supported by circadian- aligned diet quality, regular physical activity, stress reduction, mindfulness practices, sleep hygiene, smoking and alcohol cessation, and social support. Additionally, this review reveals significant disparities in sleep opportunity and practicality when exploring socioeconomic contexts. This further highlights the role of structural and environmental constraints. Overall, this thesis supports positioning sleep as a vital assessment in clinical settings and the implementation of lifestyle medicine as a first-line framework for addressing sleep disturbances. Compared to current standard care and pharmacologic approaches, lifestyle medicine interventions demonstrate meaningful improvements in sleep quality with fewer long-term risks. Integrating lifestyle-based sleep interventions into clinical care, health professional education, and public policy may offer a more sustainable, preventative, and equitable approach to improving sleep health and reducing the chronic disease burden the United States currently faces.