Prolonged exposure to poor sleep quantity and quality may have negative health outcomes for adolescents who are particularly vulnerable to circadian changes and neuro-cognitive disturbances. But, cumulative effects or gender differences are not studied in adolescents. Two studies examined whether cumulative sleep deficits were linked to sub-optimal health or depression among youth in BC. We found 11–15% of BC adolescents were chronically sleep deprived and 61% had persistent sleep disturbance. Chronic sleep deprivation was not associated with self-reported health in adolescents, but was associated with increased risk of depression in young women only. By contrast, chronic sleep disturbance increased the odds of reporting sub- optimal health at follow-up in both young women and men compared to counterparts with no history. Model re-specification did not alter results. Findings showed that chronic sleep deprivation may be an important determinant of mental health outcomes in adolescent girls, whereas chronic sleep disturbance matters for general health of both girls and boys. Adolescent health promotion requires relevant strategies to support young women in achieving recommended amounts of sleep and to help all youth in addressing difficulty falling or staying asleep.