Teen Insomnia: When Your Teenager Can't Fall Asleep

Your teenager lies awake for hours, staring at the ceiling, mind racing. They're exhausted but sleep won't come. Or they fall asleep fine but wake at 3 AM and can't get back to sleep. This isn't the normal teen sleep shift—it's insomnia, and it's more common in adolescents than many parents realize.

Insomnia in teenagers can significantly impact their mental health, academic performance, and daily functioning. Understanding what's causing the sleeplessness—and knowing effective treatments—can help you support your teen through this challenging issue. AAP

What Is Teen Insomnia?

Insomnia is more than occasional trouble sleeping. It's characterized by: NSF

Key features:

• Difficulty falling asleep despite opportunity
• Difficulty staying asleep (waking and can't return)
• Waking too early
• Sleep that doesn't feel restorative
• Happening 3+ nights per week
• Lasting at least 3 months (chronic) or shorter (acute)

What it ISN'T:

• Choosing to stay up (that's behavioral, not insomnia)
• The normal teen circadian shift (feeling sleepy later)
• Not having time to sleep (that's sleep deprivation, different issue)

The teen distinction:
Real insomnia means lying in bed trying to sleep and being unable to—not choosing screens over sleep.

Why Insomnia Happens in Teens

Multiple factors can drive teen insomnia: AAP

Anxiety and stress:

• The most common cause of teen insomnia
• School pressure, social stress, future worries
• Anxiety disorder (may not be diagnosed)
• Racing thoughts at night
• "My brain won't turn off"

Depression:

• Commonly co-occurs with insomnia
• Sometimes insomnia is the first sign of depression
• Can be both cause and effect
• Always worth exploring

Other mental health:

• ADHD (common sleep difficulties)
• OCD (nighttime rituals, intrusive thoughts)
• Trauma/PTSD (hypervigilance, nightmares)

Physical causes:

• Caffeine (more sensitive during adolescence)
• Certain medications
• Chronic pain
• Restless legs syndrome
• Sleep apnea

Learned insomnia:

• After acute insomnia (illness, stress), poor sleep becomes a pattern
• Bed becomes associated with wakefulness
• Trying too hard to sleep makes it worse
• Anxiety about sleep creates a self-fulfilling cycle

Signs Your Teen Has Insomnia (Not Just Teen Sleep Shift)

Classic teen sleep shift looks like:

• Can't fall asleep until late (11 PM+)
• Sleeps fine once asleep
• Very hard to wake for school
• Sleeps easily until noon on weekends
• Feels rested when allowed to sleep late

Insomnia looks like:

• Lies awake for hours regardless of bedtime
• May fall asleep then wake at 2-4 AM
• Anxious about trying to sleep
• Poor sleep even on weekends with no alarm
• Exhausted despite time in bed
• Daytime symptoms (fatigue, mood, focus)

Effective Treatment Approaches

CBT-I (Cognitive Behavioral Therapy for Insomnia):
This is the gold standard treatment—more effective than medication long-term. NSF

Components include:

• Sleep restriction (counterintuitive but effective)
• Stimulus control (bed = sleep only)
• Cognitive restructuring (addressing anxious thoughts)
• Sleep hygiene education
• Relaxation training

Can be delivered by:

• Therapist specializing in sleep or CBT
• Digital CBT-I programs (with parental guidance)
• Sleep psychologist

Sleep hygiene (necessary but not sufficient):

• Consistent sleep/wake times
• Screen-free hour before bed
• Cool, dark, quiet room
• No caffeine after noon
• Regular exercise (not too close to bed)
• Bed only for sleep

Addressing underlying causes:

• Treat anxiety/depression if present
• Reduce stress where possible
• Address academic pressure
• Rule out physical causes

What Parents Can Do

Create the environment for good sleep:

• Enforce screen curfew
• Keep consistent household rhythms
• Reduce evening activity/stimulation
• Ensure bedroom is optimized

Don't add pressure:

• Insomnia causes anxiety; anxiety worsens insomnia
• "Just relax and sleep" doesn't help
• Lecturing about sleep importance adds stress
• Be supportive, not frustrated

Teach coping skills:

• Deep breathing techniques
• Progressive muscle relaxation
• Mindfulness for anxious thoughts
• What to do when lying awake

Monitor for mental health:

• Watch for depression symptoms
• Note anxiety patterns
• Track mood alongside sleep
• Don't dismiss "just tired" if it persists

When Lying Awake: What Your Teen Should Do

Lying in bed awake for long periods can make insomnia worse. Teach your teen:

The 20-minute rule:
If awake for approximately 20 minutes, get up. Go to a dimly lit room. Do something boring/relaxing (not screens). Return to bed when sleepy.

Why it works:
Staying in bed awake teaches the brain that bed is for wakefulness. Breaking that association is crucial.

What to do:

• Keep lights dim
• No screens
• Read something boring (not exciting)
• Light stretching
• Write worries in a journal (then close it)

What not to do:

• Watch TV or use phone (light and stimulation)
• Eat a meal (associates night with eating)
• Engage in anything exciting or productive
• Check the time repeatedly

When to Seek Professional Help

See a doctor or therapist if: AAP

Duration:

• Insomnia lasts more than a month
• Sleepless nights are more common than not
• Home strategies aren't helping

Severity:

• Daytime functioning significantly impaired
• Grades dropping, can't focus
• Mood is notably affected
• Missing school due to exhaustion

Mental health concerns:

• Signs of depression or anxiety
• Panic attacks
• Hopelessness or dark thoughts
• Self-harm or suicidal ideation (seek help immediately)

Physical symptoms:

• Snoring or breathing issues
• Restless legs
• Unusual movements during sleep
• Excessive daytime sleepiness despite time in bed

Medication: A Last Resort

Sleep medications are generally not recommended for teen insomnia: AAP

Why not:

• Don't address underlying cause
• Side effects and risks
• Potential for dependency
• Often stop working over time
• Not well-studied in adolescents

If prescribed:

• Should be short-term only
• Alongside behavioral treatment
• With close monitoring
• As last resort after CBT-I

Melatonin:

• May help with sleep timing (see our melatonin guide)
• Not a sleeping pill—doesn't treat insomnia per se
• Low dose, correct timing if used

What Other Parents Ask

Q: My teen says they can't sleep without their phone. Is that insomnia?
A: No—that's a behavioral sleep association (and screen dependency). True insomnia is inability to sleep despite trying in good conditions. That said, screens can contribute to insomnia, and the phone should still be removed from the bedroom. NSF

Q: Should I let my teen stay home from school if they didn't sleep?
A: Occasionally, if they're truly non-functional, yes. But chronically missing school creates additional problems. Better to address the insomnia directly than to accommodate by staying home regularly.

Q: Will my teen outgrow this?
A: Sometimes insomnia improves after a stressful period passes. But untreated insomnia often continues or worsens. Don't assume they'll grow out of it—address it now.

Q: Is sleeping late on weekends helping or hurting?
A: For insomnia, keeping a consistent schedule (even weekends) is important. Irregular timing disrupts the body clock further. Limit weekend sleep-ins to 1 hour.

The Bottom Line

Teen insomnia is more than typical adolescent sleep challenges. When your teenager genuinely can't sleep despite trying, anxiety, depression, or learned sleep associations may be involved. CBT-I is highly effective, and behavioral approaches should be tried before medication.

Key points:

• True insomnia is inability to sleep despite opportunity
• Different from choosing to stay up or normal teen sleep shift
• Often linked to anxiety, stress, or depression
• CBT-I is the most effective treatment
• Don't lie in bed awake for long periods
• Address underlying mental health
• Seek help if it persists more than a month
• Medication is a last resort for teens

Clara is here to help you support your teen through sleep difficulties.