The nation’s teens are dealing with unprecedented levels of mental health challenges, leading experts to declare a national emergency in child and adolescent mental health last fall. When it comes to teens who are experiencing comorbid anxiety and insomnia, which disorder should be treated first?
We polled our readers, and out of 732 respondents, a majority (44%) voted to treat the anxiety first, while 34% said to treat both at the same time, and 22% voted to prioritize the insomnia. But there may be more to consider when deciding on a treatment plan.
Caroline Buzanko, PhD, a licensed psychologist and clinical director of Koru Family Psychology, explains, “Teens are already vulnerable to anxiety and sleep challenges. When a teen experiences both anxiety and insomnia, it can be tricky because we know anxiety can spill into the night, making it hard to fall asleep and stay asleep.”
Below, Dr. Buzanko shares her recommendations for treatment.
First, look for medical causes of sleep disruption
“If there is something happening medically that is disrupting sleep, such as restless legs, GERD, or sleep apnea, then it is important to address those issues first (it can be helpful to do a polysomnogram to see),” explained Dr. Buzanko.
Address sleep as soon as possible
“Teens’ internal sleep clock changes because the sleep hormone, melatonin, is released later than adults. As a result, they can have a hard time falling asleep, which disrupts their sleep-wake cycle,” she noted. For this reason, it is crucial to encourage good sleep hygiene.
“[The sleep] cycle is further disrupted with electronic devices, which further delays melatonin [release],” she noted. “Therefore, it is essential to address sleep so it does not contribute to anxiety.”
When the teen expresses worry about sleep, address the anxiety first
“However, if teenagers worry about falling asleep and getting enough sleep, then the anxiety needs to be addressed first so they can learn to cope with that anxiety effectively so they can fall asleep.” Dr. Buzanko further clarified that even in these situations, healthy bedtime routines should still be happening, including no screens before bed.
Without getting enough deep sleep, teens can experience more anxiety, she said, especially if they start to worry about getting enough sleep (more on the anxiety cycle). “Moreover, the lack of sleep in and of itself makes it hard to regulate our emotions and cope with stress, which can contribute to and worsen anxiety,” Dr. Buzanko said.
Dr. Buzanko shares more on how to manage anxiety in adolescents. Listen to her podcast series on adolescent psychiatry, sleep, and more.
Additional Clinical Resources
The independent relationships between insomnia, depression, subtypes of anxiety, and chronotype during adolescence. Alvaro P et al. Sleep Med. 2014.
Insomnia disorder in adolescence: Diagnosis, impact, and treatment. De Zambotti et al. Sleep Med Rev. 2018.
Sleep and anxiety in late childhood and early adolescence. McMakin DL et al. Curr Opin Psychiat. 2015
The UCLA Sleep Disorders Center offers information for families about sleep and teens.
