Why Teens Can't Sleep: Understanding Teen Insomnia and How CBT-I Helps
A light is on under the door, it’s close to midnight on a school night and you thought your typically responsible teen was asleep an hour ago. This is an increasingly common scene on a weekday night for parents of teens - one that causes dread for the morning wake-up battles to come. But there is often a deeper dread and fear that their teen’s sleep issues might have no solution.
Laziness is the easy answer - people assume teens make the irresponsible decision to stay up late and miss their alarm or are constantly on their phones at night. However, science shows a more nuanced story. Adolescents are fighting real biological, physical and behavioral forces that cause poor sleep, and when those forces are unaddressed, consequences of poor sleep set in. Now is the time to broaden the understanding of what is going on for teens and their sleep patterns and learn new evidence-based strategies that can help.
Teen Sleep Is Biologically Different — and That Matters
During puberty (which starts roughly between 9-14 years old), the brain shifts into a delayed sleep phase, causing the circadian rhythm to reset. This understanding is imperative for parents and teens to grasp. Sleep issues do not always start with poor choices, they often start with a biological shift in the brain that can lead to difficulty sleeping. One example of this shift is melatonin production - in the teen years melatonin is released later at night which also leads to drowsier mornings.
For teens, a main struggle is early school start times - most schools start before or by 8:00 am. This naturally causes conflict between the late-sleep shift and the reality of school start times. The American Academy of Pediatrics recommends 8-10 hours of sleep for teens, but with an early school day, many teens are averaging 6-7 hours of sleep.
Parents are often frustrated with their teens and teens may feel shame about not being able to “get it together” and be responsible – this leads to a negative cycle in families. Understanding the natural biology shift that impacts teen sleep lessens the need for blame and shame on both sides. Parents and teens can instead be on the same team and address sleep issues together.
Why Teen Insomnia Is More Than Just a Late Bedtime
Anxiety-driven insomnia
Anxiety is one of the most underrecognized causes of teen insomnia
Teens with anxiety disorders are more prone to rumination, racing thoughts, physical symptoms, worry for the future, all of which show up right at bedtime
Add on academic stress, social pressure and a developing sense of self and identity - it’s no wonder the brain has trouble resting
Screen use and sleep architecture
Blue light use even an hour before bedtime delays melatonin production
Social media, gaming and video content wire the brain for alertness and hyperactivity, making it even harder to put the screens down and go to sleep
Phones and screens in the bedroom at night keep teens in a state of alertness, even when the phone is not in their hands
The mood-sleep loop
Poor sleep increases anxiety and depressive symptoms which in turn lead to poor sleep
This negative loop contributes to school avoidance, social isolation and poor academic performance
How CBT-I Is Adapted for Teens
Starting with good sleep hygiene is key - screens away, a consistent bedtime routine and a dark and cool environment. However, this does not address underlying insomnia issues.
Cognitive Behavioral Therapy for Insomnia (CBT-I) is the research-backed gold standard for treating insomnia without medication or invasive interventions. CBT-I goes deeper, addressing associations with sleep and behavioral patterns that are perpetuating insomnia.
CBT-I offers evidence-based strategies to re-wire the brains association of sleep including:
Stimulus control: retraining the brain to see the bed as a place of sleep and relaxation, not alertness
Sleep Consolidation: A trained clinician can suggest ideal wake-windows and length of sleep in order to increase sleepiness and get the body used to falling asleep and sleeping through the night again
Restructuring thoughts around sleep - anxiety causes negative thoughts that impact sleep by increasing arousal in the brain. CBT coaches teens on identifying and reframing these thoughts and regulating corresponding emotions
Parent Involvement
Parent involvement is a key component of CBT-I for teens and contributes to better treatment outcomes. When parents understand the biology behind adolescent sleep and the strategies their teen is learning in therapy, the dynamic at home shifts — from the familiar tension of parents pushing and teens resisting, to a team working toward the same goal. Parents can support with strategies such as lowering the lights around the house before bedtime, screen time restrictions for smart devices (especially for younger teens who struggle more with self-regulation), and having clear rules about having devices outside the room at bedtime.
Seeking Treatment
If your teen is struggling with sleep issues lasting longer than a month, battling sleep anxiety and dreading bedtime and experiencing poor sleep that is impacting home, academic and social life - seek out treatment of a trained CBT-I specialist.
CBT Denver has multiple clinicians who work with adolescents, all of whom are trained in treating insomnia and working with teens to improve sleep. Reach out to schedule an appointment.