At 17, Ellie Gnadt, a Fort Collins, Colo. teen, was diagnosed with severe anxiety and depression. But she didn’t want to take medicine. “I was nervous about the medication changing my personality and how I would handle stressful things.” So instead, she went to bed.
“As one of my coping mechanisms, I tried to sleep off the stress and take naps periodically. I would consider this a mental health reset and would become ‘recharged’ which would allow me to be more productive,” she says. She started to see a pattern in her self-imposed treatment plan. It was working.
“I noticed that days I wouldn’t take 20-30 min. naps, I would just work through the stress and would maybe get 2-3 hours of solid sleep. That made me feel miserable for a couple days after and would take a long time to feel back to normal,” she says. Now, as a college student, she prioritizes sleep, and has a message for other teens — “Your sleep is very, very important and needs to be taken seriously or else you will be miserable.”
Gnadt just might be onto something for teens who need more sleep than others in general, but especially for teenagers battling mental health conditions.
The Connection Between Teens’ Sleep and Mental Health
The Centers for Disease Control and Prevention report that over half of middle school students don’t get enough sleep on school nights, and 7 in 10 high school students don’t. They also connect sleep deprivation with increased physical and mental health problems, including attention and behavior related issues. It even increases teens’ risk of suicide, they report. In another study, late bedtimes were associated with higher risks of emotional health and behavioral disorders, and showed that males tend to externalize these feelings, while females internalize them.
Teens are getting less sleep than ever before. So, Sleepopolis conducted some of our own research as well, asking teens and their parents about their sleep habits. The top response for the types of sleep issues teens are experiencing, is that over half have trouble falling asleep. One third have trouble waking up, and just over 1 in 4 teens reported sleeping too much. All of these points to a vicious cycle between sleep and mental health — sleep issues are a top symptom of multiple mental health conditions such as depression and anxiety, but ironically of course, sleep deprivation increases the risk of those same conditions.
This leaves teens, experts, and their parents to try to unpack this chicken and the egg scenario to get to the bottom of both sleep struggles and mental health conditions. The cycle even impacts parents’ mental health as well. Half of our parent participants reported that they’ve had trouble sleeping as well due to anxiety about their children.
Barriers to teens getting enough high quality sleep
Most teens don’t set out to avoid sleep — for many families, it just happens. “As kids get older, parents start to actually let them stay up longer, and sleep for less time, which is contraindicated, when in fact, their brains and bodies are developing, and they’re just coming into their own emotional identity, and therefore require more sleep,” says father of 5, Mendi Baron, Las Vegas-based LCSW and Founder and CEO of Moriah Behavioral Health. Baron says his own preteen, age 12, has difficulty with focus, irritation, and frustration when he doesn’t sleep enough. “The fix in that situation? Sleep.”
School and sports schedules
It’s just biology — as puberty hits, kids are less able to go to bed early quite as easily, and their bodies want to sleep in more, according to experts in a CBS News report on teens and sleep. But society just isn’t set up to accommodate their biological clock, with high schools still starting at the crack of dawn in many states, and sports schedules pushing homework way into the wee hours of the night, effectively pushing teens to “burn the candle at both ends.”
Lisa L. Lewis, MS, Los Angeles-based author of The Sleep-Deprived Teen, Why Our Teens Are So Tired, and How Parents and Schools Can Help Them Thrive, is on a mission to push school start times later and to help teens get more sleep as a result. She played a key role in helping get later start times enacted in California, which went into effect last summer. She explains that right now it’s the only state to define how early is too early, though Florida passed legislation that will go into effect in a few years. She wants statewide legislation in each state to work to fix this issue, saying districts handling it on their own is a start, but a “patchwork approach” that leaves some kids without this solution.
“Being sleep deprived exacerbates everything from anxiety to depression to suicidality. For our teens, who are already facing tremendous pressure and are at risk for mental-health issues, adding sleep deprivation to the mix increases this risk. Getting enough sleep (8-10 hours up until age 18) helps with emotional resilience,” she says.
Social media and bedtime
After a long day, teens, much like adults, might want to just zone out scrolling on their phones, often on social media. This can push bedtime long into the wee hours of the night, robbing kids of essential sleep.
“Start times are a key factor affecting teens’ sleep, but bedtimes play a role as well,” Lewis says. “For teens who are staying up quite late, take a look at why this is happening: are they on their tech devices until late at night? Are they overscheduled and not getting home until late due to various activities and therefore not starting on homework until late at night? Both of these – overscheduling and tech use — can also be affecting mental health, compounding the issue even further.”
In our survey of 18-21 year olds, 82 percent check social media before bed. Another 59 percent text or chat with friends. Not only can social media be upsetting to teens, as they navigate nuanced and difficult social situations well into the night online, but late screen time has also been proven to disrupt sleep.
We’ve all been there, and teens especially struggle with this — losing sleep as they lay in bed, worrying. So, we asked them in our survey what they are worrying about. Here’s what they said:
- 78 percent — the future
- 63 percent — money
- 63 percent — relationships and friendships
We also found that the top worries teens conveyed to parents included:
- 48 percent — doing well in school/getting good grades
- 40 percent — their appearance
- 34 percent — stories in the news about politics or current events
For one Columbia, Md. teen, this is a daily reality. Kiersten Simms, 18 years old, who has anxiety and depression, says she can barely get out of bed on her “bad mental health days.” This happens when she is worrying.
“My brain won’t turn off. I’m overthinking everything, and doubting myself, so I can’t sleep at all. My mind has to be at ease in order for me to sleep,” she says. “So I try to always keep myself in a positive mindset, so my brain is comfortable enough to turn off so I can sleep soundly. Now I still have my bad days and I always will, but getting better sleep with the help of meditation has made my mental health better than it has been in a long time, while at the same time, bettering my mental health has made it easier for me to sleep.”
Matthew Schubert, Boise, Idaho-based mental health counselor and CEO of Gem State Wellness explains that there’s a distinct connection between poor sleep and “unhealthy thought patterns.”
“Sleep forms the bedrock of overall well-being,” he says, pointing to inadequate sleep which lays the groundwork for mental health issues such as anxiety and depression to arise. “This stems from the impairment of cognitive function that results from insufficient sleep, which, in turn, propels individuals into unhealthy thought patterns. These patterns gradually take root and eventually give rise to feelings of depression and anxiety.”
Physical conditions behind lack of sleep, mental health concerns
Sometimes, teens are struggling with sleep and therefore mental health (or vice versa), due to a physical condition they may or may not know about. For example, sleep disorders and chronic pain conditions are linked, and sleep issues can even increase the perceived intensity of pain, research shows. For a variety of reasons, from sports injuries to health conditions, 11 to 38 percent of kids suffer from chronic pain, including musculoskeletal pain, abdominal pain, headache, and other issues.
Stephanie Krauss, St. Louis-based educator, social worker, and author of Whole Child, Whole Life, experienced this with her 12-year-old, who previously had been showing some signs of serious depression, including suicidality, she says. “ As a social worker married to a social worker, we immediately sought therapeutic supports, but never considered whether there was a basic health culprit at play,” she says. Her son had to have surgery, and the doctors told them afterwards that based on how his body responded to anesthesia, he might need a sleep study. The results of that study were shocking, she says.
“It turned out that our son was waking up almost 100x per night, caused by a pediatric version of restless legs syndrome – which is brought on by iron deficiency. He also had a partial obstruction in his tonsils/adenoids,” she says. “His symptoms of depression were real, but they were overwhelmingly the result of incredible sleep deprivation. We had no idea!” Her only other signs of a sleep issue were seeing his blankets thrown off the bed in the morning, but they chalked it up to having a kid who gets hot easily.
Now, whenever her son is tired or sad, they monitor his iron levels, and he is sleeping better after his tonsils and adenoids were removed, along with the help of a triangular shaped pillow that props him up. “From a mental health perspective, we always look at any unusual symptoms against the “three S’s” – sleep, stress, sickness. We try to address those as a first line of defense. Almost always, it works,” she says.
Sleep as Medicine — What Families Can Do to Improve Sleep, Mental Health in Teens
While it can seem daunting to help your teen with both mental health struggles and sleep problems, it’s a fight worth fighting. The Association for Child and Adolescent Mental Health suggests that targeting sleep difficulties during adolescence may have long term mental health benefits.
In our survey, we found that parents and teens are trying quite a few interventions to figure out the solution. Parents have encouraged physical activity over screen time (57 percent), limiting screen time (37 percent), and melatonin or sleep supplements (34 percent). Teens themselves report trying supplements (48 percent), no interventions (31 percent), marijuana (22 percent), and weighted blankets or toys (22 percent).
Though different solutions might work for different families, there are some tried and true, research backed solutions. Here’s what the experts recommend.
Luca*, age 17, is a graduate of Newport Virginia’s residential program to improve his sleep and mental health. “An unhealthy sleep schedule affected how I was able to cope with stressful situations. It caused me not to be able to go out and participate in social situations and events, both in my personal life and at school. This put tremendous stress on my mental health,” he says. When he sought medical help, he was able to regulate his sleep schedule. “I had dreams that caused me to lose sleep as well; however, the medication helped to reduce that.”
Schubert explains that structure starts with a consistent “day to night schedule” calling it the cornerstone of getting sufficient sleep. But this doesn’t mean a teen has to be perfect. “While occasional deviations are natural, the more one adheres to the routine, the more seamless it becomes. Incorporating good sleep hygiene practices, like refraining from screen usage half an hour before bedtime, is a crucial element in successfully upholding this regimen – a facet that teenagers often find challenging to manage.”
Baron says that implementing this structure is where parents can play an important role — after all, what teen really wants to get off social media or observe the same bedtime every night if they have a choice?
Just as you might wash your face, brush your teeth, and practice other personal hygiene processes, teens can improve your sleep quality and quantity with sleep hygiene strategies. Research shows that these practices can improve delays to falling asleep, or fragmented sleep. Teens can try these strategies:
- Use those structured sleep and wake times consistently
- Create a cool, dark, calm, clean, and electronic-free sleep environment
- Reserve the bed for sleeping only, not homework, gaming, or hanging out
- Avoid heavy meals and exercise before bed
- Stop using electronics an hours before bed
- Get out of bed if you can’t sleep within ten minutes, then do a calming activity and try again later
This is also an area where parents can practice what they preach and get involved by doing a hygiene “challenge” or other collaborative effort with their kids. For example, Julie Neale, of Mother’s Quest podcast and mom to a 19-year-old son entering his sophomore year of college, just started the Oura ring sleep tracker with him. “Since getting an Oura rings we can look at the data about how much sleep we are getting, the quality of sleep, the trends…” she says, explaining this data helps her and her son “course correct” after a night of poor sleep.
No sleep practices are going to help on their own if a teen has a mental health condition that needs medical intervention. Half of adolescents have had a mental health disorder at some point in their life, and the Office of Population Affairs explains that early intervention and treatment can help lessen the impact on their lives. But since the pandemic, in a surging mental health crisis, not everyone who has a condition has been able to access medication, therapy, and other treatments they need. Even for those in crisis, emergency mental healthcare can sometimes take days to access. Those are days that some teens, suffering with suicidal thoughts and self-harm behaviors, and even eating disorders leading to severe health problems, might not have.
So, what is a parent to do if medical intervention is difficult to find? First, use your pediatrician and their connections and resources to their full extent and ability, even as you wait on specialized mental health care. Even if a psychiatrist is months out for appointments, they can fill the gaps with mental health medication management and therapy recommendations. Next, create a weekly reminder for yourself to call and check on any cancellations at mental health care places you are waiting on, to see if you might be able to get in sooner. Finally, even if there is a care shortage, don’t hesitate to call promptly or head to the ER in a mental health emergency, and let the experts there sort out finding relevant care. Keep the suicide & crisis lifeline number (988) available, and teach your teens about this number too, to help themselves and friends if needed (but encourage them to always come to you as well).
Using Social Media for Good
There’s no use in trying to prevent teens from using and loving social media, in spite of its flaws — so instead, teach them how to follow accounts and influencers who promote strong sleep and mental health habits. Teyla Baker, a Georgia-based TikTok teen who struggled with mental health, has built a community for teens struggling with mental health on TikTok herself, and has 125k followers. A month after losing her big brother to suicide, this is where she turned to make an impact — for herself, and other teens at risk. “I wasn’t sleeping, nor eating, in general I wasn’t taking care of myself. I started making content in the hopes others struggling would find my videos and relate. Hoping they wouldn’t feel alone like my brother did,” she says.
Like other teens, she’s learning and sharing more about the connection between sleep and mental health conditions.
“As someone who has struggled with insomnia, suicide, endless hospital stays, depression, anxiety and more, I’ve learned when people don’t get enough sleep, their moods can become more negative and their ability to handle stress is diminished,” she says. “Poor sleep can also interfere with the body’s ability to produce melatonin, which is important for regulating the body’s circadian rhythm.”
By seeking to educate teens on the platforms they already use, they just might be inspired to head off to bed before 2 a.m. —and their mental health just might depend on it.
*First name only used to maintain this teen’s privacy, at their request.