Sleep Strategies for Managing Anxiety in Adolescents and Young Adults
One of the most common co-occurring challenges for clients presenting with anxiety is disrupted or maladaptive sleep patterns. Poor sleep and anxiety often create a self-perpetuating cycle: anxiety contributes to difficulty initiating or maintaining sleep, while inadequate or poor-quality sleep exacerbates anxiety symptoms the following day. This is particularly due to reduced executive functioning and impaired emotional regulation, making it harder for individuals to suppress intrusive or distressing thoughts.
The gold-standard psychological treatment for sleep issues is Cognitive Behavioural Therapy for Insomnia (CBT-I). This structured, short-term therapy (typically 6–8 sessions) has strong empirical support, including evidence that CBT-I is as effective as pharmacotherapy in the short term for treating primary insomnia American Journal of Psychiatry, 2002. Importantly, CBT-I is also effective in reducing comorbid symptoms of anxiety and depression, particularly in younger populations.
Adolescents and young adults report the most benefit when sleep interventions are engaging and relatable. Digital sleep trackers, goal-setting with peers, and gamified routines help sustain motivation and compliance. Evidence consistently shows that multi-component approaches—those combining routine, relaxation, and cognitive strategies—are more effective than sleep hygiene alone. For anxious students in particular, consistent schedules, calming routines, cognitive reframing, and relaxation skills offer a practical, evidence-based toolkit.
Core Sleep Hygiene Strategies
Sleep hygiene provides the behavioural foundation for better sleep regulation. The following strategies are commonly used and easily introduced in primary care discussions:
Maintain a consistent sleep–wake schedule, even on weekends.
Establish a pre-bed routine (e.g. quiet reading, warm shower) to cue the body and mind for sleep.
Ensure a sleep-conducive environment: dark, cool, and quiet. Remove or turn off electronic devices at least 30–60 minutes before bedtime.
Avoid late-day naps, particularly those longer than 20–30 minutes.
Eliminate stimulants such as caffeine, nicotine, and alcohol in the late afternoon and evening.
Use the bed only for sleep—not for homework or screen use. If unable to sleep within 15–20 minutes, get out of bed and engage in a calming activity until drowsy.
Encourage regular daytime exercise, preferably in the morning or early afternoon. Avoid intense exercise within two hours of bedtime.
Relaxation, Mindfulness, and Exposure Techniques
Evening relaxation strategies are particularly helpful for clients with anxiety-related sleep problems. Some techniques are simple enough to introduce in primary care, while others can be further supported through referral to a psychologist.
Progressive muscle relaxation, paced breathing, and guided mindfulness help reduce somatic arousal at bedtime.
Short, guided meditations (e.g. 5-minute “breathing space” exercises) can be effective immediately before bed.
Mindfulness-based CBT-I has shown significant reductions in insomnia, anxiety, and depressive symptoms in teens and young adults.
Graded exposure can help address sleep-related fears (e.g. fear of the dark or of being alone).
Interoceptive exposure teaches tolerance of uncomfortable bodily sensations often interpreted catastrophically by anxious youth.
Worry journals or scheduled “worry time” earlier in the evening can offload intrusive thoughts before bedtime.
Nightmare rescripting—writing and mentally rehearsing a more positive dream outcome—can reduce night-time anxiety and improve sleep continuity.
Lifestyle and Circadian Regulation
Lifestyle factors also influence sleep outcomes and can be modified with basic psychoeducation:
Morning light exposure (e.g. sunlight within 30 minutes of waking) helps stabilize circadian rhythms.
Avoid bright lights and stimulating activities (e.g. gaming, studying, intense conversations) for at least one hour before bed.
Limit technology use at night. Introduce a “digital curfew” and disable notifications to reduce night-time checking and FOMO-driven anxiety.
Advance bedtime gradually (by 10–15 minutes every few nights) to increase total sleep duration in adolescents with delayed sleep phase.
Encourage regular wake-up times, even on weekends, to support circadian consistency.
Tech-Based and Gamified Supports
For adolescents and young adults, digital tools can support behavioural change through engagement and accountability:
Gamified sleep trackers like Sleepagotchi, Sleep Quest, and Pokémon Sleep provide incentives for bedtime routines.
Mindfulness and meditation apps such as Smiling Mind and Headspace offer user-friendly support for sleep-related relaxation, especially when incorporated into wind-down routines.
Final Thoughts for GPs
For adolescents and young adults experiencing anxiety-related sleep difficulties, psychological interventions can yield significant improvements in both sleep quality and mental health. These strategies are safe, cost-effective, and evidence-based. While GPs can introduce foundational sleep hygiene and relaxation practices, referring patients to a psychologist trained in CBT-I or adolescent anxiety can offer more comprehensive and sustained support.
References (selected):
Morin, C. M. et al. (2002). Cognitive Behavioral Therapy vs. Pharmacotherapy for Primary Insomnia, Am J Psychiatry.
Barlett et al. (2024). Sleep Interventions in Youth with Anxiety Disorders, Frontiers in Sleep.
Becker et al. (2020). CBT-I in University Students, Behavioral Sleep Medicine.
Alvaro et al. (2023). Digital CBT and Sleep Hygiene Tools in Adolescents, J Adolesc Health.