Insomnia mirrors youth mental health struggles

'Constant craving'

For clinicians working with adolescents and young adults, insomnia is rarely the illness itself — it is the most visible trace of something deeper happening.

Ni Zhe, an associate chief physician at the Social Psychological Service Department of the Mental Health Center affiliated with Zhejiang University School of Medicine, also known as Hangzhou Seventh People's Hospital, said the rising visibility of sleep complaints among young patients reflects a broader deterioration in adolescent mental health. Rates of school refusal and medical leave from school have climbed sharply, he said, and both typically indicate underlying anxiety and depression.

"In our clinical work, we see three phenomena that almost always appear together," Ni said.

"Disturbed sleep, overuse of the internet, and social disconnection. They form a vicious cycle. The patient falls out of the ordinary rhythm of life — they stop eating to a schedule, they barely exercise, and then of course they cannot sleep normally either."

Ni explained that the prefrontal cortex in adolescents is still developing, and its job is to "inhibit, control, coordinate, and organize".

"When young people are exposed to high-intensity stimulation — short videos, mobile games — over long periods, the stimulation threshold rises significantly," he said. "They live in a state of constant craving, and that craving does not dissipate on its own. Daily self-regulation fails. And at night, when the body is supposed to lower that threshold in order to sleep, it resists."

Double stigma

Shi Yu, founder of Beijing's Mentaverse Psychological Service Studio, said that among the adolescents she treats, sleep disorders are almost always a surface expression of conditions that deserve direct psychiatric attention — depression, anxiety, and bipolar disorder. But many of these patients never reach the psychiatric clinic in the first place.

"A lot of children end up at sleep clinics because their parents refuse to take them to the psychiatric department where they actually belong," Shi said. "For many parents, a psychiatric visit is a double stigma — evidence of the child's illness, and evidence of their own failure as educators. They cannot accept it. So the family settles on insomnia as the acceptable diagnosis."

Shi described a second layer of the problem that she said is routinely underestimated: a generation of Chinese adolescents who have grown up chronically short of sleep, never meeting the hours recommended for their age.

"Their bodies and minds are in a prolonged state of fatigue. Insomnia is just one of many symptoms."

A third factor, she said, is how sleep has become entangled with adolescents' search for autonomy. With weekends consumed by tutoring and extracurricular activities, real social life has shrunk, and phones have filled the gap.

"They understand that the daytime belongs to their parents — to school, to tutoring, to adult supervision. But the night is theirs. Staying up late is the one act of self-governance they have left. It is the only territory in which they feel free. And so they expand it, night after night, at the expense of sleep."

The fourth factor is the atmosphere inside the contemporary Chinese household, Shi said. "There is a lot of insecurity. Repetitive drills, crowded schedules, parents who do not trust their children, children who cannot see a clear future. Internal conflict grows. Over years, this produces a subclinical mental state — not quite illness, but nowhere near health. Sleep problems settle into that space and cycle on their own."