Insomnia and Circadian Rhythm Disruption Run Through OCD From Childhood to Adulthood
Sleep has long been regarded as collateral damage in obsessive-compulsive disorder (OCD), a secondary symptom to be managed once the core obsessions and compulsions are addressed. A new systematic review in the Journal of Sleep Research challenges that assumption, marshaling evidence that insomnia and circadian rhythm disruption are not merely consequences of OCD but may be woven into the disorder itself from childhood onward, potentially influencing its onset, severity, and treatment resistance.
A Two-Part Sleep Disruption in OCD
The review, led by researchers at several European institutions, analyzed studies spanning pediatrics to adulthood and found a consistent two-part signature: insomnia and circadian desynchronization.
Insomnia rates in OCD populations far exceed those in the general population. Across the studies examined, people with OCD reported significantly higher scores on standardized insomnia scales, with difficulty falling asleep, frequent night awakenings, and non-restorative sleep emerging as the most common complaints. These patterns held true even after controlling for co-occurring depression and anxiety, suggesting that OCD contributes independently to sleep disruption.
The second finding concerns circadian rhythms, the roughly 24-hour biological clock that governs sleep-wake cycles, hormone release, and metabolism. The review found converging evidence that adults with OCD exhibit delayed circadian phases, meaning their internal clocks run later than normal. This manifests as later bedtimes, later wake times, and a mismatch between their biological timing and social schedules, a phenomenon known as social jet lag. In one included study, actigraphy data revealed that people with OCD had significantly more fragmented sleep and lower circadian rhythm stability compared to controls.
From Childhood to Adulthood: A Developmental Thread
Perhaps the most striking contribution of this review is its developmental perspective. The authors systematically compared findings across pediatric and adult studies to trace how sleep disruption evolves over the course of OCD.
In children and adolescents, sleep problems frequently precede or coincide with the first onset of OCD symptoms. Bedtime resistance, delayed sleep onset, and shorter total sleep time are common in pediatric OCD populations. These early disruptions may represent a vulnerability marker, a sign that the circadian system is already dysregulated before obsessions and compulsions fully crystallize.
In adults, the relationship becomes bidirectional and self-reinforcing. Late-night compulsive rituals delay bedtime, which shifts the circadian clock, which worsens sleep quality, which in turn amplifies anxiety and intrusive thoughts the next day. Over time, this cycle may entrench both the OCD symptoms and the sleep disruption, making each more resistant to treatment.
Why This Matters for Treatment
The review’s findings carry direct implications for how OCD is assessed and treated in clinical settings. Currently, standard OCD therapies include cognitive-behavioral therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs), yet they do not systematically address sleep. Yet the evidence suggests that untreated sleep disruption may blunt treatment response.
Circadian-informed interventions such as timed bright light exposure, melatonin scheduling, and chronotherapy could realign the biological clock and potentially improve OCD outcomes. Similarly, CBT for insomnia (CBT-I) has been adapted for psychiatric populations and may offer a path to break the insomnia-OCD feedback loop.
The review also highlights the need for routine sleep screening in OCD assessment. Simple tools such as the Pittsburgh Sleep Quality Index or actigraphy monitoring could identify patients whose sleep disruption warrants targeted intervention, potentially improving both sleep and OCD outcomes simultaneously.
The authors call for prospective longitudinal studies to determine whether early sleep intervention can prevent or delay the onset of OCD in at-risk children, and whether circadian-based treatments can augment existing therapies in treatment-resistant adults.
Source
Systematic review: Van den Broek, A., Junsel, J., van der Heijden, K. B., & van der Meijden, W. P. (2026). A systematic review on insomnia and circadian rhythms desynchronization in obsessive-compulsive disorder: From childhood to adulthood. Journal of Sleep Research, e70322. https://doi.org/10.1111/jsr.70322