Objective To observe the efficacy of auricular pressure, auricular acupressure, and shamuricular acupressure in treating anxiety-related insomnia in college students. Methods A total of 150 college students with anxiety-related insomnia from a higher vocational institution in Dali State were recruited. The participants were divided into three groups using a randomized computerized method: the auricular pressure group(Wang bu liu xing seeds) with 50 cases, the auricular acupressure group with 50 cases, and the sham auricular acupressure group with 50 cases. The Pittsburgh Sleep Quality Index(PSQI) and Hamilton Anxiety Scale(HAMA) scores were compared among the three groups after treatment. Results After treatment, the PSQI and HAMA scores of all three groups decreased(P<0.05), with the auricular acupressure group [4.5(2.75, 7.0 ) showing significantly better PSQI scores than the auricular pressure group [5.5(3, 8.25)] and the sham auricular [8 ± 3.356] (P<0.05). The HAMA scores showed that the auricular acupressure [5.5(2.0, 9.25)] was significantly better than the sham auricular group (P<0.05), but there was no statistically significant difference compared to the auricular pressure group. The treatment effective rate of the auricular acupressure group (8%) was significantly higher than that of the auricular pressure group (70%) and the sham auricular group (38%) (P<0.05). The analysis of risk factors indicated that being an only child, single-parent family, smoking and drinking, and nutritional status were significant risk factors anxiety-related insomnia(P<0.05). Conclusion All three interventions can improve sleep and anxiety, but auricular acuressure is the most effective, and specific lifestyle and family structure factors significantly affect the occurrence of the disease.