Treatment of Insomnia in Adolescents

Assessment and Screening

All adolescents with sleep difficulties should be screened for insomnia using targeted questions about sleep onset, sleep maintenance, sleep quality, and daytime functioning 2
Evaluation should include assessment of potential medical contributors to insomnia, including gastrointestinal disorders, epilepsy, pain, nutritional issues, and other sleep disorders such as sleep-disordered breathing 1, 2
Psychiatric conditions such as anxiety, depression, and bipolar disorder should be considered as they may contribute to insomnia 2
A careful review of current medications should be performed as many can contribute to insomnia 1

Cognitive Behavioral Therapy for Insomnia (CBT-I) is the recommended first-line treatment for adolescents with insomnia 3, 4
Educational approaches should include promotion of good sleep habits, assessment of habits that may interfere with sleep, implementation of consistent bedtime routines, and visual supports and schedules when appropriate 2
Sleep hygiene education is an important component of CBT-I 4

Pharmacologic therapy may be indicated in specific situations when behavioral approaches are not feasible 1
Pharmacologic therapy may be indicated when the intensity of symptoms has reached a crisis point 2
Short-intermediate acting benzodiazepine receptor agonists may be considered in specific cases, but should be used with caution in adolescents 4, 5
Any pharmacologic treatment should be supplemented with behavioral and cognitive therapies whenever possible 5

Sleep diary data should be collected prior to and during the course of active treatment 4
Clinical reassessment should occur every few weeks until the insomnia appears stable or resolved 4
When a single treatment has been ineffective, other behavioral therapies, pharmacological therapies, combined therapies, or reevaluation for occult comorbid disorders should be considered 4

Sleep hygiene alone is insufficient for treating chronic insomnia and should be used in combination with other therapies 4
The choice of specific pharmacological agent, when needed, should be directed by symptom pattern, treatment goals, past treatment responses, patient preference, comorbid conditions, and potential side effects 4