Treatment Options for Insomnia in Teenagers
Cognitive Behavioral Therapy for Insomnia (CBT-I) should be the first-line treatment for teenagers experiencing difficulty staying asleep, as it provides sustained benefits without risks of tolerance or adverse effects that can impact morbidity, mortality, and quality of life. 1
Initial Assessment
When evaluating a teenager with insomnia:
Screen for medical contributors to sleep disturbance:
- Gastrointestinal disorders
- Neurological conditions
- Pain
- Anxiety or depression
- Medication side effects
Assess for other sleep disorders:
- Sleep-disordered breathing
- Restless legs syndrome
- Periodic limb movements
Evaluate social media and screen use, as these significantly impact teenage sleep patterns 2
- Presence of electronic devices in bedroom
- Nighttime screen use
- Social media engagement after bedtime
First-Line Treatment: CBT-I
CBT-I is recommended by the American Academy of Sleep Medicine and American College of Physicians as the primary intervention for insomnia due to its:
- Equivalent efficacy to sleep medications 3
- No side effects
- Fewer episodes of relapse
- Continued sleep improvement after treatment ends
The five key components of CBT-I include:
- Sleep consolidation - Restricting time in bed to match actual sleep time
- Stimulus control - Associating bed with sleep only
- Cognitive restructuring - Addressing unhelpful beliefs about sleep
- Sleep hygiene - Establishing healthy sleep habits
- Relaxation techniques - Methods to reduce physiological arousal
For teenagers specifically, implementing structured bedtime routines with visual schedules may be particularly effective 4.
Sleep Hygiene Recommendations
Sleep hygiene should be implemented alongside CBT-I:
- Maintain consistent sleep/wake schedule, even on weekends 5
- Create a regular bedtime routine
- Remove electronic devices from the bedroom 2
- Limit screen time at least 1 hour before bed
- Avoid caffeine and heavy meals in the evening
- Ensure bedroom is dark, quiet, and comfortable
Pharmacological Options
If CBT-I is unsuccessful after 4-6 weeks or if symptoms are severe, medication may be considered as a short-term adjunct:
For sleep onset difficulties:
For sleep maintenance issues:
Important cautions with medications:
- Use lowest effective dose for shortest period necessary
- Take 30 minutes before desired sleep time on an empty stomach
- Avoid long-term use when possible
- Monitor for side effects including daytime drowsiness, dizziness, and behavioral changes
- Be aware that no medications are FDA-approved specifically for pediatric insomnia 4
Follow-Up and Monitoring
- Schedule follow-up within 2-4 weeks after initiating any treatment 1
- Expect to see benefits within 4 weeks 4
- Assess for:
- Improvement in sleep parameters
- Daytime functioning
- Side effects of medications
- Need for referral to sleep specialist
When to Refer to a Sleep Specialist
Consider referral if:
- Insomnia is not improving with initial interventions
- Symptoms are particularly severe
- Daytime impairment is significant
- Multiple medications are being used for sleep
- Suspected underlying sleep disorders 4, 8
Special Considerations for Teenagers
- Social media use significantly impacts teenage sleep patterns, with sleep-deprived teens more likely to have electronic devices in their bedrooms 2
- Sleep education should begin early (around age 11) and involve parents 2
- Parent-controlled bedtimes have been shown to increase teenage sleep time 2
- Sleep deprivation in teens is associated with reduced energy, increased irritability, and feelings of sadness 2
By implementing CBT-I as the cornerstone of treatment and addressing social media use, most teenagers with insomnia can achieve significant improvements in sleep quality and duration, leading to better daytime functioning and overall quality of life.