What are the recommended sleep medications for a 15-year-old with insomnia?

Recommended Sleep Medications for a 15-Year-Old with Insomnia

For a 15-year-old with insomnia, cognitive behavioral therapy for insomnia (CBT-I) should be the first-line treatment, with melatonin as the only recommended pharmacological option if necessary. 1, 2, 3

First-Line Approach: Non-Pharmacological Interventions

• Cognitive Behavioral Therapy for Insomnia (CBT-I) is the most appropriate initial treatment for adolescents with insomnia, combining different behavioral treatments with cognitive restructuring 1
• Sleep hygiene education should be implemented, including:
  • Maintaining stable bed times and rising times 1, 2
  • Avoiding caffeine, nicotine, and alcohol 2, 4
  • Limiting daytime napping to 30 minutes and avoiding napping after 2 pm 1, 2
  • Using the bedroom only for sleep 1, 2
  • Leaving the bedroom if unable to fall asleep and returning only when sleepy 1, 2
• Relaxation therapy techniques such as progressive muscle relaxation, guided imagery, and diaphragmatic breathing can be beneficial 1

Pharmacological Options for Adolescents

• Melatonin (3mg) is the only recommended pharmacological option for adolescents with insomnia, as it is drug-free, non-habit forming, and has a favorable safety profile 3, 5
• Melatonin should be considered only after non-pharmacological approaches have been tried 2, 3
• Melatonin is particularly effective for circadian rhythm sleep-wake disorders that may underlie insomnia symptoms in adolescents 4

Medications to Avoid in Adolescents

• Benzodiazepines and non-benzodiazepine hypnotics (Z-drugs) should be avoided in adolescents due to significant risks of dependence, abuse, and adverse effects 1, 2, 5
• Antidepressants such as trazodone are not recommended for adolescents with insomnia due to limited efficacy evidence and potential adverse effects 2, 6
• Antihistamines (including OTC sleep aids) should be avoided due to antimuscarinic effects and tolerance development 6, 5
• Prescription sleep medications approved for adults (including doxepin, suvorexant, ramelteon) are not FDA-approved for adolescents 1, 6

Important Considerations for Adolescent Insomnia

• Underlying causes of insomnia should be identified and addressed, including:
  • Psychiatric conditions such as depression or anxiety 1
  • Medical conditions that may disrupt sleep 1
  • Use of medications that may interfere with sleep 1
• Combining behavioral and pharmacological therapy (when appropriate) may provide better outcomes than either approach alone 1
• Any pharmacological intervention should be short-term and regularly reassessed 1, 5

Common Pitfalls to Avoid

• Prescribing adult sleep medications to adolescents without sufficient safety and efficacy data 1, 6
• Relying solely on pharmacological approaches without addressing sleep hygiene and behavioral factors 1, 2
• Failing to identify and treat underlying conditions contributing to insomnia 1
• Using medications with high risk of dependence or adverse effects in this vulnerable age group 1, 2