From the Guidelines
For a 16-year-old female with insomnia that hasn't responded to sleep hygiene measures, I strongly recommend starting with cognitive behavioral therapy for insomnia (CBT-I) as the first-line treatment, as it has the most evidence available in the literature and is the only approach to receive a Strong recommendation 1.
Key Components of CBT-I
- Stimulus control
- Sleep restriction
- Relaxation techniques
- Cognitive restructuring to address unhelpful thoughts about sleep CBT-I is a multicomponent intervention that has been shown to be effective in improving sleep and alleviating distress or dysfunction caused by insomnia 1.
Considerations for Treatment
- Availability and accessibility of CBT-I providers
- Patient preferences and values
- Comorbid medical and psychiatric conditions that may impact treatment
- Potential undesirable effects of treatment, such as sleepiness and fatigue It's essential to discuss different CBT-I delivery modalities with the patient, including in-person individual or group treatment, internet-based programs, and align the delivery modality based on availability, affordability, treatment format, duration, and the patient's preferences and values 1.
Additional Recommendations
- Rule out underlying conditions like depression, anxiety, ADHD, or sleep disorders that might be causing the insomnia
- Screen for substance use, including caffeine, alcohol, and recreational drugs
- Evaluate for potential medication side effects if the patient is taking any Regular follow-up is crucial to monitor response and adjust treatment, as the adolescent brain is still developing, making non-pharmacological approaches preferable when possible, but targeted medication can be appropriate when insomnia significantly impacts daily functioning, mood, and academic performance.
From the FDA Drug Label
PRINCIPAL DISPLAY PANEL - Vitamin Bottle Label Safrel Melatonin 3mg Tablets: Helps establish normal sleep patterns 100%Drug-free and non-habit forming melatonin is a nighttime sleep aid for occassional sleeplessness.
The FDA drug label does not answer the question.
From the Research
Treatment Options for Insomnia
For a 16-year-old female with insomnia that is refractory to sleep hygiene measures, the following treatment options can be considered:
- Cognitive Behavioral Therapy for Insomnia (CBT-I) as the first line treatment 2, 3, 4
- Sleep restriction therapy, which has been found to be an effective component of CBT-I 5
- Stimulus control therapy, which can improve self-reported and objective total sleep time 5
- Relaxation training and cognitive therapy, which are also components of CBT-I 2, 3, 4
Considerations for Adolescents
When treating insomnia in adolescents, it is recommended to:
- Integrate parents into the treatment, especially for school-aged children with insomnia 6
- Consider the specific characteristics and models of child and adolescent insomnia, as more research is needed in this area 6
Delivery of CBT-I
CBT-I can be delivered in various ways, including:
Efficacy of CBT-I
CBT-I has been found to be an effective treatment for insomnia, with significant improvements in: