53, 54 Less rigorous studies also indicate benefit of CBTi for sleep parameters in adolescents. 52 A 1-year follow-up study showed persistent benefit or improvement in sleep efficiency and quality-of-life scores in both treatment groups. Similarly, subjective reports of insomnia and symptoms of sleep deprivation improved in both groups. Those receiving CBTi showed improvements in sleep onset latency, sleep efficiency, total sleep time, and waking after sleep onset in both CBTi groups compared with the control group. The study tracked both subjective report of sleep symptoms as well as objective sleep measures using actigraphy. A randomized controlled trial with Internet-based individual therapy and group therapy used 6 weekly sessions in which participants received counseling on sleep hygiene, sleep restriction, stimulus control, psychoeducation, and relaxation techniques. Data for CBTi in adolescents are not as robust, but studies do indicate benefit for this population. 50, 51 Table 3 includes the common components of CBTi. 48, 49 CBTi is shown to be more effective than conventional sleep aids in the long-term for adults. 33Ĭognitive behavioral therapy for insomnia (CBTi) is an effective treatment of PI in adults that is based on more than a decade of research into both short-term and long-term improvement. Studies show a prevalence as high as 14% in the adolescent population. However, when she or he sleeps at the wrong times on the basis of social demands, DSPD is common. An adolescent with DSPD has a normal quantity and quality of sleep when allowed to sleep at will. Delayed sleep-wake phase disorder (DSPD) is diagnosed when this mismatch causes functional impairment (see Table 1 for diagnostic criteria). 28– 32 A delay in circadian physiology predisposes to a mismatch between an adolescent’s preferred sleep time and social demands, such as school. 27 Second, melatonin secretion shifts to a later time, causing a delay in the circadian rhythm. This translates into a longer time to fall asleep and easier ability to stay awake at night when comparing postpubertal and prepubertal teenagers. First, the homeostatic drive to sleep, which increases with increased wake time, accumulates slower during adolescence. This shift is mediated by 2 distinct processes. Pubertal onset corresponds with a biologically mediated shift in sleep timing with a predisposition to a later sleep-wake cycle.
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