Defining, Assessing, and Treating Adolescent Insomnia and Related Sleep Problems

  • Amy R. Wolfson
  • Alison Quinn
  • Anna Vannucci
Part of the Current Clinical Neurology book series (CCNEU)


As parents, teachers, coaches, health care providers, and teenagers themselves know, adolescence is filled with significant physical, cognitive, emotional, and social change. Sleep is a crucial and often ignored aspect of adolescents’ lives as it changes and influences factors in their overall development, as well as in their daily lives. The quality and quantity of adolescents’ sleep significantly influences their ability to think, behave, and feel in school, on the playing field, at work, as well as in a variety of other situations. Over the last two decades, laboratory data have demonstrated that adolescents have an increased need for sleep and experience a phase delay during puberty (1, 2, 3, 4, 5). Despite this need, survey and field studies indicate that as early as sixth grade, adolescents obtain less sleep, report increased morning drowsiness, and have more spontaneous daytime naps than do younger children (6, 7, 8). School schedules, work and extracurricular hours, and other environmental constraints are not beneficial to adolescents’ sleep schedules and requirements (2,4,7,9). In fact, teenagers develop a sleep debt by getting a minimal amount of sleep on school nights and making up for this by sleeping longer on the weekends (7). Sleep debt results in frequent absences or tardiness from school, sleepiness and emotional lability, attention difficulties, and academic struggles (7,10, 11, 12, 13). Other adolescents may develop sleep disorders such as insomnia, phase-delay disorder, sleep apnea, or other sleep problems that also impair ability to function during the day. Recently, the National Institutes of Health recognized adolescents and young adults (12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25 years) as a population at high risk for problem sleepiness based on “evidence that the prevalence of problem sleepiness is high and increasing with particularly serious consequences” (14). This chapter focuses on insomnia and phase-delay disorders in adolescents.


Sleep Disorder Sleep Problem Daytime Sleepiness Poor Sleep Quality Sleep Hygiene 
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  1. 1.
    Carskadon, M.A., C. Acebo, and O.G. Jenni, Regulation of adolescent sleep: implications for behavior. Ann NY Acad Sci, 2004;1021:276–291PubMedCrossRefGoogle Scholar
  2. 2.
    Carskadon, M.A., K. Harvey, P. Duke, T.F. Anders, and W.C. Dement, Pubertal changes in daytime sleepiness. Sleep, 1980;2:453–460.PubMedGoogle Scholar
  3. 3.
    Carskadon, M.A., C. Vieira, and C. Acebo, Association between puberty and delayed phase preference. Sleep, 1993;16(3):258–262.PubMedGoogle Scholar
  4. 4.
    Carskadon, M., A. Wolfson, C. Acebo, O. Tzischinsky, and R. Seifer, Adolescent sleep patterns, circadian timing, and sleepiness at a transition to early school days. Sleep, 1998;21(8):871–881.PubMedGoogle Scholar
  5. 5.
    Carskadon, M.A. and C. Acebo, Regulation of sleepiness in adolescents: update, insights, and speculation. Sleep, 2002;25(6):606–614.PubMedGoogle Scholar
  6. 6.
    Sadeh, A., R. Raviv, and R. Gruber, Sleep patterns and sleep disruptions in school-age children. Dev Psychol, 2000;36(3):291–301.PubMedCrossRefGoogle Scholar
  7. 7.
    Wolfson, A.R. and M.A. Carskadon, Sleep schedules and daytime functioning in adolescents. Child Dev, 1998;69:875–887.PubMedCrossRefGoogle Scholar
  8. 8.
    Wolfson, A.R., C. Acebo, G. Fallone, and M.A. Carskadon, Actigraphically-estimated sleep patterns of middle school students. Sleep (Suppl), 2003;26:313.Google Scholar
  9. 9.
    Wolfson, A. Bridging the gap between research and practice: What will adolescents’ sleep/wake patterns look like in the 21st century? In: Adolescent Sleep Patterns: Biological, Social, and Psychological Influences (M.A. Carskadon, ed.). New York: Cambridge University Press, 2002, pp. 198–219.Google Scholar
  10. 10.
    Carskadon, M.A. Patterns of sleep and sleepiness in adolescents. Pediatrician, 1990;7:5–12.Google Scholar
  11. 11.
    Comstock, G. Televison and the American Child. San Diego, CA: Academic Press, 199Google Scholar
  12. 12.
    Wahlstrom, K. Changing times: findings from the first longitudinal study of later high school start times. NASSP Bull, 2002;86(633):3–21.CrossRefGoogle Scholar
  13. 13.
    Wolfson, A.R. and M.A. Carskadon, Understanding adolescents’ sleep patterns and school performance: a critical appraisal. Sleep Med Rev, 2003;7(6):491–506.PubMedCrossRefGoogle Scholar
  14. 14.
    Working Group Report on Problem Sleepiness. Bethesda, MO: National Institutes of Health, National Center on Sleep Disorders Research and Office Prevention, Education, and Control, 1997Google Scholar
  15. 15.
    Carskadon, M.A. The second decade. In: Sleeping and Waking Disorders: Indications and Techniques (C. Guilleminault, ed.). Menlo Park: Addison-Wesley, 1982, pp. 99–125.Google Scholar
  16. 16.
    Strauch, I. and B. Meier, Sleep need in adolescents: a longitudinal approach. Sleep, 1988;11(4):378–386.PubMedGoogle Scholar
  17. 17.
    Thorleifsdottir, B., J.K. Bjornsson, B. Benediktsdottir, T. Gislason, and H. Kristbjarnarson, Sleep and sleep habits from childhood to young adulthood over a 10-year period. J Psychosom Res, 2002;53:529–537.PubMedCrossRefGoogle Scholar
  18. 18.
    Price, V.A., T.J. Coates, C.E. Thoresen, and O.A. Grinstead, Prevalence and correlates of poor sleep among adolescents. Am J Dis Child, 1978;132:583–586.PubMedGoogle Scholar
  19. 19.
    Carskadon, M.A., J. Orav, and W.C. Dement, Evolution of sleep and daytime sleepiness in adolescents. In: Sleep/Wake Disorders: Natural History, Epidemiology, and Long-Term Evolution (C. Guilleminault and E. Lugaresi, eds.). New York: Raven Press, 1983:201–216.Google Scholar
  20. 20.
    Andrade, M.M., A.A. Silva-Benedito, E.E.S. Domenice, I.J.P. Arnhold, and L.M. Menna-Barreto, Sleep characteristics of adolescents: a longitudinal study. J Adolesc Health, 1993;14:401–406.PubMedGoogle Scholar
  21. 21.
    Ishihara, K., Y. Honma, and S. Miyake, Investigation of the children’s version of the morningness-eveningness questionnaire with primary and junior high school pupils in Japan. Percept Motor Skills, 1990;71:1353–1354.Google Scholar
  22. 22.
    Manber, R., R.E. Pardee, R.R. Bootzin, et al. Changing sleep patterns in adolescence. Sleep Res, 1995;24:106.Google Scholar
  23. 23.
    Gau, S.F. and W.T. Soong, Pediatric sleep disorders: sleep problems of junior high school students in Taipei. Sleep, 1995;18:667–673.PubMedGoogle Scholar
  24. 24.
    Laberge, L., D. Petit, C. Simard, F. Vitaro, R.E. Tremblay, and J. Montplaisir, Development of sleep patterns in early adolescents. J Sleep Res, 2001;10:59–67.PubMedCrossRefGoogle Scholar
  25. 25.
    Stores, G. Practicioner review: assessment and treatment of sleep disorders in children and adolescents. J Child Psychol Psychiatry, 1996;7(8):907–925.CrossRefGoogle Scholar
  26. 26.
    Mindell, J.A. Insomnia in children and adolescents. In: Insomnia Principles and Management (M.P. Szuba, J.D. Kloss, and D.F, Dinges, eds.). New York: Cambridge University Press, 2003:125–135.Google Scholar
  27. 27.
    American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th ed., revised. Washington, DC: American Psychiatric Association, 1994.Google Scholar
  28. 28.
    Sack, R.L., R.J. Hughes, M.L.N. Pires, and A.J. Lewy, The sleep-promoting effects of melatonin. In Insomnia Principles and Management, ed MP Szuba, JD Kloss, and DF Dinges. New York: Cambridge University Press, 2003:96–114.Google Scholar
  29. 29.
    Boivin, D.B. and F.O. James, Insomnia due to circadian rhythm disturbances. In: Insomnia Principles and Management (M.P. Szuba, J.D. Kloss, and D.F. Dinges, eds.). New York: Cambridge University Press, 2003:155–191.Google Scholar
  30. 30.
    Regestein, Q.R. and T.H. Monk, Delayed sleep phase syndrome: a review of its clinical aspects. Am J Psychiatry, 1995;152:602–608.PubMedGoogle Scholar
  31. 31.
    National Sleep Foundation. Treating Insomnia in the Primary Care Setting. Washington, DC: National Sleep Foundation, 2000.Google Scholar
  32. 32.
    Ohayon, M.M. and R.E. Roberts, Comparability of sleep disorders diagnoses using DSM-IV and ICSD classifications with adolescents. Sleep, 2001;24(8):920–925.PubMedGoogle Scholar
  33. 33.
    Morrison, D.N., R. McGee, and W.R. Stanton, Sleep problems in adolescence. J Am Acad Child Adolesc Psychiatry, 1992;31(1):94–99.PubMedCrossRefGoogle Scholar
  34. 34.
    Roberts, R., C. Roberts, and I.G. Chen, Impact of insomnia on future functioning of adolescents. J Psychosom Res, 2002;53:561–569.PubMedCrossRefGoogle Scholar
  35. 35.
    Roberts, R.E., E.S. Lee, M. Hernandez, and A.C. Solari, Symptoms of insomnia among adolescents in the Lower Rio Grand Valley of Texas. Sleep, 2004;27(4):751–759.PubMedGoogle Scholar
  36. 36.
    Roberts, R.E., C.E. Roberts, and I.G. Chen, Ethnocultural differences in sleep complaints among adolescents. J Nerv Ment Dis, 2002;188(4):222–229.CrossRefGoogle Scholar
  37. 37.
    Wolfson, A.R. The Women’s Book of Sleep: A Complete Resource Guide. Oakland, CA: New Harbinger Publications, Inc., 2001.Google Scholar
  38. 38.
    Bailly, D., I. Bailly-Lambin, D. Querleu, R. Beuscart, and C. Collinet, Sleep in adolescents and its disorders. A survey in schools. Encephale, 2004;30(4):352–359.PubMedGoogle Scholar
  39. 39.
    Johnson, E.O., T. Roth, and N. Breslau, Epidemiology of DSM-IV insomnia among a community based cohort of adolescents. Sleep (Suppl), 2004;27:A112.Google Scholar
  40. 40.
    Yang, L., C. Zuo, and L.F. Eaton, Research note: sleep problems of normal Chinese adolescents. J Child Psychol Psychiatry, 1987;28:162–172.CrossRefGoogle Scholar
  41. 41.
    Camhi, S.L., W.J. Morgan, N. Pernisco, and S.F. Quan, Factors affecting sleep disturbances in children and adolescents. Sleep Med, 2000;1:117–123.PubMedCrossRefGoogle Scholar
  42. 42.
    Driver, H.S. and F.C. Baker, Menstrual factors in sleep. Sleep Med Rev, 1998;2(4):213–229.PubMedCrossRefGoogle Scholar
  43. 43.
    Baker, F.C. and H.S. Driver, Self reported sleep across the menstrual cycle in young, healthy women. J Psychosom Res, 2004;56:239–243.PubMedCrossRefGoogle Scholar
  44. 44.
    Dickerson, L.M., P.J. Mazyck, and M.H. Hunter, Premenstrual syndrome. Am Fam Physician, 2003;67(8):1–15.Google Scholar
  45. 45.
    Derman, O., N.O. Kanbur, N.E. Tokur, and T. Kutluk, Premenstrual syndrome and associated symptoms in adolescent girls. Eur J Obstet Gynecol Reprod Biol, 2004;116(2):201–206.PubMedCrossRefGoogle Scholar
  46. 46.
    Krystal, A.D. Insomnia in women. Chron Insomnia, 2003;5(3):41–50.Google Scholar
  47. 47.
    Spielman, A.J. and P.B. Glovinsky, The diagnostic interview and differential diagnosis for complaints of insomnia. In: Understanding Sleep: The Evaluation and Treatment of Sleep Disorders (M.R. Pressman and W.C. Orr, eds.). Washington, DC: American Psychological Association, 1997, pp. 125–160.CrossRefGoogle Scholar
  48. 48.
    Dahl, R.E., N.D. Ryan, M.K. Matty, B. et al. Sleep onset abnormalities in depressed adolescents. Biol Psychiatry, 1996;39(6):400–410.PubMedCrossRefGoogle Scholar
  49. 49.
    Choquet, M., V. Kovess, and N. Poutignat, Suicidal thoughts among adolescents: an intercultural approach. Adolescence, 1993;28:649–659.PubMedGoogle Scholar
  50. 50.
    Patten, C.A., W.S. Choi, J.C. Gillin, and J.P. Pierce, Depressive symptoms and cigarette smoking predict development and persistence of sleep problems in U.S. adolescents. Pediatrics, 2000;106(2):1–17.CrossRefGoogle Scholar
  51. 51.
    Van den Bulck, J. Text messaging as a cause of sleep interruption in adolescents, evidence from a cross sectional study. J Sleep Res, 2003;12(3):263.PubMedCrossRefGoogle Scholar
  52. 52.
    Van den Bulck, J. Television viewing, computer game playing, and internet use and self-reported time out of bed in secondary school children. Sleep, 2004;27(1):101–104.PubMedGoogle Scholar
  53. 53.
    Johnson, J.G., P. Cohen, S. Kasen, M.B. First, and J.S. Brook, Association between television viewing and sleep problems during adolescence and early adulthood. Arch Pediatr Adolesc Med, 2004;158(6):652–568.CrossRefGoogle Scholar
  54. 54.
    Carskadon, M.A. and C. Acebo, A self-administered rating scale for pubertal development. J Adolesc Health, 1993;14:190–195.PubMedCrossRefGoogle Scholar
  55. 55.
    Morin, C.M. Cognitive-behavioral approaches to the treatment of insomnia. J Clin Psychiatry, 2004;65(16):33–40.PubMedGoogle Scholar
  56. 56.
    Jacobs, G.D., E.F. Pace-Schott, R. Stickgold, and M.W. Otto, Cognitive behavior therapy and pharmacotherapy for insomnia: a randomized controlled trial and direct comparison. Arch Intern Med, 2004;164(17):1888–1896.PubMedCrossRefGoogle Scholar
  57. 57.
    Bastien, C.H., A. Vallieeres, and C.M. Morin, Precipitating factors of insomnia. Behav Sleep Med, 2004;2(1):50–62.PubMedCrossRefGoogle Scholar
  58. 58.
    Weil, G. and M.R. Goldfried, Treatment of insomnia in an eleven-year-old child through self-relaxation. Behav Ther, 1973;4:282–294.CrossRefGoogle Scholar
  59. 59.
    Anderson, D.R. Treatment of insomnia in a 13-year-old boy by relaxation training and reduction of parental attention. J Behav Ther Exp Psychiatry, 1979;10:263–265.CrossRefGoogle Scholar
  60. 60.
    Barowsky, E.I., J. Moskowitz, and J.B. Zweig, Biofeedback for disorders of initiating and main-taining sleep. Ann NY Acad Sci, 1990;602:97–103.PubMedCrossRefGoogle Scholar
  61. 61.
    LeBourgeois, M.K., F. Giannotti, F. Cortesi, A.R. Wolfson, and J. Harsh, The relationship between reported sleep quality and sleep hygiene in Italian and American adolescents. Pediatrics, 2005;115:257–265.PubMedCrossRefGoogle Scholar
  62. 62.
    Spielman, A.J., P. Saskin, and M.J. Thorpy, Treatment of chronic insomnia by restriction of time in bed. Sleep, 1987;10(1):45–56.PubMedGoogle Scholar
  63. 63.
    Kallepalli, B.R., V.S. Bhatara, B.S. Fogas, R.C. Tervo, and L.K. Misra, Trazadone is only slightly faster than fluoxetine in relieving insomnia in adolescents with depressive disorders. J Child Adolesc Psychopharmacol, 1997;7:97–107.PubMedCrossRefGoogle Scholar
  64. 64.
    Labyak, S. Sleep and circadian schedule disorders. Nurs Clin North Am, 2002;37:599–610.PubMedCrossRefGoogle Scholar
  65. 65.
    Garcia, J., G. Rosen, and M. Mahowald, Circadian rhythms and circadian rhythm disorders in children and adolescents. Semin Pediatr Neurol, 2001;8:229–240.PubMedCrossRefGoogle Scholar
  66. 66.
    Wyatt, J.K. Delayed sleep phase syndrome: pathophysiology and treatment options. Sleep, 2004;27(6):1195–1203.PubMedGoogle Scholar
  67. 67.
    Okawa, M., U. Michiyama, S. Ozaki, K. Shibui, and H. Ichikawa, Circadian rhythm disorders in adolescents: Clinical trials of combined treatments based on chronobiology. Psychiatry Clin Neurosci, 1998;52:483–490.PubMedCrossRefGoogle Scholar
  68. 68.
    The International Classification of Sleep Disorders-Revised: Diagnostic and Coding Manual. Rochester, MN: American Sleep Disorders Association, 1997.Google Scholar
  69. 69.
    Wolfson, A.R., M.A. Carskadon, C. Acebo, R. Seifer, G. Fallone, S.E. Labyak, and J.L. Martin, Evidence for the validity of a sleep habits survey for adolescents. Sleep, 2003;26(2):213–216.PubMedGoogle Scholar
  70. 70.
    Sadeh, A., P.J. Hauri, D.F. Kripke, and P. Lavie, The role of actigraphy in the evaluation of sleep disorders. Sleep, 1995;18:288–302.PubMedGoogle Scholar
  71. 71.
    Acebo, C., A. Sadeh, R. Seifer, et al., Estimating sleep patterns with activity monitoring in children and adolescents: How many nights are necessary for reliable measures? Sleep, 1999;22(1):95–103.PubMedGoogle Scholar
  72. 72.
    Halbower, A.C. and C.L. Marcus, Sleep disorders in children. Curr Opin Pulm Med, 2003;9(6):471–476.PubMedCrossRefGoogle Scholar

Copyright information

© Humna Press Inc., Totowa, NJ 2006

Authors and Affiliations

  • Amy R. Wolfson
    • 1
  • Alison Quinn
    • 1
  • Anna Vannucci
    • 1
  1. 1.Department of PsychologyCollege of the Holy CrossWorcester

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