![]() Finally, we highlight some of the gaps in the literature and suggest future directions for research to enable greater recognition of insomnia disorder and its impact in adolescents.Ĭomprehensive literature searches were conducted on epidemiological, clinical, and experimental studies published in the English language on insomnia disorder in adolescents using the electronic databases, PubMed, Google Scholar, Web of Science, PsycINFO. Topics covered in this review include the challenge in diagnosing insomnia in adolescence, risk factors for insomnia that emerge during adolescence including sex-specific differences in risk profiles, associations between insomnia and psychiatric disorders, physiological functioning, and cognition, and available treatment options. ![]() In cases where we have deviated from this age range, we have specified ages of included participants. For the purposes of this review, therefore, we have focused on research about insomnia in the second decade. Chronotype has been suggested as a physiological marker of the end of adolescence, with peak eveningness being reached at around the age of 20 years ( 8). The World Health Organization (WHO) defines adolescents as those people between 10 and 19 years ( ). ![]() Adolescence is different from puberty, which describes the period during which the reproductive system matures, ending with the cessation of bone growth ( 7). Adolescence is the transitional period between childhood and adulthood, and is considered part physiological, part psychological, and part social construct ( 7). This review aims to offer a picture of insomnia disorder in the context of social, behavioral and bioregulation changes normally occurring in adolescence. Insomnia is frequently comorbid with other mental conditions, with half of adolescents with insomnia also reporting comorbid psychiatric disorders ( 4). Further, insomnia tends to be chronic with 88% of adolescents with a history of insomnia reporting current insomnia ( 4). Insomnia in adolescence is common, particularly in older adolescents and in girls ( 4, 5), with a prevalence that is comparable of that of other major psychiatric disorders (e.g., depressive disorders) ( 6). Insomnia disorder is the most severe clinical manifestation of recurrent and chronic perceived sleep dissatisfaction (difficultly falling asleep and staying asleep despite having an adequate opportunity to sleep) occurring several times per week, resulting in significant distress and daytime consequences (e.g., sleepiness difficulties with attention, concentration and memory mood lability). Over and above these typical changes in sleep is the emergence of insomnia disorder in a portion of adolescents, which has received less attention in the literature. Typical developmental changes and challenges to sleep faced by adolescents have been the topic of several recent reviews ( 1– 3). Insufficient sleep and sleepiness in adolescents is a serious public health issue ( 1). Current evidence indicates that insomnia in adolescence is an independent entity that warrants attention as a public health concern in its own right. ![]() Cognitive behavioral treatments have proven efficacy for adolescent insomnia and online methods seem to offer promising cost-effective options. ![]() Insomnia disorder is associated with depression and other psychiatric disorders, and is an independent risk factor for suicidality and substance use in adolescents, raising the possibility that treating insomnia symptoms in early adolescence may reduce risk for these adverse outcomes. Insomnia disorder goes beyond an individual complaint of poor sleep or a sleep state misperception, and there is emerging evidence supporting the association of insomnia symptoms in adolescents with alterations in several bio-systems including functional cortical alterations and systemic inflammation. However, insomnia disorder in adolescence is poorly characterized, under-recognized, under-diagnosed, and under-treated, and the reason for the female preponderance for insomnia that emerges after puberty is largely unknown. Insomnia disorder is very common in adolescents it is particularly manifest in older adolescents and girls, with a prevalence comparable to that of other major psychiatric disorders (e.g., depressive disorders). ![]()
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