Insomnia is common and chronic among adolescents and confers a burden comparable to that associated with other psychiatric disorders, according to the results of a prospective study by Robert E. Roberts, PhD, a Professor of Behavioral Sciences at the University of Texas School of Public Health at Houston, and colleagues. The research team reported their findings in the March Journal of Adolescent Health.

Dr. Roberts and his coresearchers assessed insomnia status as well as somatic, psychological, and interpersonal functioning of 4,175 youths ages 11 to 17. Nearly 27% reported at least one symptom of insomnia, and about 5% met diagnostic criteria for insomnia. At one-year follow-up, about 46% of those who reported one or more symptoms at baseline remained cases, and 33.5% reported daytime fatigue or sleepiness in addition to the symptoms. DSM-IV criteria for chronic insomnia were met by 24% of participants at follow-up.

The researchers calculated the impact of chronic sleep problems on somatic, interpersonal, and psychological problems and daily activities. After controlling for prior functioning, age, gender, ethnicity, and family income, the investigators found that the odds of poor functioning remained significantly increased across multiple indicators, ranging from 1.63 for perceived health to 5.30 for perceived mental health. Specifically, Dr. Roberts and colleagues reported that chronic nonrestorative sleep predicted the highest number of negative outcomes, followed by chronic difficulty initiating sleep and chronic early morning awakening.

“The key contribution of the results reported here is that many of the findings about factors associated with the occurrence of insomnia … may be the consequences rather than the causes of insomnia,” said the researchers. They noted that another recent study found that the risk of incident insomnia was predicted by many of the same factors investigated in the present study. “There appear to be strong reciprocal relations over time between insomnia and psychosocial risk factors, such that these factors increase future risk of insomnia and, in turn, insomnia—particularly chronic insomnia—predicts negative psychosocial outcomes,” they added.

Parent reports at baseline and follow-up indicated that 50% and 44% of the adolescents had two or more medical care contacts in the previous year for somatic health problems. Although use of school or outpatient mental health services was low overall (6% and 12%), participants with chronic sleep problems received more mental health care in those settings.

The researchers suggested that screenings and intervention may present a potential opportunity for reducing the impact on functioning and the burden on the health care system; however, as it is difficult to differentiate between insomnia and depression, ADHD, or substance abuse, for example, they stated the need for a validated algorithm for clinicians to use for diagnosing and treating sleep disorders in adolescents. “Greater attention to symptoms of insomnia may contribute to more accurate differential diagnosis, and thus, more effective treatment. However, much of the remedy for adolescent sleep deprivation lies in the broader societal context of adolescent lives, particularly as related to school, leisure, and work,” concluded the authors.

—Jessica Dziedzic

Suggested Reading
Roberts RE, Roberts CR, Duong HT. Chronic insomnia and its negative consequences for health and functioning of adolescents: a 12-month prospective study. J Adolesc Health. 2008;42(3):294-302.

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