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Insomnia Chronic and Common Among US Adolescents
Caroline Cassels

March 28, 2008 ? A new study suggests that insomnia among adolescents in the United States is chronic and common, with a prevalence that is as high as or higher than that of other psychiatric conditions, including major depression, generalized anxiety, conduct disorders, and substance abuse.

In the first prospective, community-based study to examine chronic insomnia in youth aged 11 to 17 years, researchers at the University of Texas Health Science Center, in Houston, found that more than 25% of those surveyed had 1 or more symptoms of insomnia, and 5% of subjects met the diagnostic criteria for insomnia.

Further, almost 46% of those who reported 1 or more symptoms of insomnia at study outset continued to have symptoms a year later, and 24% met diagnostic criteria for chronic insomnia.

The investigators also found the impact of insomnia on adolescents compared with their non?sleep-deprived counterparts was profound.

"Kids' chronic insomnia was much more likely to have all types of negative sequelae and had more physical and psychological health problems, difficulties with interpersonal relationships, and more problems with daily activities," principal investigator Robert E. Roberts, PhD, told Medscape Neurology & Neurosurgery.

The study is published in the March issue of the Journal of Adolescent Health.

Cause Not Consequence

Data were collected from 4175 youths at baseline and 3134 subjects a year later. Insomnia was assessed by youth-reported Diagnostic and Statistical Manual of Mental Disorders, 4th ed (DSM-IV) symptom criteria, and study outcome measures included somatic health, mental health, substance use, interpersonal problems, and daily activities.

Unadjusted analyses showed that youth with chronic insomnia had a 2- to 5-fold increased risk for poor outcomes across multiple indicators of interpersonal, somatic, and psychological functioning. However, even after adjustment, these associations remained.

When investigators examined individual symptoms of insomnia, they found that chronic nonrestorative sleep posed the greatest risk for poor outcomes at 1-year follow-up. This was followed by chronic difficulty initiating sleep.

According to Dr. Roberts, the study findings suggest chronic insomnia may be the underlying cause, rather than the consequence, of health, psychological, or behavioral problems in adolescents.

Chronically Sleep Deprived

Previous recent research by his group has shown that chronic sleep deprivation is common among youth, with 25% of individuals reporting they get 6 or fewer hours of sleep per night. In contrast, he said, research from sleep studies indicates that adolescents, just like children, need 9 or more hours of sleep per night.

One of the difficulties, he said, is that during adolescence children's circadian rhythms change, causing them to stay up later and sleep later. However, he said, while the majority of youth go to bed later once they hit adolescence, the demands of daily life do not allow them to sleep later.

"The societal norms for how a day is structured are not conducive to the well-being of adolescents as far as sleep is concerned. We could do young people a great favor by starting school at 10 am or midday once they get to high school," he said.

It is important, said Dr. Roberts, that primary care physicians and parents should also screen adolescents for potential sleep disturbances and encourage them to practice proper sleep hygiene. In cases of chronic insomnia, cognitive behavioral therapy, which has been shown to be effective in adults, may also help young patients.

Dr. Roberts said his team will continue to follow the study cohort to determine whether insomnia and its adverse consequences persist into early adulthood.
 
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