Teen Insomnia Medication and Treatment
Treatment of Insomnia in Older Children and Adolescents
Effective treatment of teenage insomnia in older children and adolescents begins with accurate identification of all pertinent contributory influences. It is not unusual to identify multiple concurrent predisposing factors, each deserving of an insomnia treatment or medication. For example, a teenager who presents with an isolated complaint of insomnia may be found to have simultaneous bedtime resistance, poor sleep hygiene, and delayed sleep phase. Treatment of bedtime resistance for the older child differs from the extinction techniques typically used for younger children. Treatment instead relies on enforcement of a bedtime appropriate for the child's age and individual sleep needs.
Appropriate limits must be set for disruptive behaviors such as stalling or emotional agitation. As in younger children, consistent limit-setting is crucial for effective treatment of bedtime resistance. Any suboptimal aspects of general sleep hygiene should also be addressed to the extent possible. Maintenance of a regular sleep schedule and avoidance of daytime napping should be encouraged. Potentially disruptive influences such as watching television or listening to music while in bed should be avoided. Use of caffeinated beverages, vigorous exercise, and excessively stimulating activities should be avoided during the evening time hours.
Although a recommendation to maintain a fixed bedtime and waking time 7 days weekly is usually received less than enthusiastically by a teen, it is often possible to improve compliance by working with patient and parents to implement age-appropriate incentives or by developing a "contract" that offers increasing flexibility of bedtime schedule on non-school nights after specified milestones are met. Elements of psychophysiological insomnia may be addressed in the same fashion used for adult patients. Stimulus control techniques, sleep restriction, and biofeedback have demonstrated some efficacy in adults but have not been rigorously studied in children.