Insomnia in youth : impact, intervention and prevention

Abstract

Insomnia is the most common sleep problem affecting up to 36% of the youths. Youth insomnia is tied with an array of negative consequences, including adverse mental and physical health, cognitive impairments and behavioral problems. Therefore, timely intervention and prevention of the development of insomnia in youths are important approaches to generate substantial health gain and reduce the healthcare burden associated with insomnia. Treatment options for insomnia include cognitive behavioral therapy for insomnia (CBT-I), which is currently considered as the first-line treatment for insomnia in adults. Nonetheless, the evidence on the effectiveness of CBT-I in youth remains limited. This thesis aimed to evaluate the impact of insomnia on youth health and daytime functioning, and to evaluate the efficacy of cognitive behavioral approach in treating and preventing youth insomnia. Study 1: This cross-sectional study involved seven secondary schools. Adolescents were invited to complete self-reported questionnaires to assess their sleep, chronotype, daytime sleepiness, mood symptoms and suicidality. The results indicated that both insomnia and everningness were very common among adolescents and were independently associated with daytime impairment and psychopathology. In particular, insomnia was significantly associated with suicidal ideations even after controlling for other comorbid psychiatric disorders. Study 2: This study was a randomized controlled trial that compared the effects of group-based and email-delivered self-help CBT-I to the waitlist control group. A total of 135 youths were enrolled in the study. The findings indicated that both treatment modalities were able to improve insomnia symptoms and other functional outcomes in youths. The relatively comparable treatment effects between the groups suggested that self-help CBT-I is an acceptable and feasible alternative treatment option for young people. However, the high dropout rate in the email group underscored the need of additional support to enhance treatment adherence so as to maximize the effects of this alternative and more accessible treatment approach. Study 3: This study involved a prevention program targeting high-risk adolescents who had a positive family history of insomnia and were currently experiencing sub-threshold insomnia symptoms. A total of 242 adolescents were randomly assigned to either intervention or control group. All participants were assessed at baseline, and 2-week, 6-month and 12-month after the intervention. The incidence rate of insomnia in the intervention group was significantly lower than the control group over the 12-month follow-up period. In addition, the insomnia severity and vulnerability to stress-related insomnia were lessened in the intervention group. They also reported an improvement of daytime sleepiness and total sleep time immediately after the intervention, which maintained throughout the study period. There was a reduction of depressive symptoms in the intervention group at 12-month follow up at a marginal significant level, as compared to the control group. In summary, insomnia is a prevalent and distressing sleep problem associated with numerous negative outcomes in the youth population. Our findings suggested the need for scalable and accessible treatment and prevention programs using CBT-I for youth insomnia. Further research is needed to examine the long-term effects of CBT-I on mental, behavioral and physical health in youths.