Adolescent sleep : comorbid problems and behavioral treatment of insomnia

Background: Sleep problems, especially insomnia, are common in adolescents and are often associated with other problems, such as anxiety, depression and chronic pain. Even though there are effective psychological treatments for adults with insomnia, the scientific basis for adolescents is weak. Cognitive behavioral therapy for insomnia (CBT-I) could be a feasible and efficient way to treat insomnia in adolescents and could also affect comorbid conditions.

Aims and methods: The main aim of this thesis was to evaluate the effect of CBT-I in adolescents, the feasibility and preliminary efficacy of the intervention and to investigate the relationship between disturbed sleep and co-morbid conditions. The effect of cognitive and behavioral interventions was evaluated through a systematic review and meta-analysis of existing treatment studies. Feasibility and preliminary efficacy of CBT-I in a Swedish context were evaluated in two different formats and two clinical environments; as a face-to-face treatment in specialist care (child- and adolescent psychiatry and a pain clinic) and as an internet-delivered treatment within a digital special unit. Specifically, feasibility (treatment retention and patient satisfaction), change in insomnia symptoms, sleep and comorbid symptoms following treatment were evaluated. The relationship between disturbed sleep and other problems was investigated through a cross-sectional study in which young people were asked to answer questions about sleep, mood and daytime function.

Results: Results showed that CBT-I was an effective treatment and that it was feasible in the context of Swedish healthcare, both as a face-to-face and internet-delivered intervention. The vast majority of participants completed the treatments and reported overall satisfaction. Participants in both treatment formats reported decreased insomnia symptoms and improved sleep, as well as decreased comorbid symptoms. Regarding the relationship between sleep and other problems and functions, the results showed that young people with disordered sleep to a greater extent reported impaired executive functioning, internal emotional distress and sleep- and school related worry and dysfunction.

Conclusion: CBT-I for adolescents is a feasible treatment, both in regular care and as internet-delivered treatment program in Swedish healthcare and shows good preliminary effects for insomnia symptoms, sleep and co-morbid conditions. Disturbed sleep is associated with lower executive functioning, internal emotional distress and worry and dysfunction related to school and sleep. These results are promising, but controlled studies with rigorous study designs are needed to confirm the findings.

List of scientific papers

I. Åslund, L., Arnberg, F., Kanstrup, M., Lekander, M. (2018). Cognitive and Behavioral Interventions to Improve Sleep in School-Age Children and Adolescents: A Systematic Review and Meta-Analysis. Journal of Clinical Sleep Medicine. 14(11), 1937-1947.
https://doi.org/10.5664/jcsm.7498

II. Åslund, L., Lekander, M., Wicksell, R., Henje, E., Jernelöv,S. (2020). Cognitive-behavioral therapy for insomnia in adolescents with comorbid psychiatric disorders: a clinical pilot study. Clinical Child Psychology and Psychiatry. 25(4), 958-971.
https://doi.org/10.1177/1359104520929376

III. Åslund, L., Järnelöv, S., Henje, E., Wicksell, R., Vigerland, S., Serlachius, E., Lekander, M. Internet-delivered cognitive-behavioral therapy for adolescent insomnia: feasibility and preliminary efficacy. [Manuscript]

IV. Åslund, L., Andreasson, A., Lekander, M., Henje, E., Dennhag, I. Disturbed sleep and patterns of psychiatric symptoms and function in a school-based sample of adolescents. [Manuscript]