Understanding Adolescent and Young Adult Insomnia
This informational page aims to provide valuable insights into insomnia, its symptoms, treatments, and available resources.
What is Insomnia?
According to the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition), insomnia disorder is characterized by dissatisfaction with sleep quantity or quality. Insomnia occurs at least three nights per week and is present for at least three months despite adequate opportunity for sleep. The sleep disturbance is not better explained by and does not occur exclusively during the course of another sleep-wake disorder. It should not be attributable to the physiological effects of a substance or a coexisting mental disorder or medical condition. Additionally, the sleep disturbance must cause clinically significant distress or impairment in social, occupational, educational, academic, behavioral, or other important areas of functioning.
Insomnia testing and diagnosis
Diagnosing insomnia typically involves a comprehensive evaluation that includes several steps:
Clinical interview:
A detailed medical and sleep history is obtained, including questions about your sleep patterns, bedtime routines, waking times, and any sleep disturbances. Information about your lifestyle habits, stressors, and any underlying medical or psychiatric conditions is also gathered.
Sleep diary:
You may be asked to keep a sleep diary for one to two weeks, recording sleep times, wake times, number and duration of awakenings, and any other relevant details about your sleep patterns.
Sleep questionnaires:
Standardized questionnaires, such as the Insomnia Severity Index (ISI) or the Epworth Sleepiness Scale (ESS), may be used to assess the severity of insomnia and its impact on your daily functioning.
Sleep Study:
In some cases, especially when another sleep disorder is suspected, an overnight sleep study (polysomnography) may be conducted. This test records brain waves, blood oxygen levels, heart rate, breathing, and eye and leg movements during sleep.
Physical examination:
A physical exam may be conducted to identify any underlying medical conditions that could be contributing to sleep disturbances.
Assessment of mental health:
An evaluation of mental health conditions, such as depression or anxiety, which can contribute to or exacerbate insomnia is also typically part of an insomnia evaluation.
Symptoms of Insomnia
Difficulty initiating sleep.
Difficulty maintaining sleep, characterized by frequent awakenings or problems returning to sleep after awakenings.
Early-morning awakening with an inability to return to sleep.
These three symptoms define an insomnia diagnosis, regardless of type. How those symptoms manifest in your daily life is often unique.
How does Insomnia effect daily functioning?
Fatigue or low energy.
Mood disturbances such as irritability, anxiety, or depression.
Cognitive impairments, including difficulty concentrating, memory problems, and impaired performance at work or school, “brain fog”.
Impaired social, occupational, or academic functioning.
Increased errors or accidents.
Concerns or preoccupation with sleep.
Daytime sleepiness, excessive napping and erratic sleep schedules.
What are common treatments for Insomnia?
Common treatments for insomnia include behavioral and cognitive approaches and pharmacological approaches. The choice of treatment depends on the severity and duration of insomnia, underlying causes, and individual patient preferences.
Cognitive Behavioral Therapy for Insomnia (CBT-I):
Stimulus Control Therapy: Helps associate the bed and bedroom with sleep and establish a consistent sleep-wake schedule.
Sleep Restriction Therapy: Limits time spent in bed to the actual amount of time spent sleeping, gradually increasing this time as sleep improves.
Cognitive Therapy: Addresses negative thoughts and beliefs about sleep.
Relaxation Techniques: Includes methods such as progressive muscle relaxation, deep breathing exercises, and mindfulness meditation.
Lifestyle and Environmental Changes:
Regular Physical Activity: Engaging in regular exercise, but not close to bedtime.
Healthy Diet: Avoiding heavy meals, caffeine, and substance use close to bedtime.
Bedroom Environment: Ensuring a comfortable, quiet, and dark sleeping environment.
Pharmacological Treatments
Sleep Medications: Some anxiety and sleep medications are used to help someone get sleep when it’s critically needed. These are often advised for short term use as they do not totally address the sleep problem. Long term use can sometimes worsen insomnia.
Melatonin Receptor Agonists: Such as ramelteon, which mimic the sleep-regulating hormone melatonin.
Orexin Receptor Antagonists: Such as suvorexant, which inhibit the wake-promoting orexin neuropeptides.
Over-the-Counter Medications:
Antihistamines: Such as diphenhydramine, which can induce drowsiness but are generally not recommended for long-term use due to side effects and decreased effectiveness over time.
Melatonin Supplements: Can help regulate sleep-wake cycles, particularly useful for certain types of insomnia, such as those caused by shift work or jet lag.
Multimodal Approaches
Often, a combination of treatments may be used to address different aspects of insomnia. For example, CBT-I may be combined with medication for immediate relief, with the goal of tapering off medication once behavioral strategies are effective.
Available Insomnia resources
Insomnia is a prevalent and multifaceted sleep disorder that significantly impacts overall well-being and daily functioning. Understanding its symptoms, diagnostic criteria, and treatment options are crucial for effective management. From cognitive behavioral therapies to pharmacological interventions, a tailored approach often yields the best outcomes. Additionally, implementing good sleep hygiene and lifestyle changes can enhance treatment effectiveness. For specialized care and comprehensive strategies to manage insomnia, especially in adolescents and college students, consider consulting Tampa Pediatric Psychology for expert guidance and support.