Adolescence is a critical period of physical growth and self-discovery, but it also might be the most important phase for keeping an eye on your kid’s insomnia.
Children who slept around seven hours or less when they were about age 9 were over two and a half times more likely to have insomnia in young adulthood (age 24 on average), compared with participants who had normal sleep during childhood, according to a new study published Thursday in the journal Pediatrics.
Those who had insomnia during adolescence (age 16 on average) had a five and a half times higher risk of their symptoms worsening into adult insomnia in comparison to adolescents who had slept normally. The study authors said their research is the first long-term study to describe the developmental trajectories of childhood insomnia symptoms to adulthood by both subjective and objective measures.
“Based on our and others’ prior studies, we did not expect insomnia symptoms to persist in about 40% of (these) roughly 9-year-old children all the way through young adulthood once they were roughly 24 years old,” said the study’s lead author Julio Fernandez-Mendoza, a clinical psychologist board-certified in behavioral sleep medicine and director of the Behavioral Sleep Medicine program at Penn State Health and Penn State College of Medicine.
“That is a proportion much higher than previously believed,” Fernandez-Mendoza said via email. “We should not expect childhood insomnia symptoms to developmentally go away (remit), at least in a significant proportion of children. We should consider adolescence a critical developmental period for insomnia symptoms to worsen into a … chronic clinical condition.”
During participants’ first lab visit between 2000 and 2005 and second visit between 2010 and 2013, researchers monitored their sleep from “lights out” – 9 p.m. to 11 p.m. – until “lights on” – 6 a.m. to 8 a.m. – using polysomnography, a test that records brain waves, blood oxygen level, heart rate, breathing, and leg and eye movements during sleep. At the third survey, which occurred between 2018 and 2021, all the participants had reached adulthood and reported that they usually slept between three and a half and 11 hours daily.
Children’s sleep vulnerability
Persistent insomnia symptoms in the transition to adolescence were either mostly determined by behavioral factors or by being more biologically vulnerable during the adolescent developmental period, the authors wrote.
People with insomnia tend to spend excessive time in bed or do other things in bed that aren’t solely sleeping – behaviors likely learned early on, Fernandez-Mendoza said.
“However, one of the main insomnia mechanisms is hyperarousal, understood as a biological dysregulation of the stress symptoms and the brain centers that control arousal/wakefulness,” he explained. Adolescents are known to have this type of hyperarousal. Other factors such as gender, race or ethnicity, and socioeconomic status could also influence insomnia symptoms.
Managing and treating insomnia symptoms
The study emphasizes the need to address childhood insomnia “expeditiously and try and get on top of the issues that may be leading to insomnia or poor sleep,” said Dr. Robin Lloyd, a pediatric sleep medicine physician at the Mayo Clinic, who wasn’t involved in the study.
“We see insomnia with not only physical challenges but mental health challenges,” Lloyd said. “There tends to be a bidirectional relationship, in that people who have more mental health issues tend to have more sleep issues; people who have more sleep issues tend to have more mental health issues.”
Focusing on “good habits and behaviors that we can control, especially in childhood and adolescence – it’s only going to beget good behaviors and positive habits as an adult,” Lloyd added.
If you have a teenager who’s always tired, that’s not OK, Lloyd said. Don’t assume they’re just reckless sleepers – they could be exhausted because they have a sleep or circadian rhythm disorder or mental health issues impacting sleep.
Parents, teachers and pediatricians should address these signs immediately.
“Always consult with the pediatrician and behavioral health provider, if any,” Fernandez-Mendoza said. There are “evidenced-based, safe behavioral therapies that are effective and can be implemented with supervision of a trained clinician to make their children sleep independently without bedtime resistance or the need of a parent to sleep in the room.”
For adults, cognitive behavioral therapy for insomnia (CBT-I) is the “first-line treatment for insomnia disorder, and it is gaining greater and greater support in adolescence. Many of us scientist-clinicians treat insomnia in adolescents using CBT-I with minimal adaptations,” he added. “The earlier we treat it, the better. Sleep medications should be a second-line treatment.”
One of the most important tips is controlling technology use or screen time. “I’ve had kids with narcolepsy say, ‘Oh, as long as I have a screen in front of me, I’m alert,’” Lloyd said. “That speaks volumes. If they’re so alerting that even a person with narcolepsy can be alerted and not dozing off while watching a screen, then how’s that impacting (the sleep of people without narcolepsy)?”
Lloyd recommended following the American Academy of Pediatrics’ recommendations for limiting screen time by having a cutoff time that enables kids’ minds to wind down and not have the technology exposure that can suppress their melatonin, a crucial sleep hormone.
General sleep hygiene is important for both children and young adults. It includes maintaining a consistent sleep schedule, as well as a quiet, dark and cold room.
Having insomnia and insufficient time to sleep because of educational obligations could lead to significant long-term impact, so school systems letting kids start classes later in the morning to work with their natural circadian rhythms – as AAP recommendations for school start times suggest – could also be helpful, Lloyd added.