Insomnia in childhood and adolescence: clinical aspects,

diagnosis, and therapeutic approach

Alvarado Miranda Ximena, Ramírez López Cecilia Alejandra
Universidad del Valle de México, Ciudad de México, CDMX, México

Abstract The research journey navigates the

In the nocturnal symphony of our complexities of diagnosis,
lives, the prevalence of sleeping emphasizing the power of
disorders casts a shadow that conversation and tools such as sleep
extends beyond the silence of the diaries and self-report measures. It
night. Often underestimated, these further explores the multifaceted
disorders impact individuals across landscape of treatment, advocating
the age spectrum, with for a comprehensive approach that
approximately 30% of children and goes beyond symptom
adolescents navigating the labyrinth management. From
of sleep challenges. This research cognitive-behavioral therapy to
delves into the intricate landscape of complementary practices, caution
insomnia, a prevalent sleep disorder with dietary supplements, and
affecting a significant portion of the pharmacological options, each
population, and its ripple effects on treatment modality is examined with
health, well-being, and societal a focus on personalized care.
dynamics.
The consequences of untreated
The exploration encompasses the sleep disorders extend beyond
prevalence and impact of insomnia in individual health, influencing family
adults, children, and the elderly, dynamics and societal structures.
shedding light on the intricate dance Children and teenagers, often
between sleep disorders and other overlooked in discussions on sleep
pathologies. Despite the universal health, bear a heavier burden, with
nature of these challenges, there is a implications for cognitive function,
surprising lack of routine clinical academic performance, and social
discourse about sleep issues, leaving interactions. The intricate web of
a gap in the proactive identification sleep disorders with psychiatric
and intervention for sleep disorders. comorbidities adds layers of
Sleep, often trivialized as mere rest, complexity to the well-being of the
emerges as a critical player in the younger generation.
symphony of overall health, affecting
biological functions, physiological The urgency of early detection and
recovery, learning, memory, cognitive intervention becomes evident,
processes, and emotional well-being. presenting a crucial opportunity to
prevent or alleviate adverse health

1
outcomes. The significance of quality
sleep is underscored, not only for
individual health but also for the
economic well-being of society. As
the clock ticks into the late hours of
the night, the research concludes
with a call to elevate the discourse
on sleep health, recognizing its
profound impact on lives and society.
Armed with awareness and empathy,
the journey towards a harmonious
night—a night where sleep is a
symphony of well-being—is
envisioned.
Keywords: sleep disorders, insomnia,
prevalence, impact, children,
adolescents, adults, elderly,
diagnosis, treatment,
cognitive-behavioral therapy,
complementary practices,
pharmacological options, societal
implications, family dynamics, mental
health, holistic healthcare,
well-being, sleep health awareness,
economic implications, personalized
care.
Introduction
It's late at night, you toss around bed
as time passes by and you can't
figure out how to fall asleep. As soon
as you fall asleep you start stressing
out and having nightmares, as you
wake up you´re unable to carry your
morning routine as you should. This
is what having a sleeping disorder
feels like and unfortunately they are
more common than we know of.
Sometimes as adults we don't pay
enough attention to this, thinking that
it's nothing so relevant or that
2
important to pay attention to. About
30% of children and adolescents
suffer from sleeping disorders that
can lead up to shifting dynamic
interaction of biological,
psychological and social factors.
Sleep is an essential active process
that must be executed and to do so it
must be understood.
In this research we will learn some of
the most important things to know
about this problem, the treatment
and most important how to be able
to diagnose this.
Body
Insomnia is a prevalent sleep
disorder that affects a significant
portion of the population, with
women being 1.5 times more likely to
experience insomnia than men. It can
be caused by a wide range of factors,
including psychiatric, medical,and
underlying sleep disorders. Chronic
insomnia can impair daytime
functioning and is associated with
adverse health and social outcomes.
Furthermore, insomnia can lead to
the development of negative
emotions such as anxiety and
depression, as well as decreased
immunity.
Insomnia is not only prevalent in
adults but also in children and
adolescents. Pediatric insomnia can
be caused by a wide range of factors,
including medical and behavioral
issues. It is often diagnosed based on
parent reports and can be
challenging to assess due to
developmental differences and
cultural influences. Insomnia in
children and adolescents can have
significant impacts on their
development and well-being.
Moreover, insomnia is a common
sleep disorder in the elderly
population, with as many as 50% of
older adults complaining of difficulty
falling or staying asleep. Insomnia is
associated with significant morbidity,
including an increased risk of
depression, heart disease, diabetes,
metabolic syndrome, and cognitive
impairment.
Despite the prevalence and impact
of insomnia, there is a lack of routine
clinical discussion about sleep
issues. Only about one-third of
pediatricians routinely ask about
sleep habits. However, there are
tools available to aid in this
assessment, such as sleep diaries
and self-report measures.
Sleep, often overlooked as merely a
period of rest, actually plays a critical
role in our overall health and
well-being. Research has shown that
sleep disorders are more prevalent
than commonly thought, affecting up
to 15-20% of the general adult
population. Moreover, these
disorders can have widespread
effects, impacting biological
functions, physiological recovery,
learning, memory, cognitive
processes, and emotional health.
The significance of quality sleep
extends across all age groups, as
3
sleep disorders increase with aging
and can even contribute to
neurodegeneration. It is essential to
recognize the potential severity of
these disorders and their
under-diagnosed nature.Insufficient
or poor quality sleep not only poses
a risk to individual health but also has
significant economic implications
(Chang et al., 2018)
. Untreated sleep
disorders have been linked to an
increased risk of developing obesity,
diabetes, cardiovascular disease, and
depression (Klingman et al., 2017). In order to
address the impact of sleep
disorders on individuals and society
as a whole, it is crucial to prioritize
the detection and treatment of these
conditions. Understanding and
treating sleep disorders is essential
to maintaining overall wellness and
reducing the onset and burden of
chronic diseases .
Untreated Sleep Disorders
Untreated sleep disorders cast a
shadow not only on individual health
but also on the fabric of our society
(Zhou et al., 2023). Individuals left
grappling with untreated sleep issues
find themselves at an elevated risk of
developing a myriad of health
conditions, including obesity,
diabetes, cardiovascular disease, and
depression (Klingman et al., 2017).
Moreover, the repercussions extend
beyond initial diagnosis, negatively
influencing the trajectory and
treatment of these chronic conditions
once they take root. The urgency of
early detection and intervention
becomes evident, presenting a
crucial opportunity to prevent or
alleviate these adverse health
outcomes.
Furthermore, the ramifications of
untreated sleep disorders extend
their reach into cognitive functioning,
memory, and daily functioning,
particularly among children and
teenagers. This age group, often
overlooked in discussions on sleep
health, bears a heavier burden than
we might realize. Sleep disorders
become not just a nocturnal struggle
but a potential precursor to other
pathologies, such as asthma, obesity,
gastroesophageal reflux disease,
epilepsy, attention disorders, and
autism spectrum disorders.
Additionally, the intertwining of
sleep disorders with psychiatric
comorbidities, including anxiety,
depression, and bullying, adds a
layer of complexity to the overall
well-being of young individuals.
Consequences on Children and
Teenagers: A Deeper Dive
The impact of sleep disorders on the
younger generation goes beyond
restless nights. Cognitive function
takes a notable hit, as the
developing brain heavily relies on
sufficient and quality sleep to
consolidate memories, learn new
information, and maintain optimal
cognitive performance. The
persistent deprivation of sleep can
translate into difficulties in
concentration, memory retention,
and a ripple effect on overall
academic performance, potentially
paving the way for long-term
challenges in educational attainment.
4
Behavioral issues emerge as a
consequence of disrupted sleep
patterns, with irritability, mood
swings, and difficulties managing
emotions becoming more
pronounced in sleep-deprived
individuals. This isn't just confined to
the home environment; it spills over
into educational settings, affecting
the child or teenager's ability to
navigate social interactions and
adhere to expected norms of
behavior.
The physical health implications for
young individuals with sleep
disorders are noteworthy, with an
increased risk of obesity being a
common outcome. Hormonal
imbalances caused by inadequate
sleep contribute to this risk.
Moreover, the linkage between sleep
disorders and conditions like asthma
and obesity further complicates the
overall health landscape for children
and teenagers.
Navigating the Educational Terrain
and Social Dynamics
Academic performance takes a
noticeable hit when sleep is
compromised. The learning process,
intricately linked to adequate sleep,
becomes disrupted, hindering a
student's ability to focus, participate
in class, and perform well in exams.
This, in turn, can have lasting
consequences on educational and
career trajectories, potentially
limiting future opportunities for these
young individuals.
Social functioning becomes a
battleground influenced by sleep
disorders. Fatigue and irritability
create challenges for sleep-deprived
children and teenagers to engage in
social activities. The emotional toll of
sleep disorders may contribute to
feelings of isolation, negatively
impacting interpersonal relationships
and overall social well-being.
Psychiatric comorbidities, including
anxiety and depression, often
accompany sleep disorders in this
age group. The interplay between
sleep and mental health forms a
complex web, where inadequate
sleep can contribute to the
development or exacerbation of
these conditions, further highlighting
the need for a holistic approach to
health.
Beyond the individual, sleep
disorders reverberate into family
dynamics. Parents, faced with the
challenges of a child or teenager
experiencing sleep issues, grapple
with increased stress and fatigue.
This strain has a cascading effect,
disrupting family relationships and
creating an additional layer of
challenges within the home
environment.
Holistic Healthcare for the Younger
Generation
Addressing sleep disorders in
children and teenagers demands
more than just treating the
symptoms; it requires a
comprehensive approach. Early
detection, timely intervention, and
the establishment of healthy sleep
habits are crucial in mitigating the
far-reaching consequences. Ensuring
that young individuals have the best
chance for optimal development and
5
well-being involves recognizing the
intricate connections between sleep,
physical health, academic success,
and social functioning. This holistic
approach is not just a facet of
healthcare; it is a critical necessity for
nurturing the well-being of the
younger generation and shaping a
healthier society.
Mystery of Children and Teen
Insomnia
Identifying insomnia in children and
teens involves vigilant observation of
various behavioral and physiological
indicators. Signs may include
persistent difficulty falling asleep,
frequent night wakings, or early
morning awakenings that disrupt the
overall sleep duration. Additionally,
daytime symptoms such as
excessive sleepiness, fatigue,
irritability, and difficulties
concentrating may signal underlying
sleep issues. Changes in behavior,
mood swings, or increased anxiety
around bedtime can also be
indicative. Resistance to bedtime
routines and physical symptoms like
headaches or stomach aches may
further suggest sleep disturbances.
Monitoring the impact on school
performance, including academic
decline or behavioral issues, provides
additional insights. Screen time
habits before bedtime, especially
the use of electronic devices, should
be considered. In cases where
concerns persist, consulting
healthcare providers is crucial for a
comprehensive assessment.
Healthcare professionals can delve
into the specifics of sleep patterns,
behaviors, and overall well-being,
offering guidance and, if necessary,
referring to sleep specialists for a
more detailed evaluation. Regular
communication with children and
teens about their sleep experiences
enhances the identification and
management of insomnia, fostering a
collaborative approach to address
potential sleep challenges.
Diagnosis of Sleep Disorders
Figuring out sleep problems can be
tricky because they're not always
easy to spot. We need to look at a
bunch of different things to really
understand what's going on (Zhou et
al., 2023).
Talking to Patients
When doctors talk to people about
their sleep, it's a big deal. Even if
someone doesn't come right out and
say they're having trouble sleeping,
doctors can find out by asking
questions. Knowing about when
someone goes to bed, wakes up, and
if anything weird happens during the
night helps doctors understand what
might be going on.
How Common is it?
Lots of people have issues with sleep
- maybe between 10-40% of all
people (Klingman et al., 2017). So,
doctors asking about sleep during
regular check-ups is really important.
It helps catch problems early, before
they get worse.
Tools for Understanding
6
Doctors might ask people to keep a
sleep diary, which is just writing
down when they go to bed, wake up,
and if anything strange happens at
night. There are also simple
questions to answer. These tools help
doctors see patterns and figure out if
there's a sleep problem.
When Extra Help is Needed
Sometimes, doctors might need
more info. They could ask specialists
or use machines to see what's
happening during sleep. It's like a
sleep movie - showing what the
body does when someone is asleep.
Doctors don't just think about sleep.
They also check for other problems
that could make sleep tricky. By
looking at the whole picture, they
can figure out the best way to help.
Treatment of Sleep Disorders
When the night feels like an endless
toss-and-turn session, and sleep
remains elusive, it's more than just a
minor inconvenience. The struggle
intensifies when dreams turn into
stress and nightmares, leaving you
groggy and unable to tackle the
morning routine. Unfortunately, these
experiences are the harsh reality of
dealing with a sleeping disorder, a
prevalent issue often underestimated
by adults who might brush it off as
inconsequential. Shockingly, sleeping
disorders affect a considerable
portion of the population, more than
we might realize.
In the realm of children and
adolescents, the impact is
substantial, with approximately 30% sleep is understandable,
grappling with sleeping disorders. current data doesn't strongly
These issues are not isolated; they support their efficacy. It's
have a domino effect, influencing the crucial to approach them with
intricate interplay of biological, caution and consult with
psychological, and social factors. healthcare professionals
Recognizing the significance of sleep before incorporating them into
as an essential and active process is a treatment plan.
the first step in addressing these ● Pharmacological Options: In
challenges. some cases, medicines might
be necessary. Options range
Understanding the Treatment from benzodiazepine-receptor
Landscape agonists to melatonin,
antidepressants,
When it comes to treating insomnia,
antipsychotics, and
it's not a one-stop-shop solution. The
antihistamines. However,
complexity of sleep disorders
navigating this landscape
demands a thoughtful and
requires a careful
multifaceted approach, considering
consideration of the
the unique aspects of each
associated concerns and risks.
individual's situation.
Drugs Used To Treat Insomnia
● Cognitive-Behavioral Therapy
● Antidepressants: Some
(CBT): This stands out as a
antidepressant drugs, such as
front-runner in insomnia
Trazodone (Desyrel), are very
treatment. CBT goes beyond
good at treating sleeplessness
just addressing the symptoms;
and anxiety.
it delves into the root causes,
● Benzodiazepines: These older
making it a comprehensive
sleeping pills- Emazepam
and effective option.
(Restoril), Triazolam (Halcion),
● Complementary Practices:
and others may be useful
Beyond traditional
when you want an insomnia
approaches, there's a growing
medication that stays in the
body of evidence supporting
system longer. For instance,
the use of mindfulness-based
they have been effectively
practices, yoga, and tai chi as
used to treat sleep problems
complementary treatments.
such as sleepwalking and
These practices bring an
night terrors. But these drugs
additional layer of holistic
may cause you to feel sleepy
well-being to the table.
during the day and can also
● Caution with Dietary
cause dependence, meaning
Supplements: While the allure
you may always need to be on
of dietary supplements for
the drug to be able to sleep.

7
● Doxepin (Silenor): This sleep
drug is approved for use in
people who have trouble
staying asleep. Silenor may
help with sleep maintenance
by blocking histamine
receptors. Do not take this
drug unless you are able to
get a full 7 or 8 hours of sleep.
● Eszopiclone (Lunesta): Lunesta
also helps you fall asleep
quickly, and studies show
people sleep an average of 7
to 8 hours. Don't take Lunesta
unless you are able to get a
full night's sleep as it could
cause grogginess. Because of
the risk of impairment the next
day, the FDA recommends the
starting dose of Lunesta be no
more than 1 milligram.
● Ramelteon (Rozerem): This
sleep medication works
differently than the others. It
works by targeting the
sleep-wake cycle, not by
depressing the central
nervous system. It is
prescribed for people who
have trouble falling asleep.
Rozerem can be prescribed for
long-term use, and the drug
has shown no evidence of
abuse or dependence.
● Suvorexant (Belsomra): It
works by blocking a hormone
that promotes wakefulness
and causes insomnia. It is
approved by the FDA to treat
people that have insomnia due
to an inability to fall asleep or
to stay asleep. The drug may
8
cause you to feel sleepy the
following day.
● Zaleplon (Sonata): Of all the
newer sleeping pills, Sonata
stays active in the body for the
shortest amount of time. That
means you can try to fall
asleep on your own. Then, if
you're still staring at the clock
at 2 a.m., you can take it
without feeling drowsy in the
morning. But if you tend to
wake during the night, this
might not be the best choice
for you.
● Zolpidem (Ambien, Edluar):
These medicines work well at
helping you get to sleep, but
some people tend to wake up
in the middle of the night.
Zolpidem is now available in
an extended release version,
Ambien CR. This may help you
go to sleep and stay asleep
longer. The FDA warns that
you should not drive or do
anything that requires you to
be alert the day after taking
Ambien CR because it stays in
the body a long time. You
should not take zolpidem
unless you are able to get a
full night's sleep at least 7 to 8
hours. The FDA has approved
a prescription oral spray called
Zolpimist, which contains
zolpidem, for the short-term
treatment of insomnia brought
on by trouble falling asleep.
● Over-the-counter sleep aids:
Most of these sleeping pills
are anti-histamines. There is no
proof that they work well for
 insomnia, and they can cause
some drowsiness the next day.
They're safe enough to be sold
without a prescription. But if
you're taking other drugs that
also contain antihistamines
like cold or allergy
medications you could
inadvertently take too much.
Navigating Concerns and Risks
The treatment journey is not without
its challenges. Controversies
surround sedative hypnotic drugs,
and the evidence regarding their
long-term use is conflicting. It's a
delicate balancing act, weighing the
potential benefits against the risks
associated with each treatment
option.
In essence, treating sleeping
disorders is a personalized endeavor.
It involves understanding the unique
aspects of each individual's
experience, exploring a range of
treatment modalities, and being
mindful of the potential pitfalls along
the way. By approaching treatment
with a comprehensive mindset,
addressing the root causes, and
considering the nuances of each
case, we can pave the way for more
restful nights and improved overall
well-being.
As the clock ticks into the late hours
of the night, the struggle to find
solace in sleep becomes a familiar
9
battleground. Tossing and turning,
the elusive embrace of slumber
transforms into a canvas of stress
and nightmares, casting a shadow on
the morning routine. Unfortunately,
this nocturnal ordeal is not an
isolated experience; it's a glimpse
into the world of sleeping disorders,
a pervasive issue often dismissed by
adults as inconsequential. Yet, the
reality is stark—sleeping disorders
weave their intricate web across the
population more commonly than
perceived.
In the realm of children and
adolescents, the impact is palpable,
with approximately 30% navigating
the labyrinth of sleeping disorders.
These issues, far from isolated
incidents, set in motion a cascade of
effects, altering the delicate dance of
biological, psychological, and social
factors. Recognizing sleep as an
essential and active process is the
first crucial step in addressing these
nocturnal challenges.
Insomnia emerges as a prevalent
protagonist in the realm of sleep
disorders, affecting a substantial
portion of the population.
Astonishingly, women find
themselves 1.5 times more likely to
grapple with insomnia than their
male counterparts. This sleep
disorder, characterized by difficulty
falling or staying asleep, becomes a
silent disruptor of daytime
functioning, wielding the power to
impact both health and social
outcomes. The consequences ripple
further, fostering the growth of
negative emotions such as anxiety
and depression while simultaneously
compromising the body's immune
defenses.
Yet, the impact of insomnia extends
its reach beyond the boundaries of
adulthood. Children and adolescents,
too, find themselves entangled in its
web, facing challenges that extend
beyond the darkened hours of the
night. Pediatric insomnia, fueled by a
myriad of factors including medical
and behavioral issues, becomes a
puzzle diagnosed through the lens of
parental reports. The assessment,
however, is not without its
complexities, navigating the
developmental differences and
cultural influences that shape these
young sleepers. The implications of
insomnia on the developmental
trajectory and overall well-being of
children and adolescents cast a long
shadow, emphasizing the need for a
holistic understanding.
The elderly population, too, is not
immune to the clutches of insomnia,
with as many as 50% of older adults
wrestling with the difficulty of falling
or staying asleep. The repercussions
echo through the corridors of
morbidity, linking insomnia to an
increased risk of depression, heart
disease, diabetes, metabolic
syndrome, and cognitive impairment.
Yet, for all its prevalence and impact,
there exists a startling lack of routine
clinical discourse about sleep issues.
Only a fraction of pediatricians delve
into inquiries about sleep habits,
10
leaving a chasm in the proactive
identification and intervention for
sleep disorders. The slumber, often
trivialized as mere rest, emerges as a
critical player in the symphony of our
overall health and well-being.
Research unfurls the sobering truth
that sleep disorders lurk beneath the
surface more pervasively than
commonly acknowledged, affecting
up to 15-20% of the general adult
population. These disorders seep
into the very fabric of our biological
functions, physiological recovery,
learning, memory, cognitive
processes, and emotional health.
The significance of quality sleep
spans the continuum of age, with
sleep disorders gaining momentum
as aging progresses, even
contributing to the ominous realm of
neurodegeneration. The severity of
these disorders, often
underdiagnosed, unfolds a tale with
far-reaching implications. Insufficient
or poor-quality sleep becomes a
harbinger of not just individual health
risks but also ushers in significant
economic implications. Untreated
sleep disorders emerge as silent
architects of an increased risk of
developing obesity, diabetes,
cardiovascular disease, and
depression. To address the
reverberations of sleep disorders in
individuals and society, it becomes
paramount to prioritize detection and
treatment. Unraveling the intricacies
of these conditions stands as a
linchpin in the quest to uphold
overall wellness and mitigate the
onset and burden of chronic
diseases.
Conclusion
In the grand finale of our exploration,
the importance of crafting a
nocturnal overture resounds. Sleep,
far from a passive interlude, emerges
as an active process intricately
woven into the fabric of our health.
The consequences of overlooking
sleep's significance are not mere
whispers; they are the echoes of
untreated disorders that reverberate
through individual lives and societal
structures.
It is a call to action—a call to elevate
the discourse on sleep health, from
routine medical assessments to
family conversations. It is an invitation
to recognize the silent struggles of
insomnia, the shadows cast by
untreated disorders, and the
profound impact on the younger
generation. As we navigate the
nocturnal landscape, armed with
awareness and empathy, we embark
on a journey toward a harmonious
night—a night where sleep is not just
a respite but a symphony of
well-being, playing its melody in the
hearts of all.
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