Efficacy of cognitive behavioral therapy in children and adolescents with insomnia: a systematic review and meta-analysis

Abstract

Insomnia is highly prevalent in children and adolescents. However, the efficacy of cognitive behavioral therapy for insomnia (CBT-i) in children and adolescents remains controversial. Therefore, this systematic review and meta-analysis aimed to assess the efficacy of CBT-i in children and adolescents. We conducted a search of PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, CINAHL, and PsycINFO to select primary studies evaluating CBT-i in children and adolescents that were primarily diagnosed through standardized diagnostic criteria. The primary outcomes of the meta-analysis included sleep onset latency (SOL), wake after sleep onset (WASO), total sleep time (TST), and sleep efficiency (SE%). Six randomized controlled trials and four open-label trials met all inclusion criteria. A total of 464 participants (ranging from 5–19 years of age) were included. Based on the results from sleep logs, a significant pooled effect size was observed for SOL and SE%. However, no significant pooled effect size was found for WASO or TST. Results from actigraphy were consistent with the sleep logs. A significant pooled effect size was observed for SOL and SE%, and no significant pooled effect size was found for WASO or TST. CBT-i might be effective in the treatment of children and adolescents with insomnia.

Insomnia in Adolescence

“…This has been found to be as efficacious and more long lasting than medication alone [ 71 ]. In the adolescent population, CBT-I delivered in person one-on-one [ 72 ] as well as in a group setting and through specific internet-based programing has been shown to be effective for the treatment of insomnia [ 73 ]. The treatment of adolescent insomnia with CBT-I was shown to decrease somatic complaints as well as anxiety, oppositional behavior, and ADHD symptoms [ 74 ].…”

Sleep and Orofacial Pain: Physiological Interactions and Clinical Management

“…A synergistic (CBT-I + CBT-P) approach was associated with significant greater improvements either in pain and sleep when compared with each isolated strategy. Fatigue, depression, and overall improvement in quality of live with less pain interference were observed in patients treated with this combination [81].…”

Practical Approaches and Knowledge Gaps in the Care for Children With Leukodystrophies

“…Based on literature available in pediatric sleep disorders, recommendations include sleep hygiene counseling, followed by the use of melatonin, and finally, use of prescription medications. 25,26,34,[40][41][42] General sleep interventions include the implementation of nightly bedtime routines, the graduated extinction techniques (delaying response time to child's night waking), and the maintenance of a dark room during sleep (by removing electronics and sources of light stimuli). 24 In addition to finding benefit to traditional sleep hygiene techniques, parents of children with leukodystrophy in the Hunter's Hope Consortium also reported benefit from weighted blankets and the use of aromatherapy pillows to position small children in bed.…”

“…Insomnia has been shown to improve with cognitive behavioral therapy. 41,43,44 Likewise, there has been success in alleviating sleep disturbances in other disease processes through treatment of comorbid mood, anxiety disorders, attention-deficit hyperactivity disorder (ADHD), or other neuropsychiatric comorbidities. However, the pharmacologic agents commonly used, including stimulants and selective serotonin reuptake inhibitors, are associated with disruption of REM sleep.…”