Gender Differences in Adolescent Sleep Disturbance and Treatment Response to Smartphone App–Delivered Cognitive Behavioral Therapy for Insomnia: Exploratory Study (Preprint)

Abstract

BACKGROUND Insomnia and sleep disturbance are pervasive and debilitating conditions affecting up to 40% of adolescents. Women and girls are at greater risk of insomnia, yet differences in treatment responsiveness between genders has not been investigated. Additionally, while women report greater symptom severity and burden of illness than men, this discrepancy is yet to be examined in adolescents. OBJECTIVE The purpose of the current study was to examine gender differences in sleep symptom profiles and treatment response in adolescents. METHODS Baseline insomnia symptom severity, sleep quality, sleep characteristics derived from sleep diaries and digital cognitive behavioural therapy for insomnia (CBT-I) treatment responsiveness were compared in boys and girls (aged 12-16 years) who participated in a pilot evaluation of the Sleep Ninja smartphone app. RESULTS We found that girls reported greater symptom severity (P=.04) and night-time wakefulness (P=.01 and .04) and reduced sleep duration (P=.02) and efficiency (P=.03), but not poorer sleep quality (P=.07), number of night-time awakenings (P=.16) nor time to get to sleep (P=.21), compared to boys. Treatment response to CBT-I was equivalent between boys and girls when comparing reductions in symptom severity and improvements in sleep quality (P=.70 and .06, respectively). CONCLUSIONS These results demonstrate the presence of gender differences in insomnia symptoms and severity in adolescents, and suggest further research is required to understand gender differences in insomnia symptom profiles to inform the development of gender-specific digital interventions delivered to adolescents.