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Adolescents with chronic insomnia report 'twofold to fivefold' increase in personal problems

March 24, 2008

Documenting a "twofold to fivefold" increase in personal problems among adolescents with persistent sleeplessness, public health researchers at The University of Texas Health Science Center at Houston say they have completed the first prospective study demonstrating the negative impact of chronic insomnia on 11 to 17 year olds. More than one fourth of the youths surveyed had one or more symptoms of insomnia and almost half of these youngsters had chronic conditions. Findings appear in the March issue of the "Journal of Adolescent Health" and are based on interviews with 3,134 adolescents in metropolitan Houston.

"Insomnia is both common and chronic among adolescents," wrote lead author Robert E. Roberts, Ph.D., a professor of health promotion and behavioral sciences at The University of Texas School of Public Health. "The data indicate that the burden of insomnia is comparable to that of other psychiatric disorders such as mood, anxiety, disruptive and substance abuse disorders. Chronic insomnia severely impacts future health and functioning of youths."

Researchers measured 14 aspects of personal wellbeing and found that adolescents with chronic insomnia were much more likely to have problems with drug use, depression, school work, jobs and perceived health.

The study involved adolescents enrolled in health maintenance organizations who were screened for sleep problems and issues affecting physical health, psychological health and interpersonal relationships at the beginning and end of a 12-month-period. The initial screening was in 2000 and the follow up evaluation in 2001.

"Almost half of the adolescents who reported one or more symptoms of insomnia during the initial screening had similar issues a year later," Roberts said. "Twenty-four percent met the symptom criteria for chronic insomnia as defined by the American Psychiatric Association (APA)." Insomnia is considered a psychiatric disorder.

The adolescent data was gleaned from Teen Health 2000, a community-based, prospective study of the epidemiology of psychiatric disorders among adolescents, which involved a structured psychiatric interview, demographic data on the youths and the household, as well as queries about stress exposure. Interviews took one to two hours.

The symptom criteria for insomnia, according to the APA's Diagnostic and Statistical Manual of Mental Disorders (DSM) IV, includes difficulty initiating sleep, difficulty maintaining sleep, early morning awakening and nonrestorative sleep over the past four weeks.

In the initial screening, 27 percent had one of more symptoms of insomnia, 7 percent had one or more symptoms of insomnia plus daytime fatigue or sleepiness or both, and 5 percent met the DSM clinical diagnosis criteria, which attempts to rule out other psychiatric disorders, as well as the effects of alcohol, drugs or medication, which can be confused with chronic insomnia.

Other studies indicate that chronic insomnia among adolescents can be caused by behavioral and emotional issues, Roberts said.

Roberts said adolescents with chronic insomnia were more likely to seek medical care. "These data suggest that primary care settings might provide a venue for screening and early intervention of adolescent insomnia," he said.

University of Texas Health Science Center at Houston