Addressing Pediatric Sleep Disturbance in Anxious Youth
Addressing Pediatric Sleep Disturbance in Anxious Youth
Pediatric primary care providers (PCPs) are increasingly faced with addressing sleep disturbances related to anxiety symptoms in children and teens. These co-occurring conditions often complicate treatment and may pressure PCPs to provide prompt relief. While medication may seem like an immediate solution, it is important to balance pharmacological treatments with non-pharmacological approaches, especially for younger patients.
Non-pharmacological approaches1:
For children and teens experiencing sleep disturbances and anxiety, sleep hygiene should be emphasized as the first-line intervention. Encouraging healthy sleep habits can significantly improve both sleep quality and anxiety symptoms. Key sleep hygiene practices include maintaining a consistent bedtime routine, limiting stimulating activities like screen time before bed, and ensuring a quiet, dark, and comfortable sleep environment. Additionally, avoiding caffeine in the afternoon and evening is critical for promoting healthy sleep patterns. Cognitive Behavioral Therapy for Insomnia (CBT-I) and Cognitive Behavioral Therapy (CBT) for anxiety are considered first-line therapies for sleep and anxiety disorders. Illinois DocAssist can assist with finding these referral resources for your patients.
Pharmacological treatment1,3:
When medication is warranted, Selective Serotonin Reuptake Inhibitors (SSRIs) are typically the first-line choice for managing anxiety disorders with comorbid sleep disturbances. SSRIs such as sertraline (Zoloft), escitalopram (Lexapro), and fluoxetine (Prozac) are well-supported in treating these conditions in children and teens. For short-term management of severe sleep disturbances in adolescents, low-dose trazodone or melatonin can also be considered as adjuncts to improve sleep. For preschool and school age children, short term immediate release melatonin, or clonidine, may be used to reduce activation from anxiety and initial use of SSRIs.
There is no evidence-based data to support the ongoing use of medications for chronic sleep disturbance. It is important to initiate a comprehensive diagnostic work-up including review of the psychosocial history, ACEs status, medical history, a sleep study, and labs to determine if trauma and/or organic conditions are contributing to the problem. Please see the Webinar “Recognizing and Treating Sleep Disturbances” for more information. To assess ACEs, tools for different ages and populations can be found here.
Pharmacological treatment1,3:
When medication is warranted, Selective Serotonin Reuptake Inhibitors (SSRIs) are typically the first-line choice for managing anxiety disorders with comorbid sleep disturbances. SSRIs such as sertraline (Zoloft), escitalopram (Lexapro), and fluoxetine (Prozac) are well-supported in treating these conditions in children and teens. For short-term management of severe sleep disturbances in adolescents, low-dose trazodone or melatonin can also be considered as adjuncts to improve sleep. For preschool and school age children, short term immediate release melatonin, or clonidine, may be used to reduce activation from anxiety and initial use of SSRIs.
There is no evidence-based data to support the ongoing use of medications for chronic sleep disturbance. It is important to initiate a comprehensive diagnostic work-up including review of the psychosocial history, ACEs status, medical history, a sleep study, and labs to determine if trauma and/or organic conditions are contributing to the problem. Please see the Webinar “Recognizing and Treating Sleep Disturbances” for more information. To assess ACEs, tools for different ages and populations can be found here.
Guidance for Pediatric PCPs:
One.
Comprehensive assessment: Begin by assessing the severity of anxiety and sleep issues in children and teens using validated tools like the SCARED – Parent and Child Versions and the Children’s Sleep Habits Questionnaire
Two.
Prioritize non-pharmacological options: Educate children, teens, and their families on the importance of sleep hygiene and practical strategies to improve sleep habits. Refer patients to engage in psychotherapy to target anxiety symptoms and sleep disturbance.
Medications as adjuncts: If symptoms persist and are significantly impairing daily functioning, SSRIs can be considered. Use caution with sedating medications like benzodiazepines, as they are not recommended for long-term use in children.
Monitor and follow-up: Regular follow-up is essential to assess the effectiveness of treatment, whether pharmacological or non-pharmacological, and to adjust care as needed.
Want to learn more? Access our free learning series:
Managing Pediatric Anxiety in Primary Care
Expand your knowledge and skills in screening, diagnosing and treating anxiety disorders in this four-part webinar series. Watch all four 20-30 minute videos, or select only the content you need. Go to learning activity
Resources for Pediatric PCPs:
- Recognizing and Treating Sleep Problems in Primary Care- Recorded Webinar
- Anxiety Screening Tools for Primary Care
- Sleep Tips for Your Family's Mental Health from the American Academy of Pediatrics
- Managing Anxiety: Tips for Families from the American Academy of Pediatrics
- Anxiety Disorders: Parents’ Medication Guide (English) from the American Academy of Child & Adolescent Psychiatry
- Sleep Disorders: Parents' Medication Guide from the American Academy of Child & Adolescent Psychiatry