Clinical research and consensus guidelines suggest that the following treatments are effective:
- Behavior therapy refers to one or more of a set of interventions that have demonstrated efficacy in treating insomnia. These include, but are not limited to, parent education, establishing a regular bedtime routine, extinction training, bedtime fading, and scheduled awakenings.
There is limited data for the pharmacological treatment of pediatric insomnia. However, consensus guidelines suggest that pharmacotherapy may be considered when the child does not respond to behavioral interventions or when the parent is unable to implement these interventions. Importantly, medication is not considered a first-line treatment for pediatric insomnia and interventions should be short-term in nature. Additionally, adolescents should be screened for the presence of substance use disorders before medications are prescribed due to the potential for abuse and drug-drug interactions. With these caveats in mind, the following treatments have been identified as potentially efficacious for children with chronic insomnia:
- Antihistamines containing diphenhydramine or doxylamine
- Alpha agonists, in particular clonidine and guanfacine
The hypnotic medication zolpidem has demonstrated efficacy in treating adult insomnia, but failed to show a benefit in a trial for pediatric insomnia. At present, there is insufficient data to recommend the use of antidepressant medications for treating pediatric insomnia. The American Academy of Pediatrics recommends against the use of chloral hydrate to treat pediatric insomnia.
For more information about drug prescribing in insomnia disorder, click here.
Additional Treatments to Consider
Preliminary evidence suggests that yoga, while not a substitute for the more well-validated treatments described above, might also be considered.