Insomnia nonpharmacologic therapy

SAD can present in children of preschool to elementary school age. If the disorder is not treated, it can persist into adulthood and increase the risk of depression and substance abuse. CBT and social skills training are effective nonpharmacological therapies in children. Pharmacological evidence is limited to case studies or open-label trials. SSRIs are considered first-line therapy because of tolerability and effectiveness. Fluoxetine, fluvoxamine, sertraline, and paroxetine were effective in children with SAD. Headache, nausea, drowsiness, insomnia, jitteriness, and stomach aches were reported in children receiving SSRIs. 

Patients with short-term or chronic insomnia should be evaluated after 1 week of therapy to assess for drug effectiveness, adverse events, and compliance with nonpharmacologic recommendations. Patients should be instructed to maintain a sleep diary, including a daily recording of awakenings, medications taken, naps, and an index of sleep quality. 

Two meta-analyses on the efficacy of nonpharmacological interventions for insomnia have shown that SRT produces, along with stimulus control therapy, among the largest effect sizes on sleep onset latency and wake after sleep onset variables (3,4). However, SRT alone has been evaluated in significantly fewer studies than other interventions. Furthermore, results from meta-analyses have also shown that SRT produces a reduction of TST, particularly at posttreatment, with a rebound/gain at short-term follow-ups. Three treatment studies of late-life insomnia have directly compared the relative efficacy of SRT to other nonphar-... 

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