Sleep and Mood Disorders Among Youth

Sleep problems play an important role in the development, progression, and maintenance of unipolar and bipolar depression symptoms among children and adolescents. Identification of sleep problems as early as maternal perinatal insomnia may predict and predate depression among youth. Depression prevention through the early identification and treatment of sleep problems is an important future direction for research. Data suggest that children and adolescents who go on to develop comorbid mood symptoms and sleep problems represent a particularly high-risk group. Children and adolescents with comorbid mood symptoms and sleep problems tend to have more severe depressive symptoms, higher rates of self-harm and suicidality, and their depression symptoms tend to be less responsive to treatment. Even when depression and bipolar disorder treatments successfully improve mood symptoms, sleep problems tend to be among the most common residual symptoms and, if untreated, may be associated with recurrent depression and/or mania. Treatment research supports the idea that sleep problems can be improved through CBT-I among youth with and without depression. Although limited, the treatment research also indicates that, although CBT-I may not significantly augment depression treatment outcomes, sleep improvement is an important mediator of depression treatment outcomes. Although there are no CBT-I data among youth with bipolar disorder, adult data suggest that CBTI-BP may improve both insomnia and mood symptoms among adults with bipolar disorder. Moreover, more research is needed on sleep problems that have been underevaluated and undertreated, such as delayed sleep phase.