How often are child psychiatrists prescribing sleeping pills?
According to new research, insomnia in children is a widespread problem, and psychiatrists often resort to medication.
Dr. Judith Owens from the Brown Medical School in Providence and her colleagues found that in a survey of child psychiatrists, “insomnia was a major problem in almost a third of their school-aged and adolescent patients and (they) endorsed using medication to treat the insomnia in at least a quarter of these patients.”
Insomnia in children has been linked to a wide variety of medical, psychological and behavioral problems, including neurodevopmental problems, ADHD, poor concentration in school, aggressive behavior, oppositional behavior, and anxiety. Up to 25 percent may have difficulty sleeping at some point in childhood. Causes can vary widely but include medical and neurological conditions as well as psychological disorders. In addition to medication, treatment options include improved sleep hygiene (careful attention to bedtime conditions that promote sleep), relaxation techniques, meditation, hypnosis, and cognitive behavioral therapy. At present in the there are no FDA-approved sleep medications for children.
To assess what methods are currently used by child psychiatrists, Owens sent surveys to 6,018 members of the American Academy of Child and Adolescent Psychiatry regarding practice patterns in their school-age and teenage patients. 1,273 psychiatrists responded, reporting that insomnia was an important problem in nearly one-third of these patients.
Among the children with insomnia, more than 25 percent were treated with medication.
In addition, 96 percent of the doctors surveyed had prescribed one or more prescription medication per month, and 88 percent had recommended an over-the-counter medication. Those surveyed were highly concerned about the effects of untreated insomnia. The psychiatrists perceived the lack of data on sleep medication in children and possible side effects as a reason to not use medication more often.
Children with mood disorders were also treated with atypical antipsychotics (medications like Abilify), anticonvulsants (medications like Tegretol or Neurontin), and short-acting hypnotics (medications like Ambien).
Over-the-counter medications were also recommended often; for example, melatonin was recommended to more than one third of patients.
“The most important rationale for the use of sleep medication among child psychiatrists is to manage the effects of sleep disruption on daytime functioning. It is important to note, however, that concerns about side effects and the lack of evidence regarding their effectiveness were cited as significant barriers to their use,” said Owens. “Despite the high frequency of use and the wide range of medications chosen, practitioners also expressed a number of significant concerns about the appropriateness of sleep medication in general for children.”
These results are important in demonstrating the frequency of sleep disorders in children and how often child psychiatrists feel it necessary to resort to medication. There is clear evidence that lack of sleep not only can create behavioral and psychiatric problems, but can exacerbate existing mental health issues.
Per Owens, “That is why child psychiatrists may be potentially more likely than pediatricians to prescribe medication for insomnia. Furthermore, use of other psychotropic medications, which can have significant negative effects on sleep in this population, frequently complicates clinical management of sleep issues in child psychiatry patients.”
Given that psychiatrists are already using medicines for insomnia in children, better guidance is needed to improve this practice.
Further research regarding sleep medication in children can give pediatricians and psychiatrists information on when medication can safely be used, and which medicines are most effective for different conditions.
Owens concludes, “Mental health professionals responsible for the care of children should set as a goal the establishment of an evidence-based understanding of appropriate treatment choices for insomnia. In addition, we need a more comprehensive understanding of insomnia in the context of psychiatric disorders in general and the impact on quality of life and long-term prognosis in these patients.”
Dr. Owens’s study is published in the July 10 issue of the journal Sleep Medicine.
Source: Sleep Medicine